IN 1954, only a few years after the generalized introduction of antibiotics, doctors were already aware of the resistance problem. Natural selection meant that using these new drugs has given an advantage to the microbes that could survive aggression – and treatment that has worked today could become ineffective tomorrow. A British doctor has given the challenge in military terms: “We can get rid of effective ammunition. Then how the bacteria and the molds will serve it. ”
More than 70 years later, this concern seems premonitory. The UN called antibiotic resistance “one of the most urgent global health threats”. Researchers believe that resistance already kills more than a million people a year, this planned number. And new antibiotics are not discovered quickly enough; Many that are essential today were discovered over 60 years ago.
The thing to remember is that antibiotics are quite different from other drugs. Most drugs work by manipulating human biology: paracetamol relieves your headache by attenuating chemical pain signals; Caffeine blocks adenosine receptors and, therefore, prevents drowsiness that settles. Antibiotics, on the other hand, target bacteria. And, because bacteria spread between people, the challenge of resistance is social: it is as if each time you take an analgesic for your headache, you have increased the risk that someone else could undergo an operation without anesthesia.
This makes resistance more than a simple technological problem. But like this British doctor in 1954, we still often speak as if it was: we have to invent new “weapons” to defend ourselves.
What this framing neglects is that the extraordinary power of antibiotics is not due to human ingenuity. In fact, the majority of them derive from substances originally manufactured by bacteria and fungi, have evolved millions of years ago in a microbial competition process.
This is where I can’t help but think of another natural resource that helped create the modern world but was also dangerously overused: fossil fuels. Just as the geological forces of the earth transformed the dead plants of the carboniferous era into layers of coal and oil that we could burn for energy, so evolution created molecules that scientists of the 20th century have been able to recruit to keep us alive.
The two offered an illusory promise to be cheap, miraculous and endlessness on nature – a promise that now affects. If we consider antibiotics as the “fossil fuels” of modern medicine, could that change the way we use them? And could that help us think of ways to make the fight against fatal infections more durable?
The antibiotic era has less than a century. Alexander Fleming first noticed the activity of a strange mold against bacteria in 1928, but it was not until the late 1930s that the active – penicillin – ingredient was isolated. A daily dose was only 60 mg, almost the same as a pinch of salt. For several years, it was so rare that it was worth more than gold. But after the production scale during the Second World War, he ended up costing less than the bottle in which he entered.
This abundance has done more than fighting infectious diseases. Like the energy of fossil fuels has transformed society, antibiotics have made it possible to build the entire building of modern medicine. Consider surgery: cutting people open and breaking the protective barrier of the skin gives bacteria the possibility of rumbling in the internal tissues of the body. Before antibiotics, even the simplest procedures have often led to fatal blood intoxication. After them, it has become much more possible: heart surgery, intestinal surgery, transplantation. Then there is cancer: chemotherapy removes the immune system, making bacterial infections one of the most common complications of treatment.
The effects of antibiotics have even more undulating: they have made industrial agriculture possible, both by reducing diseases in animals maintained in narrow neighborhoods and increasing their weight by complex effects on metabolism. They are one of the reasons for the enormous increase in meat consumption since the 1950s, with all its concomitant well-being and environmental effects.
Despite the resistance crisis, antibiotics remain inexpensive compared to other drugs. Partly – as for fossil fuels – it is because the negative consequences of their use (supposedly externalities) are not evaluated. And like coal, oil and gas, antibiotics lead to pollution. A recent study estimated that 31% of the 40 most used antibiotics in the world in rivers. Once they are there, they increase resistance levels in environmental bacteria: a study of the soil in the Netherlands has shown that the incidence of certain antibiotic resistant genes has increased by more than 15 times since the 1970s. Another source of pollution is manufacturing, especially in countries like India. In Hyderabad, where factories produce enormous amounts of antibiotics for the world market, scientists have found that wastewater contain levels of certain antibiotics which are a million times higher than elsewhere.
Like the climate crisis, resistance to antibiotics has exposed global inequalities. Some high -income countries have taken measures to reduce the use of antibiotics, but only after taking advantage of their abundance in the past. This makes them difficult to take a moral position against their use in other places, a dilemma which reflects the situation to which post-industrial nations urged developing nations to give up the economic benefits of cheap energy.
This is perhaps where the similarities end. Although we are impatiently awaiting the day when fossil fuels are completely removed, this is clearly not the case with antibiotics, which will always be part of Medicine’s “energetic mixture”. After all, most deaths by bacterial disease in the world are due to the lack of access to antibiotics, not to resistance. What we will have to do is make our development approach and use much more sustainable. Currently, many pharmaceutical companies have abandoned the search for new antibiotics: it is difficult to imagine a more perfect anti -capitalist goods than a product whose value is exhausted each time you use it.
This means that we need alternative models. A proposal is that governments finance an international institute which develops public antibiotics, rather than counting on the private sector; Another is to encourage development with generously funded prices for the discovery of antibiotics. And to solve the problem of overcupeting, economists have suggested that health authorities could manage “subscription” models that remove the incentive for sale many antibiotics. In a pilot program in England, two companies receive a fixed amount per year by the NHS, regardless of the quantity of their product really used.
Finally, we must remember that antibiotics are not the only game in town. Supporting other “renewable” approaches means that we use those we have had for longer. Vaccines are essential for disease prevention – with each meningitis, diphtheria or darling, which means that the potential vaccination of antibiotics has been renamed. And the greatest reductions in infectious diseases of the 20th century did not occur not because of antibiotics, but thanks to better sanitation and public health. (Even in the 2000s, the MRSA threat was treated with proven methods such as hand washing and cleaning protocols – no new antibiotics.) Since the antibiotics themselves have emerged unexpectedly, we must also invest more in the research on blue skies.
Just as we no longer burn coal without thinking about the consequences, the era of carefree antibiotic use is now firmly in the past. In both cases, the idea that there would be no calculation has always been an illusion. But as with our slow awakening to the reality of the climate crisis, coming to appreciate the limits of our love story with antibiotics may not be a bad thing.
Liam Shaw is a biologist at the University of Oxford and author of Dangerous Miracle (Bodley Head).
Upon reading
Be fatal: medication and what matters at the end by ATUL GAWANDE (profile, £ 11.99)
Infectious: pathogens and how we fight them by John S Tregoning (Oneworld, £ 10.99)
Mortal companions: how microbes shaped our story by Dorothy H Crawford (Oxford, £ 12.49)
