Superbugs are smarter than antibiotics – ShareCafe


In 1938, Ernst Chain, a German-born biochemist working at Oxford University, found an article on penicillin written nine years earlier by British bacteriologist Alexander Fleming. In 1928, by chance, Fleming noticed an area around an invading fungus on an agar plate in which the bacteria did not grow. After isolating the mould, Fleming identified it as belonging to the Penicillium gender.

But doing anything more with the unstable compound was beyond Fleming’s skill set, and that’s where Chain came in. He proposed to his supervisor, Australian pathologist Howard Florey, to isolate, purify and test the compound to see if it could kill the microorganisms without harming their host. Florey, seeing the potential of penicillin, assembled a team that in 1939 successfully treated mice. In 1941, the group was experimenting on sick people.

In 1942, Fleming, who obtained some of the rare penicillin from the Oxford team, saved a dying British woman from an infection. The temperature from the United Kingdom published the exploit, without referring to Fleming or Florey. Fleming’s boss wrote to the newspaper to praise Fleming who bragged in press interviews while Florey refused to speak to the media. Thus, many people today mistakenly believe that Fleming offered penicillin to the world, even though Chain, Fleming and Florey also shared the Nobel Prize and connoisseurs believed that a self-promoter stole the credit from Florey. .

What matters most is that Florey’s vision led to one of the greatest medical feats in history. The decisive advantage of the drug was its low cost of production. The antibiotic has become a global cure and has increased life expectancy, primarily by reducing child deaths.

The wonders of penicillin have inspired the development of other affordable antibiotics capable of fighting an ever-widening range of diseases. As antibiotics, antifungals, antivirals and other drugs collectively referred to as antimicrobials have been developed, optimists have dared to speak of a world without deadly infections.

What could go wrong? Four things. First, in the advanced world where prescriptions are regulated, doctors over-prescribe and over-prescribe antimicrobials. Second, in the emerging unregulated world, people can buy antibiotics from pharmacies without a prescription and even find them in markets and stores. So people mistreat or overtreat themselves with these drugs because it’s cheaper and easier than seeing a doctor. The result is that up to 70% of human use may be inappropriate. Third, 80% of antibiotic use worldwide is for fattening livestock and preventing livestock infections. Efforts to combat these abuses have failed. The fourth problem is that residues of antibiotics and antifungals are too prevalent in third world drug manufacturing centers such as Hyderabad in India.

The result? The natural immunity of microbes develops over time has accelerated. Superbugs have developed resistance to antimicrobials and global deaths from drug-resistant microbes are increasing. Before antibiotics, only one in 10 million bacteria proved resistant to antibiotics. Today, it is estimated that up to 90% of the bacteria responsible for infections are immune to previously effective antibiotics.

As for deaths, a study by researchers at the University of Washington in January attributed 6.22 million deaths worldwide in 2019 to drug-resistant microbes.

The study suggested five ways to fight superbugs. First, improve sanitation and hygiene, to limit infections. Second, prevent infections by vaccination when possible. Third, reduce the use of antimicrobials in animals. Fourth, minimize the abuse of these drugs with people. Fifth, increase investment in finding drugs that can defeat superbugs.

This is a major handicap in the fight against infections that do not respond to treatment. Few superbugs are emerging because investment in the field is minimal compared to other spheres of public health. Only about US$1 billion a year worldwide is spent on research to fight superbugs, compared to US$50 billion a year to fight HIV/AIDS in low- and middle-income countries.

Pharmaceutical companies, whose income depends on prescription sales, do not invest enough because they cannot recoup an adequate return for three reasons. First, the cheapness of generic antimicrobials makes hospitals reluctant to pay high prices for superbugs. Another problem is that medical institutions are using new superbugs as a fallback when generic treatments fail. A third problem is that antimicrobials are only taken for a short time, whereas cost-effective drugs are usually the ones people take daily for years. The result is that sales volumes are too low to make new drugs profitable.

In a sign of the fragility of the economy in this field, Big Pharma players have given up the fight against superbugs and small antibiotic development companies are struggling to survive, even after gaining approval for their discoveries.

A crisis around superbugs is building. A market failure means that capitalism cannot yet find a solution to diffuse a foreseeable catastrophe. Governments must do more because only alarming levels of deaths will improve the economy. Even if the pharmaceutical industry is likely to solve the problem in extremis, it would be too late for millions of people.

To be fair, policymakers are trying to end the misuse of antibiotics – but with little success in the emerging world. Research efforts against superbugs are underway, but from a financial perspective, these efforts do not compare to the billions that Big Pharma spends on research in lucrative areas.

Increased efforts, encouraged by governments, are needed. With enough resources devoted to research, someone will surely discover a cure for superbugs. Nobody will care if the self-promoters pinch the credit.

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