Antibiotics are essential to modern medicine, not only for treating infections but also for enabling surgeries and managing chronic diseases. Yet, we are edging towards a crisis where simple infections could become deadly due to antibiotic-resistant superbugs. Unchecked, this hidden pandemic will cause more deaths than major diseases like Covid-19 or cancer, while posing severe economic threats globally.
In When The Drugs Don’t Work: The Hidden Pandemic That Could End Modern Medicine, I dive into the origins and implications of this dire situation and offer solutions to the problem. As much as we wish to avoid talking about the Covid-19 pandemic, this is a discussion over what could prove to be a bigger crisis.
Historically, the mid-20th century was a golden era of antibiotic discovery, but recent decades have seen a significant slowdown. Today, no new major class of antibiotics has emerged in decades. The pipeline is dry and the medicine cabinet is bare.
While there is no single cause for the gap between the pressing medical need and the paucity of new antibiotics, a few concerns are worth highlighting.
First, there is a mismatch between the value of antibiotics to society and their market price. We lack awareness of the true value of advanced antibiotics, which are generally prescribed for only a short period when effective, clearing infections quickly. This short treatment duration contrasts sharply with long-term medications like statins for high blood cholesterol or GLP-1 drugs for obesity, which generate sustained revenue for pharmaceutical companies. As a result, the limited revenue potential from each antibiotic prescription makes the market less attractive to companies and investors.
There’s another problem. Since the discovery of penicillin, most original antibiotics have been isolated from microbes. Pharmaceutical companies have created potent derivatives of these antibiotics, but it is harder to find new antibiotics in the environment since we’ve already identified the most obvious ones.
This innovation drought portends a post-antibiotic era, where even minor infections could prove fatal.
You might wonder how this is possible. As I write in my book, “In nearly every other realm of science and technology, as time passes and we learn more, we get better at doing things. Moore’s Law (which states that the processing power of a computer doubles every few years) is a famous observation that explains why the smartphone in my pocket is much more powerful than the guidance computer used to land the first humans on the moon in 1969.”
But as I observe: “Nature has a secret advantage over machines. Carbon-based life forms have extra capabilities that silicon-based transistors don’t have: they can evolve. Life has had plenty of time to figure out how to do things better than humans. Even when we find ways to defeat bacteria, they come back. A new generation of bacteria can grow very fast – some even double in population every twenty minutes.”
The impact of superbugs is already significant. For instance, a landmark study published in The Lancet found that superbug infections caused more deaths than HIV/AIDS, tuberculosis, or malaria five years ago, with an estimated 1.3 million deaths globally in 2019 alone. According to an article in Nature, in India, superbugs contribute to around 300,000 deaths annually, including cases of neonatal sepsis which claims the lives of 60,000 newborns each year. Superbugs are a contributing factor in a million additional deaths.
The environmental impact is equally concerning. Regions like Hyderabad have reported dangerously high levels of antibiotics in local water bodies, reflecting a broader issue of contamination from pharmaceutical companies affecting major water sources and contributing to the proliferation of superbugs. Antibiotics have been found in the Yamuna River, which millions rely on for water. New research has also shown that climate change and pollution further promote the rise of antibiotic-resistant superbugs.
In India, the misuse of antibiotics in health care and agriculture has exacerbated this crisis. Astonishingly, India accounts for nearly a quarter of global antibiotic sales, with a significant portion used in agriculture rather than for treating humans.
Many antibiotics are available in India without a prescription and there is a lack of knowledge of how harmful these potent drugs can be on a personal health level, especially if taken without medical supervision. Antibiotics disrupt our microbiomes, the complex ecosystems of microbes that play crucial roles in our overall health. This indiscriminate killing of beneficial bacteria can lead to additional health complications.
This misuse is compounded by the widespread availability of unregulated antibiotic combinations and unnecessary prescriptions, which was particularly notable during the Covid-19 pandemic.
Despite these challenges, there is hope. India, with its robust pharmaceutical sector and skilled workforce, is well-positioned to lead global efforts in combating superbugs. Innovative approaches are being explored, including the use of bacteriophages — viruses that target and kill bacteria — and leveraging Artificial Intelligence to discover new drugs. Scientists are also turning to untapped natural resources like oceans and soils, and even the human microbiome, to find potential new antibiotics.
Last week, I was fortunate enough to be in Barcelona attending the annual conference of the European Society of Clinical Microbiology and Infectious Diseases. There I got to see some of the newest research innovations at the largest conference on infectious diseases in the world. Researchers presented new findings on the control, diagnosis, and treatment of superbugs. Pharmaceutical companies showcased treatment options.
But not all tools at our disposal need to be high-tech. Prevention of the spread of drug-resistant superbugs through improved hygiene and just handwashing also goes a long way. As does rapid diagnostic tools that help doctors pinpoint causative pathogens quickly, removing the guesswork from the clinic.
I am optimistic that we can succeed. As I write in When The Drugs Don’t Work, “Humans are capable of rising to challenges once we acknowledge their existence. We may not have the same antibiotics and antibacterial drugs we do today, but twenty years from now, I believe we will have new tools to wage our continuing war against superbugs.”
Anirban Mahapatra is a scientist and author, most recently of the popular science book, When The Drugs Don’t Work: The Hidden Pandemic That Could End Medicine. The views expressed are personal.
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