The COVID-19 pandemic has laid bare how infectious disease can devastate modern society. Globalization makes public health a global problem, and institutions across our society failed us.
Another problem in infectious disease is emerging, slower than a pandemic, but requires urgent attention: antibiotic resistance. Bacteria that used to cause simple cuts to turn into life-threatening infections have been controlled by antibiotics. This drug class has found tremendous usage in medicine, and everyone is bound to end up taking antibiotics during their lifetime. Antibiotics also enable serious medical procedures like open-heart surgery and chemotherapy to be performed without the fear of a major infection. Yet, bacteria are starting to outwit our current medicine, and society has failed to produce more.
In a recent article published in the inaugural volume of the MIT Science Policy Review (an open access journal focused on disseminating a rigorous treatment of science policy to the general public; for those interested, visit sciencepolicyreview.org), myself and other MIT and Harvard health science researchers dig into the reasons why antibiotic resistance is a problem, and offer policy solutions to solve it.
Antibiotics are tremendous tools in medicine, but society has not been careful about how and when they are used. When antibiotics are used, there is a risk that bacteria will become resistant. Overtime, doctors have over-prescribed antibiotics, leading to many resistant bacteria that can only be combatted with our most powerful antibiotics. A lack of diagnostic testing is a major cause; if the medical staff does not know what the cause of an ailment, the conventional wisdom is to be ‘rather safe than sorry’ and prescribe antibiotics. Funding the development of rapid-diagnostics could allow nurses and doctors to identify whether there is an infection in a patient and determine the correct prescription. We also argue that stewardship programs that are in charge of tracking which doctors at which hospitals prescribe which antibiotics for which infections could slow the wave of antibiotic resistance seen in the clinic.
Some may ask ‘why not make new antibiotics that work against the new resistant bacteria?’ Well, who is going to make those, and why are they going to make them? Historically, most of medicine, including antibiotics, has ultimately been translated to the patient’s bedside by the pharmaceutical industry. But the pharmaceutical industry has failed to make the next-generation line of antibiotics. While the science of killing these well-armored superbugs is difficult, the lack of new drugs comes down to an economics question. Is it profitable for pharmaceutical companies to make new antibiotics?
The answer, currently, is no. We point to many aspects of the antibiotic development pipeline that make these drugs non-profitable. Think about it this way; last line of defense antibiotics should be used as sparingly as possible to prevent a new resistance. How is the pharmaceutical company that spends a decade and $2 billion going to break even on that drug, let alone make money on it? Antibiotic resistance is a demanding problem because it is not solvable in a traditional capitalistic market. Rather, we offer evidence that antibiotics should be treated as a public service. If governments offer payments to the pharmaceutical companies to develop these essential drugs, dozens of new antibiotics would be developed in the coming decades. Society has funded basic research into antibacterial resistance and antibiotics development, through agencies like the NIH. It is clear that society also has to provide monetary rewards once the drug is developed to ensure that new antibiotic drugs are available.
Left unchecked, antibiotic resistance could account for millions of deaths per year globally by 2050. Society arrived at this problem through a market failure and improper usage of a valuable public health tool, antibiotics. It is going to take combined efforts in science and policy, public and private institutions, to steer away from the brink of a post-antibiotic world.