Dame Sally Davies has a simple message about the year ahead. We face a growing antibiotic emergency that could have devastating consequences for men, women and children around the world, she said.
Davies, England’s former chief medical officer, has become a leading advocate for global action to combat the scourge of superbugs.
She told the Observer that there is a real risk that routine procedures – from surgery to childbirth – carry widespread life-threatening risks due to the spread of bacteria possessing antimicrobial resistance (AMR). “About a million people die each year due to the spread of microbial resistance, and this number will increase over the next 25 years,” she said. “It’s really scary.”
Estimates suggest that by 2050, death rates from AMR will have doubled, with figures indicating that almost 40 million people will lose their lives to superbugs over the next 25 years, with older people particularly at risk. .
“Recent data shows that AMR is decreasing in under-fives, which is good news. For those over 70, mortality rates have increased by 80% since 1990; this is very worrying.
As the population ages, more people have chronic illnesses, making them more vulnerable to AMR, researchers say.
Faced with these threats, doctors tried to limit antibiotic prescriptions as much as possible while patients were forced to follow their treatments to the end. However, medical misuse of antibiotics is not the only way resistance spreads. The landscape itself plays a crucial role, a problem that comes from the fact that about 70% of all antibiotics are given to livestock, creating a pool of animals in which resistance can evolve.
“We basically give antibiotics to cows, chickens and sheep as cheap alternatives to growth promoters or prophylactics to prevent the spread of disease,” Davies said. Such actions help microbes evolve, so they develop the ability to repel antibiotics, resistance that then spreads across the world.
“If you have intensive agriculture where lots of antibiotics are used or a busy hospital with poor sewerage, resistant bacteria can enter waterways,” Davies added. “Winds blow over these patches of contaminated land or water and pick up resistant bacteria and genes, then let them rain elsewhere. This shows how pernicious this problem has become.
The reason RAMs are spreading is a simple matter of survival of the fittest, Davies added. “The bacteria take about 20 minutes to multiply. They also mutate a lot, and if they do so in the presence of antibiotics and this mutation protects them, these strains will multiply. Above all, they can transmit it to any bacteria they come into contact with.
The ease with which AMR spreads means it is becoming increasingly important that we do not misuse the antibiotics we have. This also generates a need for the development of new antibiotics – and that again poses problems, Davies said.
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“No new classes of antibiotics have entered routine practice since the late 1980s and the market model that would encourage the creation of new classes is broken. If you develop a new antibiotic, it could be used by someone for a weekly course once a year. Where is the profit in that?
“In contrast, blood pressure medications, which must be taken daily, or cancer medications, which must be administered for months, offer pharmaceutical companies much greater profits. There is therefore no incentive for them to try to develop new antibiotics. It’s a real headache.
The problems ahead in the fight against AMR are not insurmountable, Davies insists, but they must be addressed with a heightened sense of urgency. The G7 forum of industrialized countries has at least recognized the crisis. However, there is still a lack of adequate action and it will be imperative to tackle this problem in the coming year, she insists.
