Don’t let the superbugs bite

But don't despair - we might be struggling but we are not beaten yet.

Evolution continues to be a bitch. Recently scientists gathered in Kensington, London, to have a good moan and to plan what can be done about it. “Superbugs and Superdrugs” is a great title for a meeting. Unfortunately the bugs seem to be more super than the drugs.

While that meeting went on, the US Centres for Disease Control and Prevention (CDC) issued a warning that we are entering a “nightmare” era. The CDC’s problem is a killer bacterium known as CRE, which is spreading in the US. Some strains of CRE are not only resistant to all antibiotics; they are also passing on that resistance to other bacteria, creating drug-resistant strains of E coli, for instance. On 11 March, Sally Davies, the UK government’s chief medical officer, asked the government to add the superbug problem to its “strategic risk register”, which highlights potentially catastrophic threats to the UK.

For a while, it all looked so good. When scientists discovered penicillin, then ever more weapons for our antibiotic arsenal, it seemed that bacteria had been defeated. The problem is, they fought back.

For all the worry over CRE, perhaps nowhere is this antibiotic resistance more evident than with tuberculosis. In the west, we won the war on TB so convincingly that receiving the BCG vaccine against it – once a waymark in British childhood – is no longer routine. Only in certain inner-city communities where migrant populations increase the likelihood of encountering the TB bacterium are children routinely immunised. However, in 2011, the World Health Organisation marked London out as the city with the highest TB infection rate in western Europe.

Many resistant bacteria originate in hospitals, where pharmaceutical regimes kill off the normal strains, making space in which bacteria that are naturally resistant can proliferate. Yet you can’t always blame the drugs. Research published at the end of February shows that drug resistance can arise even when the bacteria have never encountered a chemical meant to kill them.

In the study, E coli bacteria were made to suffer by exposing them to heat and restricting the nutrients in their environment. According to conventional wisdom, this should have kept proliferation in check – but it caused a spontaneous mutation that made the E coli resistant to rifampicin, one of the weapons in our antibiotic arsenal. What is worse is the observation that there was good reason for this mutation to arise: it made the stressful conditions more survivable. Bacteria with the mutation grew much faster.

Bacteria are survivors – if they can’t magic up a spontaneous mutation, they’ll pick one up in the street. A sampling of puddles in New Delhi showed that almost a third contain the genetic material that allows bacteria to produce an enzyme that destroys a swath of antibiotics. The NDM-1 gene is particularly evil. Its tricks include forcing itself into gut bacteria such as E coli that are incorporated into faeces; as a result, the resistant strains travel between hosts with ease.

Many infections involving a bacterium carrying NDM-1 are untreatable. GlaxoSmithKline is reportedly developing a drug to deal with it but it is years behind the curve. In the autumn, an EU project to mine the seabed for so far undiscovered antibiotics will start up, but it will take years for that, too, to bear fruit.

Let’s end on a positive note. Superbugs might be evolving in fiendish ways but they’re doing it blind and they’re up against evolution’s greatest invention – the human brain. We might be struggling but we are not beaten yet.

The EHEC bacteria. Image: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 25 March 2013 issue of the New Statesman, After God

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Buying into broadband’s bigger picture

Reliable internet access must be viewed as a basic necessity, writes Russell Haworth, CEO of Nominet.

 

As we hurtle towards a connected future, in which the internet will underpin most aspects of our daily lives, connectivity will become a necessity and not a luxury. As a society, we need to consider the wider benefits of enabling internet connections for all and ensure no corner of the county is left out of the digital loop.

Currently, despite government incentive schemes and universal service obligations, the rollout of broadband is left largely to the market, which relies on fixed and wireless network operators justifying deployment based on their own business models. The commercial justification for broadband deployment relies on there being sufficient demand and enough people to pay for a broadband subscription. Put flippantly, are there enough people willing to pay for Netflix, or Amazon? However, rather than depending on the broad appeal of consumer services we need to think more holistically about the provision of internet services. If road building decisions followed the same approach, it would equate to only building a road if everyone living in the area bought yearly gym membership for the leisure centre at the end of the new tarmac. The business case is narrow, and overlooks the far-reaching and ultimately more impactful benefits that are available.

Internet is infrastructure as much as roads are, and could easily prove attractive to a wider range of companies investing in digital technology who stand to gain from internet-enabled communities. Health services are one of the most compelling business cases for internet connectivity, especially in remote, rural communities that are often in the “final five per cent” or suffering with below average internet speeds. Super-fast broadband, defined as 30 Mbps, is now available to 89 per cent of UK homes, but only 59 per cent of rural dwellings can access these speeds.

We mustn’t assume this is a minority; rural areas make up 85 per cent of English land and almost ten million people (almost a fifth of the population) live in rural communities. This figure is rising, and ageing ‒ on average, 23.5 per cent of the rural population is over 65 compared to 16.3 per cent in urban areas ‒ and this presents complicated healthcare challenges for a NHS already struggling to meet demand. It goes without saying that accessibility is an issue: only 80 per cent of rural residents live within 4km of a GP’s surgery compared to 98 per cent of the urban population.

While the NHS may not have the resources to build more surgeries and hospitals, robust broadband connections in these areas would enable them to roll out telehealth options and empower their patients with healthcare monitoring apps and diagnostic tools. This would lower demand on face-to-face services and could improve the health of people in remote areas; a compelling business case for broadband.

We can’t afford to rely on “one business case to rule them all” when it comes to internet connectivity – the needs run far beyond Netflix and Spotify, and the long-term, economic and social benefits are vast. It’s time to shift our thinking, considering internet connectivity as essential infrastructure and invest in it accordingly, especially when it comes to the needs of the remote, rural areas of the country.

Russell Haworth joined Nominet as CEO in 2015. He leads the organisation as it develops its core registry business, explores the potential of new technologies in the global internet sector, and delivers on its commitment to ensuring the internet is a force for good.

This article was taken from a New Statesman roundtable supplement "The Internet as Infrastructure: Why rural connectivity is crucial to the UK’s success"

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