Continued overprescribing and abuse could lead to more people dying of resistant infections than cancer. Only global cooperation can solve the problem.

Four years ago Professor Sally Davies, England’s chief medical officer, published ‘The Drugs Don’t Work’, this gave the world a sombre warning of the growing threat posed by bacteria evolving resistance to life-saving antibiotics. If this were left unaddressed, she argued, it would lead to the erosion of modern medicine as we know it.

Doctors and scientists had long been warned of the problem, but few outside medicine were taking real heed. Consumption of antibiotics rose 36% between 2000 and 2010. When I started working at No 10, the words “antimicrobial resistance” were certainly not on the lips of those walking the corridors of Whitehall.

It was Davies who pushed the agenda – meeting the then prime minister David Cameron, to urge the government to wake up to the fact that, without effective antibiotics, we could see an end to life-saving transplants, chemotherapy and routine operations such as caesareans and hip replacements; and that continued misuse and overuse of antibiotics could, within a generation, see the global death toll from drug-resistant infections rise from 700,000 today to 10 million – more than currently die of cancer.

As soon as we understood the scale of the challenge in Downing Street, it became an international priority. Cameron raised it at every bilateral meeting with world leaders for about a year, and in 2014 he announced the launch of Jim O’Neill’s International Review on Antimicrobial Resistance, which was supported by the Wellcome Trust.

A year ago this week that review was published, offering the world a 10-point action plan to prevent healthcare returning to the dark ages. The world is now listening. Leaders accept what’s at stake and that the solution lies in global unity. But 12 months on from the review, talk is yet to turn to action.

We urgently need new antibiotics. No new classes of antibiotics have been approved since the early 1980s. Between 1940 and 1962 about 20 classes were produced, but industry backing has decreased significantly since that golden age. The pipeline of new treatments is all but dry, the void fast exploited by resistant bacteria. A concerning number are now resistant to drugs reserved as the last line of defence, and the most vulnerable are in greatest danger – the young, old and critically ill. Blood infections caused by drug-resistant microbes kill more than 200,000 new-born babies each year.

The reason for the lack of interest from the pharmaceutical industry is simple: the economics don’t add up. Developing new antibiotics is scientifically challenging, time-consuming and costly. The medicines we so badly need cannot be allowed to be sold in volume; they must be conserved for real need, with fair access guaranteed. This limits their retail value. Many early-stage projects will fail, making them a risky bet. Even those that are successful will take at least a decade to produce medicines that are safe for human use.

A new public-private partnership, CARB-X, led by Wellcome and the US government, is beginning to address this seemingly intractable problem. Over the next five years, up to $450m in funding will be given to biotech firms and research teams to develop promising antibiotics and diagnostics to combat the most difficult and deadly multi-drug-resistant pathogens.

CARB-X is an answer to the global action called for by the O’Neill review. But it will not be enough on its own. We need concerted action on many fronts, and on all O’Neill recommendations.

• Fixing the broken antibiotic market, but also ensuring fair access to new, and existing, medicines – particularly in low – and middle-income countries where need is greatest.

• More hospitals implementing measures to stop infection spread.

• Better sanitation and basic hygiene in communities to prevent infection taking hold in the first place.

• Better understanding of the environmental impact of antibiotic-resistant bacteria.

• Stopping antibiotic pollution.

• Robust national plans to reduce the spread of drug-resistant infections.

• Restrictions on the use of antibiotics in farming and agriculture.

The clock ticks on all of these. Since last year’s O’Neill review, political will has rallied. But the world cannot wait any longer for decisive action.
Last September the UN general assembly committed itself to fighting the problem together, followed by the announcement this year of a taskforce to address the issue. It needs to gain momentum fast and draw in the disparate groups across human and animal health, food and environment.

At July’s G20 summit and the next UN general assembly is September, the opportunity must not be missed for those who have listened and have shown intent to now act boldly in the fight against drug-resistant infections.

References:
The Guardian
Science Slashdot
The Drugs Don’t Work