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“Stop treating antibiotics like sweets”: the threat we face from antibioitic resistance

Currently, 700,000 people die per year from the resistance of microbes to medicine, and it is predicted that 10 million people will die per year by 2050.

Got a cold? Take some antibiotics. Feeling under the weather? Penicillin will patch you up. Or so the common advice goes. However, unless we start to rethink our dependency on antibiotics, a death every three seconds is the threat we potentially face from evolving resistance by microorganisms to the drugs. The stark warning was issued following a review which analysed the consequences we could face from needless administering of antibiotics.

The antimicrobial resistance (AMR) review was led by economist Jim O’Neill, who was tasked by the prime minister in 2014 with investigating the impact of growing resistance. Currently, 700,000 people die per year from the resistance of microbes to medicine, and the report predicts that 10 million people will die per year by 2050. An overwhelming global expense of $100trn will be the price to pay unless incisive, collaborative action is taken.

Antimicrobial resistance (as referred to in the title of the report) is an umbrella term for the resistance developed by microorganisms to drugs specifically designed to combat the infections they cause. Microorganisms include things such as bacteria, fungi, viruses and parasites. The report especially focused on the ramifications of increased resistance of microorganisms to anitbiotics.

Many medical procedures are dependent on the effectiveness of drugs such as antibiotics: treatments for cancer patients and antibiotic prophylaxis during surgeries, for example. All could be under threat by increased resistance. The continuing rise of resistant superbugs and the impotence of antibiotics would pose “as big a risk as terrorism”. A post-antibiotic world would spell dystopia.

Bacterial microbes develop resistance through evolutionary-based natural selection. Mutations to their genetic makeup are passed on to other bacteria through an exchange of plasmid DNA. Unnecessary prescriptions by doctors and inappropriate antibiotic usage by patients (such as half-finishing a course) also contribute. Over the years, a number of bacteria and viruses have found a way to counteract antibiotics used against them: E. Coli, malaria, tuberculosis and Staphylococcus aureus, to name a few.

The report employed the consultancy firms KPMG and Rand to undertake the analyses, and O’Neill outlines 10 different measures to tackle the issue. Key areas of focus include: global campaigns to expand public awareness, the upholding of financial and economic measures by pharmaceutical companies in the development of new medicines and vaccines as alternatives, greater sanitation to prevent infections spreading, and the creation of a Global Innovation Fund which will enable collective research.

O’Neill told the BBC:

“We need to inform in different ways, all over the world, why it’s crucial we stop treating our antibiotics like sweets. If we don’t solve the problem we are heading to the dark ages; we will have a lot of people dying. We have made some pretty challenging recommendations which require everybody to get out of the comfort zone, because if we don’t then we aren’t going to be able to solve this problem.”

In the foreword of the report, O’Neill states that over 1 million people have died from developing resistance since 2014. The urgency in tackling this issue is clear, which is why he has offered an incentive to companies to develop new treatments - a reward of more than $1 billion will be given to those who bring a successful new treatment to the market.

According to the report, the cost of successful global action would equate to $40bn over the next decade, which could result in the development of 15 new antibiotics. Small cuts to health budgets and a tax on antibiotics have been proposed as ways of achieving the financial quota for drug research.

Though the report has highlighted the severity of antibiotic resistance, some believe that the full extent of the matter isn’t sufficiently explored. O’Neill mentions that there are some secondary effects which haven’t been taken into account “such as the risks in carrying out caesarean sections, hip replacements, or gut surgery”. This suggests that alternative remedies should be found for non-surgical procedures, so that antibiotics aren’t made redundant in environments where they are most needed.

Since the analysis began in 2014, new types of resistance have surfaced, including a resistance to colistin, a drug which is currently used as a last-resort. Its affordability resulted in increased use, particularly as a component of animal feed, meaning greater opportunity for superbugs to develop resistance to even our most dependable of antibiotics.

Widespread drug resistance would prove to be a big issue for many charities tackling infections around the world. Dr Grania Bridgen from Médecins Sans Frontières told the BBC that the report addresses a “broad market failure”, which is important but isn’t enough.

Despite the mixed response to the report, it has had a seal of approval from the Wellcome Trust and the Department of Health. Speaking earlier this year, Chancellor George Osborne stated this issue “is not just a health problem but an economic one, too. The cost of doing nothing, both in terms of lives lost and money wasted, is too great, and the world needs to come together to agree a common approach.”

If antibiotics are to remain potent antidotes to infectious diseases in the future, we need to put a plan in motion now.

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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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