Drug resistance: how the pandemic messed up our antibiotics

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Since antibiotics were discovered over a century ago, they have dramatically improved our lives. Research suggests they even extended the average human lifespan by more than 20 years. But if we’re not very careful now, humanity may slide back into a world where our antibiotics become useless – and the common infections they were used to treat shorten our lives.

The Covid-19 pandemic has aggravated this danger. According a new report from the Centers for Disease Control and Prevention (CDC), in the first year of the pandemic, the problem of drug resistance only escalated.

Drug resistance is what happens when we misuse antibiotics in treating humans, animals or crops. When a new antibiotic is introduced, it can have great, life-saving results – for a while. But then the bacteria adapt. Little by little, the antibiotic loses its effectiveness and we are left with illnesses that we are less able to treat.

Even before Covid-19, experts had warned that we were approaching a post-antibiotic era – a time when our antibiotics would become largely useless against health conditions ranging from tuberculosis to STIs to urinary tract infections. They noted that routine hospital procedures like C-sections and joint replacements could also become more dangerous, as the risk associated with infection – especially infections acquired in hospitals – increase.

Some professionals, particularly in hospitals, had heeded the warnings of the experts, and we saw progress accordingly. Take staph infections, for example. A 2019 CDC report noted that rates of methicillin-resistant Staphylococcus aureus (MRSA) had dropped. And overall, deaths caused by drug resistance have fallen by 18% since 2013.

But the Covid-19 pandemic has undone years of hard-won progress. Deaths and infections linked to drug-resistant hospitals from seven pathogens increased by 15% from 2019 to 2020, including a 13% increase for MRSA infections, which can be deadly.

One reason is that hospitals prescribe too many antibiotics, according to the CDC. From March to October 2020, almost 80% of hospitalized Covid-19 patients received antibiotics. As a viral disease, Covid-19 is unaffected by antibiotics, but doctors may have been eager to prescribe them to cure or protect against secondary infections, especially as hospital stays Hospital for Covid-19 can be long and intensive.

“This setback can and should be temporary,” said Michael Craig, director of the CDC’s Antibiotic Resistance Strategy and Coordination Unit. said in a press release. “The best way to avoid a pandemic caused by an antimicrobial resistant pathogen is to identify the gaps and invest in prevention to keep our country safe.”

Obviously, the last thing we want is for the Covid-19 pandemic to pave the way for another pandemic caused by a drug-resistant pathogen.

Drug resistance is a problem that can be solved. Why don’t we solve it?

The good news is that we absolutely can solve the problem of drug resistance. In its new report, the CDC calls for more efforts on strategies we know, like preventing hospital-acquired infections in the first place and educating healthcare professionals about when it’s appropriate and not appropriate to distribute antibiotics.

But there’s more we could do – and at a lower cost too. Specifically, pharmaceutical companies could research and develop new antibiotics to use if our old ones stop working.

“For the United States, the total cost to fix the faulty antibiotic model is $1.5 billion to $2 billion a year,” Kevin Outterson, a resistance professor at Boston University, told me. to antibiotics. “It’s the equivalent of what we spend on toilet paper Every few months.”

Or, as a 2019 UN report put it, if every person in high- and middle-income countries invested $2 a year in this cause, we could research new drugs and implement effective measures to reduce the threat of resistance.

Unfortunately, companies simply have no incentive to create new antibiotics. Since 1990, 78% of large pharmaceutical companies have scaled down looking for antibiotics – or cutting it off completely. They know that it takes many years to do the research and development necessary to bring a new antibiotic to market. Most new compounds fail. And even when they are successful, the payoff is small: an antibiotic – which is, at least in theory, a drug of last resort – does not sell as well as a drug that must be taken daily. So for businesses, the financial incentive just doesn’t exist.

A number of experts argued that to solve this problem we need to stop treating antibiotics as if they were any other product on the open market. Instead, we should view antibiotics as public goods essential to the functioning of a society, such as infrastructure or national security. And the government should fund their research and development.

“It’s a product that we want to sell as as little as possible,” Outterson explained. “The ideal would be an amazing antibiotic that sits on the shelf for decades, waiting for when we need it. That’s great for public health, but it’s a scary disaster for a company.

This mismatch with the profitability imperative of the pharmaceutical industry is why the government (and ideally also the private sector and civil society) must intervene, according to the 2019 UN report. This could include incentives such as grants and tax credits to support early stage research. The report also urged rich countries to help poorer countries improve their health systems and recommended the creation of a major new intergovernmental panel – like the one on climate change, but for drug resistance.

Yet for governments to mobilize around this issue, the public may first have to make it an urgent priority, and it’s not clear that enough Americans see it as such.

Outterson told me he fears the death toll will have to climb very high before a critical mass of people start to notice, care and take action. “We will eventually respond,” he said. “The question is how many people will have to die before we begin this response.”

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