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?

Photo: Getty
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Out with the old: how new species are evolving faster than ever

A future geologist will look back to the present day as a time of diversification, as well as extinction.

Human population growth, increased consumption, hunting, habitat destruction, pollution, invasive species and now climate change are turning the biological world on its head. The consequence is that species are becoming extinct, perhaps faster than at any time since the dinosaurs died out 66 million years ago. This is an inconvenient truth.

But there are also convenient truths. Britain has gained about 2,000 new species over the past two millennia, because our predecessors converted forests into managed woodlands, orchards, meadows, wheat fields, roadsides, hedgerows, ponds and ditches, as well as gardens and urban sprawl, each providing new opportunities.

Then we started to transport species deliberately. We have the Romans to thank for brown hares and the Normans for rabbits. In the 20th century, ring-necked parakeets escaped from captivity and now adorn London’s parks and gardens.

Climate warming is bringing yet more new species to our shores, including little egrets and tree bumblebees, both of which have colonised Britain in recent years and then spread so far north that I can see them at home in Yorkshire. Convenient truth No 1 is that more species have arrived than have died out: most American states, most islands in the Pacific and most countries in Europe, including Britain, support more species today than they did centuries ago.

Evolution has also gone into overdrive. Just as some species are thriving on a human-dominated planet, the same is true of genes. Some genes are surviving better than others. Brown argus butterflies in my meadow have evolved a change in diet (their caterpillars now eat dove’s-foot cranesbill plants, which are common in human-disturbed landscapes), enabling them to take advantage of a warming climate and spread northwards.

Evolution is a second convenient truth. Many species are surviving better than we might have expected because they are becoming adapted to the human-altered world – although this is not such good news when diseases evolve immunity to medicines or crop pests become resistant to insecticides.

A third convenient truth is that new species are coming into existence. The hybrid Italian sparrow was born one spring day when a male Spanish sparrow (the “original” Mediterranean species) hitched up with a female house sparrow (which had spread from Asia into newly created farmland). The descendants of this happy union live on, purloining dropped grains and scraps from the farms and towns of the Italian peninsula. Some of those grains are wheat, which is also a hybrid species that originated as crosses between wild grasses in the Middle East.

This is not the only process by which new species are arising. On a much longer time scale, all of the species that we have released on thousands of islands across the world’s oceans and transported to new continents will start to become more distinct in their new homes, eventually separating into entirely new creatures. The current rate at which new species are forming may well be the highest ever. A future geologist will look back to the present day as a time of great diversification on Earth, as well as a time of extinction.

The processes of ecological and evolutionary change that brought all of Earth’s existing biological diversity into being – including ourselves – is continuing to generate new diversity in today’s human-altered world. Unless we sterilise our planet in some unimagined way, this will continue. In my book Inheritors of the Earth, I criss-cross the world to survey the growth in biological diversity (as well as to chart some of the losses) that has taken place in the human epoch and argue that this growth fundamentally alters our relationship with nature.

We need to walk a tightrope between saving “old nature” (some of which might be useful) and facilitating what will enable the biological world to adjust to its changed state. Humans are integral to Earth’s “new nature”, and we should not presume that the old was better than the new.

“Inheritors of the Earth: How Nature Is Thriving in an Age of Extinction” by Chris D Thomas is published by Allen Lane

This article first appeared in the 20 July 2017 issue of the New Statesman, The new world disorder