Acknowledging the Silent Pandemic

In our ever-evolving battle against diseases, antibiotics have been the cornerstone of modern medicine, saving countless lives and preventing untold suffering. The overuse and misuse of antibiotics have given rise to a formidable adversary – antibiotic resistance. This growing problem threatens not only our ability to treat infections but also the very foundation of modern healthcare. 

Antibiotic resistance (AMR) occurs when bacteria evolve and develop mechanisms to withstand the drugs designed to kill them. This happens through the selection of resistant strains due to the overuse and misuse of antibiotics. When antibiotics are used unnecessarily or improperly – in humans, animals, or agriculture – it provides a fertile ground for bacteria to adapt and develop these resistance genes.

A staggering 2022 report, published in The Lancet, found that 4.95 million people died in 2019 from illnesses in which AMR bacteria played a role in. Of those deaths, 1.27 million were directly attributed to AMR. While it is still not as grave as cancer-related deaths (10.1 million) in the same year, AMR killed more people than HIV/AIDS (864,000 deaths) or malaria (643,000 deaths). A 2016 review projects AMR will kill 10 million people annually by 2050.

To put an economic price on this crisis, the World Banks’ latest report suggested that in a low-impact scenario, global GDP will likely fall by 1.1% by 2050 and experience a shortfall exceeding USD $1.1 trillion annually after 2030. Conversely, in a high-impact scenario, the world will lose 3.8% of its annual GDP by 2050, with an annual shortfall of USD $3.4 trillion by 2030. To stress, these figures are from 2017, and a subsequent World Health Organization review have only suggested that the problem has gotten worse.

The Great Threat: understanding some of the factors exacerbating the crisis

1. Ineffectiveness of Antibiotics: The most immediate consequence of antibiotic resistance is the dwindling effectiveness of these life-saving drugs. Common infections that were once easily treatable are becoming increasingly resistant to antibiotics, leaving patients vulnerable to severe illness and even death.
2. Prolonged Illness and Increased Healthcare Costs: Antibiotic-resistant infections often lead to longer hospital stays, additional medical interventions, and higher healthcare costs. These infections strain healthcare systems and impact the overall well-being of individuals and communities.
3. Food Supply Chain Issues: The widespread use of antibiotics in agriculture to promote animal growth and prevent disease in crowded conditions has contributed significantly to the development of antibiotic resistance. Resistant bacteria from farm animals can enter the food supply chain, posing a risk to consumers.
4. Global Warming: Climate change is exacerbating the problem of antibiotic resistance in several ways. Rising temperatures can increase the prevalence of certain infectious diseases, leading to increased antibiotic use, or the emergence of pre-historic pathogens for which we have no treatments for. Moreover, extreme weather events can disrupt supply chains, making it challenging to access antibiotics when needed.
5. Lack of Investment: Research and development of new antibiotics have lagged behind the emergence of resistant bacteria. Both public and private capital has significantly dropped in the last few decades. Pharmaceutical companies often find it more profitable to invest in chronic disease medications rather than antibiotics, which are typically taken for a short duration. This lack of investment hampers our ability to stay ahead of evolving bacteria and stems from the absence of incentives for private companies to innovate and take risks in this space.

Addressing the Crisis: solutions that will help, but take time

1. Reducing Antibiotic Use: Implementing responsible antibiotic stewardship programs in healthcare, agriculture, and veterinary medicine is essential. This includes only using antibiotics when necessary, using the right drug for the right infection, and completing prescribed courses of antibiotics.
2. Enhancing Surveillance: Rigorous monitoring and surveillance of antibiotic-resistant infections are crucial to identify emerging threats promptly. This information can guide treatment decisions and public health responses.
3. Public and Private Investments: Governments and private sectors must invest in the research and development of new antibiotics and alternative therapies. Incentives, such as subscription models and market guarantees, can encourage the development of drugs that may not be as profitable as other pharmaceuticals.
4. Climate Action: Addressing climate change will indirectly combat antibiotic resistance by reducing the spread of infectious diseases. Mitigating extreme weather events will also reduce the likelihood of pathogens emerging from remote regions such as the Arctic and Amazon.
5. Educating the Public: Raising awareness about antibiotic resistance is vital. Educating individuals about the proper use of antibiotics and the consequences of resistance can empower them to make informed choices.

Indeed, there are positive changes being made, as highlighted by BBC’s new documentary Race Against Resistance: The Life And Death Struggle To Save Antibiotics, featuring McMaster University 's Eric Brown and Jon Stokes . Additionally, in 2022 the AMR Action Fund announced investments into Adaptive Phage Therapeutics and Venatorx Pharmaceuticals, Inc. to enhance their bacteriophage therapy and beta-lactam / beta-lactamase inhibitor programs respectively. Earlier this year, the UK’S NHS strengthened their pull incentive’s program and began paying Shionogi and Pfizer USD $13 million per year to ensure unlimited access to two new antimicrobial therapeutics. Canada is likewise exploring pull incentives, as recommended by the Council of Canadian Academies / Conseil des académies canadiennes in their latest report to spur the development of new antibiotics and broaden access to existing programs. Finally, the The Wall Street Journal reported investors are pressuring fast-food chains to augment their policies regarding antibiotic usage.

Despite these positive advancements, more is needed. It will not take clinicians, scientists, and researchers alone to solve this problem. Rather, it will require the combined efforts of politicians, economists, farmers, investors, and everyday citizens to combat this silent pandemic. We saw the economic, social, and health consequences of taken reactive measures to the emergences of SARS-CoV-2. We should not make the same mistake and proactively invest in solutions to counteract what is arguably the greatest public health emergency that few are talking about.