TIK MA Student
Antibiotics have played a leading role in saving millions of lives worldwide for over half a century. But for how long can antibiotics provide us with this state of security?
It’s a Wednesday morning. The alarm enthusiastically goes off at seven o’clock, and you start your morning routine. The commute to work is busy as usual, but you get to your cubicle at the office in time, power up the computer and sift through your e-mails. It’s an ordinary Wednesday, though you feel a slight tingle in your throat. The next couple of days you develop a fever, and eventually you call the doctor’s office. You answer a couple of routine questions and the doctor collects a few samples that indicate that you have been visited by the beta-hemolytic streptococcal bacteria. The doctor hands you a prescription for antibiotics, and you should be back to work within a few days. Confident in modern medicine’s ability to get you back on your feet, you never really worry about the illness. But is your trust rightly earned?
This very common story of a person’s short journey from sickness to health might have a different ending in a few years, as antimicrobial resistance (AMR) is rapidly increasing. AMR is when a microorganism, such as bacteria, becomes resistant to treatment by e.g. antibiotics. When treatment becomes ineffective, the bacteria survives and spreads. An estimated 700,000 deaths can be attributed to AMR each year, and if no corrective measures are taken it may increase to 10 million by 2050. The millions of deaths are themselves a tragedy, but AMR is also associated with substantial economic costs. Given this scenario, it’s estimated that up to 100 trillion USD may be lost in global production alone. Similar to, and potentially worse, than the financial crisis of 2008, this threat to the global economy will increase economic inequality and the share of people living in extreme poverty.
Antibiotics are quite extraordinary. Their story began in the late 1920s, with Alexander Fleming (1855-1951) observing staphylococcus colonies under a microscope. While doing so, the culture plates were temporarily exposed to air, and thus contamination. Fleming discovered that one of the colonies had developed mould, and was intrigued by how the surrounding staphylococcus colony faded away. This turned out to be one of the most significant medical achievements of the 20th century: the discovery of penicillin. In the following decades, several new classes of antibiotics were approved, particularly during the 1950s and 1960s, the “golden age” of antibiotics. Since the golden age, the number of antibiotics successfully brought to market has fallen significantly. Though a small increase from 2011 to 2016 shows some promise, a fair share of these target Gram-positive bacteria. These are easier to deal with, as they are without an outer membrane. The Gram-negative bacteria are more challenging, and therefore more important to address. Another difficulty lies in the fact that antibiotic resistance is a result of natural evolution, and so will inevitably develop for some of the antibiotics being used. However, the process is accelerated by misuse and overuse.
To shed some light on the issue, it is interesting to compare the presence of AMR in livestock in Norway and Denmark. The AMR in question is Methicillin-Resistant Staphylococcus Aureus (MRSA). In the species of staphylococcus, MRSA is the most frequent cause of illness. It is estimated that 20-40% of humans are carriers. MRSA is usually not dangerous for healthy people, but in health institutions such as hospitals, where patients have a low immune system, it often causes infections. This is worrisome, as MRSA is immune to all antibiotics typically employed.
Among tested herds in pig farming in Norway in recent years, around 0.1% have been identified with livestock MRSA. In Denmark, it has been identified in approximately 60-80% of the herds. While the number of MRSA incidents has increased rapidly in both Norway and Denmark in recent years, it is important to note that 84% of the registered cases in Norway were imported from abroad, compared to 20% in Denmark. The large gap can be explained by Norway’s national strategy to prevent and combat MRSA, with a strict zero-tolerance policy on outbreaks of MRSA in livestock.
The occurrence of AMR is increasing at a global level. It is one of the biggest health threats facing humanity. Why then is it not addressed by pharmaceutical companies? The main reason is low return on investment. Antibiotics are used for treatments that last a short period of time, while drugs for chronic illnesses, for example, are required for life. Pharmaceutical companies are inclined to develop drugs that will be used for as many years as possible. The use of antibiotics in livestock can be considered in relation to economies of scale: High density of livestock results in larger outbreaks that will spread as the livestock is transported. This is combatted by infection management strategies, including use of antibiotics.
In conclusion, a number of strategies should be followed to tackle AMR globally. Firstly, we need to avoiding unnecessary use of antibiotics. This can be achieved by increased global awareness and some degree of surveillance, combined with development and use of vaccines. Secondly, it is necessary to increase the number of antimicrobial drugs through global innovation funds and incentives to invest in research and development for effective drugs. Finally, we need to create an effective global coalition concerned with battling AMR.
© MicroOne/Adobe Stock
© Anthonycz/Adobe Stock