Superbugs resistant to antibiotics are a top global risk and can only be stopped with collaborative action, said the world’s foremost expert on pandemics Dr Peter Piot at the World Economic Forum’s annual meeting in the Swiss ski resort of Davos this week.
“Man-made epidemics of untreatable infections now threaten to take us back to the scenario before penicillin,” said Dr Piot, who discovered the Ebola virus and led the global battle against HIV as the executive director of UNAIDS. “This is the tipping point, we can change the dynamics if we take action now.”
In simple words, if superbugs are not stopped, people would start dying of infections that have been treated using affordable and widely available medicines for several decades.
At least some clinical isolates of bacterial species that cause tuberculosis, sepsis, diarrhoea, gonorrhoea and pneumonia, among others, have mutant genes that are resistant to most antibiotics. These mutant strains often find their way into hospitals and operation theatres, where they are amongst the biggest threat to life of critically ill-patients and those recovering after surgery.
Superbugs are created and flourish through overuse, misuse and abuse of antibiotics, which are often over-, under- or wrongly prescribed for infections that they cannot treat. Viral infections, including seasonal flu, H1N1 (popularly referred to as swine flu), H5N1 (bird flu), among others, cannot be treated with antibiotics, yet many reach out for them at the first sign of fever. Equally responsible are clinicians who prescribe antibiotics even when they are not needed simply because they need to fill up space on the prescription sheet.
Antibiotics kill most of the bacteria in the gut but sometimes a few mutate to develop resistance and survive. When these multiply, they create an army of hardier, resilient strains that survive all antibiotics prescribed to kill them. Over time, these untreatable superbugs force clinicians to use increasingly stronger antibiotics in more lethal doses to destroy them. Antibiotics are also found in food. Livestock farmers add them to animal feed to prevent the animals for falling sick and to add to their weight and bulk (it’s called increasing “feed efficiency” to make animals gain more weight per unit of feed). They find their way in fruit, vegetables and grain through contaminated soil and water, with crops that grow underground -- potatoes, onions, carrots, to name a few -- absorbing more than plants that grow overground.
The threat is an old one, but it’s only now that governments and industry are being forced to confront it. Alexander Fleming and Howard Walter Florey sounded the first warning about superbugs when they accepted the 1945 Nobel Prize for the discovery of penicillin. Scientists have expounded the warning ever since, including The Review on Antibiotic Resistance by Jim O’Neill and the study by antibiotic-resistance experts Carl Nathan and Otto Cars in the New England Journal of Medicine in 2014.
While some blame industry for moving away from drug research on antibiotic development to the more profitable medicines for lifestyle diseases such as diabetes, heart disease, arthritis and asthma -- these have to be taken in increasing doses for life -- the threat has now become big enough for the industry to seek collaborate between governments, non-profit agencies and academia to ensure we have new antibiotics for when we need them.
This week, 83 global pharma majors and eight industry associations chose Davos to sign a declaration urging governments and industry to support investment in developing new antibiotics and diagnostics to tackle drug-resistant infections. While companies committed to work harder to stop overuse and misuse of drugs that leads to drug resistance, they asked governments to ensure the pricing of antibiotics adequately reflect the benefits they bring.
Till antibiotics more powerful than the superbugs that evade them hit the market, we have to conserve what we have more efficiently. This includes better policy to control access and use among humans and animals, ensure new antibiotics are affordable to all, provide rapid point-of-care test for bacteria so antibiotics are prescribed only when needed, and make vaccines --such as pneumococcal vaccine that protects against chest infection -- widely available so people do not get disease. Using existing antibiotics together in different permutation and combinations can also help wipe out resistant superbugs.
Innovation and collaboration can help in founding of new drugs, but we can do our bit by preventing infection by getting preventable vaccinations, observing basic hygiene and using antibiotics as and when prescribed.
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