A Crisis of Infection

AntibioticsIt’s amazing what humankind can achieve with the right amount of political will and resources. After the attack on Pearl Harbor in December 1941, Roosevelt oversaw the rebuilding of the Pacific fleet in only 6-months. Driven by rivalry with the Soviet Union, Kennedy announced in May 1961, “…we choose to go to the moon …” and just 8-years later Neil Armstrong left his indelible footprint in the lunar dust. December 2019 saw the genesis of Covid-19 and within a year the UK approved the first vaccine. Other vaccines quickly followed, an astonishing achievement facilitated by an estimated global expenditure of 8.5 billion US dollars. Yet behind this story lies a long history of under-investment in vaccine development, regardless of the inevitability of recurring pandemics. And there’s another inevitable pathogenic crisis heading our way under the political radar. We are running out of effective antibiotics.

Despite claims that Covid-19 vaccines materialised through “greed and capitalism” in reality, global public investment fuelled that one year achievement. A pandemic it seems, catalyses political will like little else. Meanwhile, funding applications took up much of the development time towards vaccines such as a BCG* replacement and the recently approved malaria vaccine. Some might say, Covid-19 aside, vaccine development is more to do with accounting than science.

In 1941, a 43-year-old policeman named Albert Alexander scratched his face on a rose bush whilst gardening. The scratch became septic and he became the first person to be treated with one of the earliest antibiotics – penicillin. Unfortunately, supplies at that time were too scarce to save his life. The story marks the start of an antibiotic revolution, but also illustrates how easily death came from even the most minor of wounds. Thirty years after Albert Alexander’s death, we entered what became known as the golden era of antibiotics. It is however, frighteningly poignant to remember that the last truly novel antibiotics, the quinolones, arrived in the 1970s and discovery since this time has been dire.

The trouble with new antibiotics is not science but, once again, political will and resources. Big pharmaceutical companies have all but abandoned development of antibiotics because the “greed and capitalism” model doesn’t work in this instance – anymore than it did for vaccines. This is not some Marxist view of the world – far from it, but a recognition that free markets are not a one-size-fits-all panacea. Over the years many small biotechs have entered the antibiotic market only to go bust. The dilemma is despite an estimated 700,000 deaths worldwide from antibiotic-resistant strains, high development costs make the price per dose prohibitively expensive. The situation is perhaps exemplified by the case of Melinta Therapeutics, which had four antibiotics on the market, one of them for the treatment of much feared hospital acquired resistant infection. Melinta Therapeutics nevertheless declare bankruptcy in late 2019.

Unlike Covid-19, the number and impact of resistant strains of bacteria build up over time. They arise by stealth until we realise we’re in a crisis that politicians can no longer avoid. Once we’ve reached crisis, reactive solutions are sought as people die, but with a little foresight and vision, science has the know-how to find solutions before we reach a critical point. If Covid-19 has taught us anything, it’s what we can bring about when we put our minds to it. And I end as I started – it’s amazing what humankind can achieve with the right amount of political will and resources.

* BCG stands for Bacillus Calmette-Guérin, a vaccine used to treat tuberculosis, made from attenuated Mycobacterium bovid.

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