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I grew up believing that advances in science and medicine were going forward – that human health would continue to improve as it had been doing for hundreds of years. Over the course of my own career in health sciences, I have continued to be optimistic.
Now, I have serious doubts.
Science still works well, but deadly obstacles block the path between research and progress in the field I work in: antibiotics.
The threat to humanity is getting worse and worse by the day, but for reasons beyond my colleagues and myself, there seems to be an astonishing little collective will to do anything. thing.
This week (November 12-18) is Global Antibiotic Awareness Week. We must talk about this threat. We must develop models of public-private cooperation – to incentivize, finance and invest in the discovery and development of antibiotics.
Penicillin has led to complacency
Here is the problem: About 75 years ago, science introduced penicillin into public use, opening a new era in the control of infectious diseases, like sanitation. Infectious diseases such as pneumonia and streptococcal infection, which were usually fatal even at the time of my grandparents, were tamed – at least for a while.
(THE CANADIAN PRESS / Darryl Dyck)
In the generations that followed, life expectancy jumped 25 years and infectious diseases dropped from first place among all causes of death, where they had always been superior to bullets and bombs, even during World Wars.
With inexpensive, abundant and effective antibiotics at hand, people in developed countries have let go of the idea of controlling infections.
But all the while, while we lived better and longer, infectious diseases have made a comeback and today they are knocking on the door. In fact, they are already breaking the door.
The market will not respond to demand
In a quick example of Darwinian adaptation by natural selection, bacteria and other microbes grow to survive antibiotics. They will continue to adapt and succeed unless humanity builds new layers of defense in the form of new antibiotics and other creative approaches.
Governments around the world recognize the crisis, as they affirmed at an extraordinary high-level meeting of the United Nations General Assembly in 2016 and the G20 in 2017.
What is troubling is that we know what we need to do to create new antibiotic treatments and, although the work is undeniably difficult, there are already promising new alternatives to older drugs and others are underway of achievement.
Unfortunately, they are not yet available in the commercial market and they may never succeed unless something changes to make them viable – not as medicines, but as commodities.
The major obstacle to the production of new antibiotics is our own economic model, which trusts the market to meet demand. As Adam Smith, philosopher and economist, said, the invisible hand does not work here, and what is at stake is all the progress made possible by antibiotics.
Read more:
Canada could lead the battle for life in a post-antibiotic world
The public model is risky
In the United States, last summer, two pharmaceutical companies obtained FDA approval for new antibiotic compounds. As soon as the markets learned that these companies had created drugs that literally saved the world, their stocks fell.
This seems counterintuitive, is not it? It turns out that spending hundreds of millions of dollars to create, test and market a new drug is a significant risk, unless the drug can recover its investment in the 20 years before its expiration. patent.
It's hard to do when you are trying to recover the cost of a prescription at a time of 10 days. And when you prescribe the new drug only for infections that can not be resolved with cheap and traditional antibiotics, which still work in many cases.
The only way to create new antibiotics would be to make them astronomically expensive, in the range of rare anticancer drugs, and who would pay for it?
Many argue that we should consider antibiotics the same way we look at fire departments. As individuals, we may never need them, but we are all willing to share the costs because we expect them to be present.
A public model seems logical, but who will take the political risk?
Hospitals under threat
Without intervention – when the public, through its governments around the world, cooperates with the private sector to incentivize, finance and invest in the discovery and development of antibiotic drugs – the end of the effectiveness of antibiotics will be scary.
It will be done gradually, but it will certainly happen. The early stages are already in the form of multi-drug resistant infections that threaten the basic function of hospitals.
We will then see common procedures such as appointments for dental hygiene and joint replacements that are permanently canceled due to the risk of infection.
People of all ages will begin to die from illnesses we are used to dealing with $ 10 or $ 20 worth of pills. Those who do not die will be sick more often and longer, driving up the cost of care.
Life expectancy could be reduced to what it was in the early 1900s, and the golden age of antibiotics would have been only a brief one and happy momentary of the story.
It must not be like that. Allows us to transform our awareness into action.
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