England's chief medical officer on why the drugs don't work

Large-scale resistance to antibiotics is inevitable, yet new antibacterials aren't emerging. Why?

The Drugs Don’t Work: a Global Threat
Sally C Davies, with Jonathan Grant and Mike Catchpole
Penguin Specials, 112pp, £3.99

Professor Dame Sally Davies, England’s chief medical officer, likens the impending crisis in antimicrobial drug resistance to global warming. In both instances scientists foresee a problem and can offer solutions. In neither case is our response anywhere near sharp enough, Davies fears. Acting on antibiotic resistance should be the easier of the two; no one has a vested interest in denying the risk. Why then are we stumbling towards a selfmade but preventable calamity?

Alexander Fleming is credited with discovering antibiotics. In the summer of 1928, while working at St Mary’s hospital in London, he went on holiday and left an open plate of bacteria behind. Returning to work, he found a fungus growing on the plate that had killed the bacteria with a chemical that he named penicillin. In 1930s Oxford, Howard Florey and Ernst Chain produced enough penicillin to prove its healing ability. The penicillin production programme that followed during the Second World War is a classic tale of ingenuity under adversity. By engaging American pharmaceutical companies, the Allies were able to cure soldiers of otherwise fatally infected wounds.

Bugs create chemicals to kill other bugs as part of an aeons-old microbial arms race, so drug-hunters turned to soil microbes to help fight a range of diseases. Streptomycin, discovered in America in 1943, even cured tuberculosis, one of mankind’s greatest afflictions. Today, however, roughly a third of the world’s population still carries TB. Of the nearly 9,000 cases reported in the UK in 2011 hundreds of sufferers were resistant to at least one drug. Half a dozen cases carried incurable, “extensively drug-resistant” strains of TB. Cholera, leprosy, typhoid fever and syphilis all remain global scourges. Just last year several people in Edinburgh died after inhaling legionnaire’s disease-causing bacteria. Dozens of Germans died in 2011 after eating beansprouts contaminated with E coli.

Luckily, for now at least, we can still treat most bacterial infections, but some bacterial cells can yield over a billion progeny in just 24 hours. Genetic mutations stimulating drug resistance are inevitable. Cases of penicillin resistance appeared almost immediately: methicillin, a more stable derivative of penicillin, enjoyed only a few years of success before resistance emerged. Methicillin-resistant Staphylococcus aureus (MRSA) now kills hundreds in British hospitals every year.

Yet new antibacterials aren’t emerging. The reasons for this are primarily economic. Antimicrobial agents are usually given in shortterm doses. Compare that to statins, taken by affluent westerners with high cholesterol over decades. Most antibiotics are also off-patent, which has driven prices down. The estimated $1bn it costs to develop a drug inflates the cost of new medicines. Cash-strapped health services will use cheaper, old drugs until their utility is all but gone.

Davies fears that time might come quickly. Resistance genes are flourishing out there and bacteria are remarkably happy to share their genes. The widespread imprudent use of antibiotics has created perfect conditions to select those resistance genes and global air travel can carry resistant bugs around the world in hours.

Davies offers possible solutions. Fifteen years ago the pharmaceutical industry had largely abandoned diseases of the poor – malaria, tuberculosis, sleeping sickness, bilharzia and so on. An anti-sleeping sickness drug, called eflornithine, was even about to be withdrawn because sufferers couldn’t pay for it. When eflornithine was shown to prevent unwanted hair growth, however, pharmaceutical companies fell over themselves to produce it. Economics dictated that a drug could be made to “treat” unwanted facial hair but not to save lives. New models were needed to combat diseases of the poor. Groups such as the Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative emerged to help promote drug development. A decade on, the first new drugs are poised to appear. The pharmaceutical industry itself, though, is in crisis and shedding staff at an alarming rate.

If a pestilential Armageddon really is upon us, a cynical company might gamble on huge profits, getting new antimicrobials ready for when the competition fails. But the economic models won’t shift until the evidence becomes overwhelming. Davies also talks of incentivisation – a £50m prize to develop a new antibiotic, for instance. Given development costs, $1bn would be more realistic. Yet even that’s a snip compared to the taxpayers’ bank bailouts. Surely saving life trumps life savings. Whatever it takes, though, action is needed now. The big pharmaceutical companies continue to abandon their anti-infective programmes and with them goes the expertise and capacity that will be needed when the crisis hits.

Michael Barrett is Professor of Biochemical Parasitology at the University of Glasgow

Who decides which drugs are made, and which ones we have access to? Image: Getty

This article first appeared in the 30 October 2013 issue of the New Statesman, Should you bother to vote?

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The Man Booker Prize 2016: the longlist has been announced

Six women and four debut novels make the list on a year with a number of notable omissions and surprise inclusions.

The longlist for the 2016 Man Booker Prize has been announced today, with a number of surprises populating the line-up for the prestigious award.

To qualify for the prize, writers will have had a novel published in English between 1 October 2015 and 30 September 2016. The Man Booker has been awarded since 1969, with writers as varied as Kazuo Ishiguro, Salman Rushdie and Margaret Atwood among previous winners.

“The Man Booker dozen” lists 13 novels this year chosen by a panel of five judges from 155 submissions, with six women and seven men noted. Nobel Prize winner and two-time Man Booker Prize winner JM Coetzee headlines the list with his book The Schooldays of Jesus, while Deborah Levy, shortlisted in 2012 for Swimming Home, is picked for Hot Milk, her poignant take on the challenges and extremities of motherhood. Levy will be featured in this week’s magazine.

Also making it on the list are Paul Beatty with The Sellout - described by The Guardian as “a galvanising satire of post-racial America”, A.L. Kennedy, who has been selected for the first time with her eighth novel Serious Sweet and Elizabeth Strout, whose novel My Name is Lucy Barton has become a New York Times bestseller.

Included on the list are four debut novels: The Many by Wyl Menmuir, Eileen by Ottessa Moshfegh, Work Like Any Other by Virginia Reeves and Hystopia by David Means – an imagined retelling of the Cold War period which sees John F. Kennedy evading assassination while the Vietnam war rages on. Completing the list are Graeme Macrae Burnet, Ian McGuire, David Szalay and Madeline Thien.

For many, the list brings along with it a number of notable omissions. Don DeLillo’s Zero K – a story offering chilling foresight into a future of immortality enabled by cryonics - was widely touted to make it onto the list. Jonathan Safran Froer too, was expected to make it on the list with his first novel in more than a decade - Here I am.

Previous winners and nominees who were picked as potential candidates to be longlisted are also missing. Ian McEwan’s new novel Nutshell, set to arrive in September, experiments with narration by telling a tale through the voice of an unborn child. Julian Barnes’s The Noise of Time hasn’t made the list and nor has Emma Donoghue’s new book The Wonder which was thought to be a strong contender following her Man Booker nomination in 2010 for Room and its subsequent Oscar nomination for screen adaptation. In previous years, former prize winners will have been automatically submitted, making these absentees notable ones.

Meanwhile new novels from Zadie Smith and Ali Smith will be published just outside the competition’s timeframe, making them illegible for this year’s award. There are no Indian or Irish writers on this year’s list; the Man Booker Prize has nominated a number of writers from those countries in the past.

Last year’s award celebrated the work of Marlon James, the first Jamaican writer to win, with his third novel A Brief History of Seven Killingsan epic spanning the decades surrounding the attempted assassination of Bob Marley in Jamaica in 1976. It’s an ambitious book whose pick by the Man Booker judges in 2015 highlighted the award’s desire to bring little-known novels with experimental flair and hard-hitting narratives to the centre of the literary arena. James’s win last year may reflect on this year’s choices; 11 of the 13 writers have never been on the list before.

The 13 books will be re-read by judges over the course of the next few months, with a shortlist being announced on 13 September, and an eventual winner decided by 25 October.

The chair of the judges Amanda Foreman said: “This is a very exciting year. The range of books is broad and the quality is extremely high. Each novel provoked intense discussion and, at times, passionate debate, challenging our expectations of what a novel is and can be. From the historical to the contemporary, the satirical to the polemical, the novels in this list come from both established writers and new voices. The writing is uniformly fresh, energetic and important. It is a longlist to be relished.”