Around the world, 700,000 people die from antibiotic-resistant infections each year, and the number may be as high as 10 million by 2050, as bacteria swap genes to overcome each new medicine targeted at them.
Overuse and improper use in medicine and agriculture are the main causes of resistance. In her plenary address at the American Association for the Advancement of Science’s Annual Meeting in Seattle, Maryn McKenna likened the development to an iconic tale of a hero undone by the tragic flaw of carelessness.
The rise of antibiotic resistance and its dire consequences have been predicted by a string of scientific Cassandras ever since penicillin was first prescribed in 1941, said McKenna, a journalist and senior fellow at the Center for the Study of Human Health at Emory University.
McKenna has traced the history of resistance in two books, Big Chicken and Superbug. “With regard to antibiotics, we, our society, our culture, have been undone … we failed to give antibiotics the respect they deserved,” she said.
The world is on the cusp of a second antibiotic era, she said, where changes in agricultural practices, medicine and new incentives for companies to discover and manufacture new antibiotics could preserve their future use.
We’ve forgotten the world that antibiotics allowed us to leave behind, said McKenna. Before the first use of antibiotics, three in 10 children died from pneumonia, one in about every 100 women died from infections after childbirth, and during World War I the U.S Army lost 7 million workdays to sexually transmitted diseases such as gonorrhea and syphilis.
Sir Alexander Fleming, co-recipient of the 1945 Nobel Prize in Medicine for penicillin’s discovery, warned in his Nobel speech that antibiotic resistance would soon follow, if the public was not careful in how they used the powerful drug.
When penicillin resistance developed, an artificial version was created, “beginning a bug versus drug game of leapfrog that we embarked on without ever admitting that the game was stacked against us, because the bugs had evolution on their side,” McKenna said.
Since then, scientists have warned each decade that poor prescription practices are removing antibiotics one by one from the medical arsenal. McKenna said the U.S. Centers for Disease Control and Prevention estimates that 30% of antibiotics prescribed in the U.S. each year are not needed at all, and many others are prescribed for too long, in too high doses and are badly matched to the infections they are supposed to cure.
In the antibiotic era, global animal production consumes three times as much antibiotics as medicine, in a practice that dates to the end of World War II when chickens were fed antibiotic leftovers to increase their size during a post-war meat shortage. The bug versus drug game has since raged in cows, chickens and pigs, speeding up resistance and causing deadly outbreaks of infections by Salmonella and other pathogens.
Although we have always thought there would be another drug on the horizon to replace lost antibiotics, “we were wrong,” McKenna said. Major drug companies have stopped researching and manufacturing antibiotics because it takes so long for the medicines to be profitable. Most drugs have only two years to earn money before they lose their patent protection.
Efforts such as CARB-X, a global non-profit that funds resistance research, could help turn this trend around, McKenna said. She cited other initiatives, like McDonald’s 2018 commitment to end routine use of antibiotics throughout its entire beef supply chain, that could change the future of antibiotics as well.
Jean-Eric Paquet, director-general of the European Commission and sponsor of the plenary, spoke briefly before McKenna about the economic impetus behind the European Green Deal. AAAS CEO Sudip Parikh presented two annual AAAS awards: the Early Career Award in Public Engagement and the Mani L. Bhaumik Award for Public Engagement.
[Associated image: Robb Cohen Photography & Video]