Historically, antibiotics combated infections like strep throat and STDs. But since the end of World War II, when the use of these drugs began, the bugs have fought back, developing resistance to many antimicrobial medicines and new antibiotics as they arrive on the market.
Now, that antimicrobial resistance (AMR) is reaching a crisis point. The World Health Organization reports that multi-drug resistant tuberculosis is on the rise and in some parts of the world malaria has developed drug resistance. Multi-drug-resistant staph infections (MRSA), pneumonia, and gonorrhea, among other diseases, are also becoming worldwide problems.
To combat these rising infections, in 2014 the U.K. prime minister, David Cameron, commissioned a series of studies on drug resistance led by economist Jim O’Neill. Since then, The Review on Antimicrobial Resistance has issued eight papers, including their final report published earlier this week.
Overall, the news is not great.
Their first report published in February of 2015 revealed that 700,000 people worldwide die from antimicrobial resistant bugs each year. That number could rise to 10 million per year by 2050—more people than currently die from cancer.
“Indeed, at the current rates, it is fair to assume that over one million people will have died from AMR since I started this review in summer of 2014,” writes O’Neill in the final analysis. “This is truly shocking.”
If things continue the way they are, there could be larger consequences as well, including $100 trillion in reduced economic output. World healthcare systems would have to go through big changes to deal with the rise of the superbugs. According to Sarah Boseley at The Guardian, England’s Chief Medical Officer Sally Davies warns that AMR threatens to roll back some life expectancy gains people have experienced over the last century.
But there is hope, and the study lays out recommendations for tackling AMR effectively, with a price tag of roughly $40 billion. “My belief is that we have come up with pretty implementable solutions,” O’Neill tells Maryn McKenna at National Geographic. “What they really require is for key participants to just behave a bit differently than how they have…Forty billion dollars obviously is an enormous amount of money, but that is one-quarter of one-tenth of one percent of global GDP. It should be regarded as a very cheap investment, not a cost.”
Here are some of the recommendations from O’Neill’s report:
Reward Companies for Bringing Drugs to Market
According to The Pew Charitable Trusts, at best one in five antibiotic drugs that are tested in humans will likely make it to pharmacies, not nearly enough to keep up with the superbugs. The report suggests drug makers need to up their game and begin development of many more potential antibiotics, especially ones that treat niche infections, or at least help pay for outside researchers looking into the drugs. The report suggests “de-linking” the profitability of antibiotics from sales by offering “market entry rewards” of $800 million to $1.3 billion for companies that develop useful antibiotics that make it through rigorous FDA testing and other regulators and into doctors' hands.
In other words, instead of chasing the next Viagra, they want to encourage them to look for the next amoxicillin.
Develop Better Diagnostic Tools
According to the report, the current diagnostic tools—usually culturing an infection and waiting 36 hours to identify it—are too slow to be useful. Many times doctors must make educated guesses about what antibiotics to prescribe to their patients. This means that many antibiotics are taken by people who don’t need them or require a different drug, perpetuating issues with antibiotic resistance.
So the new report urges the development of rapid diagnostic tests. “Having rapid, low-cost and readily available diagnostics is an essential part of the solution to this urgent problem,” Margaret Chan, director of the World Health Organization says in a press release.
Reduce the Use of Antibiotics in Livestock
Around the world, almost two thirds of antibiotics are used in agriculture, mainly to fatten up cattle and chickens, and the report names this use as one of the main contributors to the rise of resistant superbugs. The scientists urge pairing down the use of antibiotics over the course of a 10-year program. Beginning in 2018, agricultural companies are expected to reduce antibiotic use in animals, restrict the use of “last-line” antibiotics (drugs like colistin, which is used when all others fail), and increase product labeling to let consumers know whether the drugs were used to produce their meat.
Create an Awareness Campaign
One of the biggest problems with AMR is public perception. Patients demand antibiotic prescriptions from their doctors or buy them over the counter for a range of ailments, whether the treatment is appropriate or not. The report suggests creating or improving campaigns to educate the public about the proper use of antibiotics. Similar campaigns have been effective elsewhere. For example, a 16-year education campaign in Belgium reduced unnecessary antibiotic use during flu season by 36 percent.
Pay Healthcare Workers Better
There’s no use making plans to combat AMR if there is no one in place to implement them. In the United States, infectious disease doctors make the least amount of money of any doctors in the 25 primary specialties, and few physicians or academic researchers choose the path. The report suggests government and institutions make more long-term research funding available. It also suggests getting more doctors and nurses well-versed in AMR on the front lines of health care so they can help colleagues make better decisions about antibiotic use.