At war with super bugs and the collateral damage on our health and the economy.

THEY’RE A HEALTH AND ECONOMIC CRISIS AND THERE’S NO CURE IN SIGHT.

Andrew Morris went into infectious disease medicine assuming he was going to be able to cure his patients. After all, antibiotics have made obliterating bacterial infections possible with little effort or expense.

But Morris, who directs the antimicrobial stewardship program at Sinai Health System University Health Network in Toronto, said his colleagues are facing an increasing number of situations where the drugs aren’t working.

“When I trained, I never imagined I wouldn’t be able to treat an infection,” he said. “I went in to cure and here I am with a patient I can’t cure.”

Decades of antibiotic overuse have led to an increase in infections from bacteria that have developed a resistance to them, rendering the drugs that have conquered pneumonia, rheumatic fever and tuberculosis powerless.

The Public Health Agency of Canada says this is one of the biggest public health risks facing the country, with 18,000 Canadians contracting drug-resistant infections each year in hospitals and 700,000 dying from them annually around the world.

If nothing is done, the problem will get far worse. The World Bank predicts antimicrobial-resistant germs could cost the global economy as much as US$27 trillion by 2050, plunge up to 24 million people into poverty and kill 10 million people per year. Canada was among 193 members of the United Nations who recently pledged to take co-ordinated action to prevent this nightmare scenario.

The World Bank estimates the cost of effective global action against anti-microbial resistance would be about US$200 billion, a relative bargain. But the perverse economics of antibiotics make this easier said than done.

Antibiotics only take a few days to clear up infections when they work. That means they’re not nearly as profitable as the drugs people take for years to manage chronic conditions, such as high cholesterol or blood pressure.

Another reason pharmaceutical companies have little incentive to invest in research and development is that if researchers discover an effective new antibiotic, public health officials want to reserve it for use in emergencies to keep bacteria from becoming resistant to it as well. As a result, only a handful of the world’s major drugmakers are pursuing antibacterial research today.

“The message pharmaceutical companies effectively receive right now is, ‘Listen, we want you to develop new antibiotics, but once you develop them, we’re not going to allow anyone to get them, because we want to hold them in reserve,’” said David Howard, a health economist at Emory University’s Rollins School of Public Health in Atlanta. “Under those conditions, it’s not particularly surprising drug companies don’t see antibiotics as a particularly profitable area to invest in.”

Experts have proposed various solutions, including offering grants for successful research, allowing drug companies who find new antimicrobials to extend patents on products of their choice and raising the price of antibiotics. All of them cost money and require political will.

Canada, in particular, is lagging behind other developed countries. The 2015 federal budget committed $2 million per year for research on infections caused by anti-microbial resistance, compared to US$1.2 billion pledged by the U.S. for initiatives related to the issue.

David Shlaes, who worked in anti-infectives in industry and academia for 30 years and writes the blog Antibiotics: The Perfect Storm, said governments have a choice to make.

“Somebody has to pay,” he said. “The question is which price is worse: The lives and years of productivity that will be lost from not doing something like this, or the capital investment you have to put down now to prevent this from happening?”

It’s also hard to muster the political will necessary to effect change because it’s hard to imagine life without cheap, effective and abundant antibiotics.

Before Alexander Fleming discovered penicillin in 1928, the average Canadian man lived to be 60, women often died in childbirth and important medical advances such as organ transplants and chemotherapy were simply not possible.

In a report on the economic threat of antimicrobial resistance, British economist Jim O’Neill estimated drugmakers sell US$40 billion of antibiotics each year. The vast majority of those sales are generic drugs, with just US$4.7 billion in patented antibiotics sold annually — about the same as the yearly sales of a single top-selling cancer drug.

Cheap and readily available generic antibiotics have led to a problem economists refer to as a negative externality, where a transaction between two parties results in a cost to someone else who wasn’t involved. Because antibiotics are cheap and easy to get, people consume a lot of them unnecessarily, avoiding responsibility for the societal cost of bacteria that develop a resistance to those drugs.

Antibiotics are so cheap that they are also fed to livestock to promote growth and prevent disease. About 70 per cent of antibiotics that are important to human health are sold for use in livestock in the U.S., according to the U.S. Food and Drug administration.

Nevertheless, some consumers and businesses appear to be getting the message about the importance of dialing back antibiotic use that seeps into the food chain. Major restaurant chains such as McDonald’s, Subway and Wendy’s have committed to serving meat raised without medically important antibiotics and many countries, including Canada, are enacting new regulations about the practice.

These changes present an opportunity as well as a challenge for companies such as Madison, N.J.-based Zoetis Inc., the world’s largest producer of drugs and vaccines for animals. Zoetis has revived its antibacterial discovery research and invested more money in developing vaccines in response to pressure from clients and consumers to reduce antibiotic use in livestock.

“Consumers are becoming more aware around antibiotic use, both in themselves as well as in their food,” said Jeffrey Watts, director of external innovation and anti-infectives at Zoetis. “We knew ... we would need new, novel agents and that those agents would need to be clearly differentiated from human health agents.”

Anti-infectives make up a larger part of the revenue of a livestock drug company such as Zoetis than they do at major human pharmaceutical companies, however, giving it more incentive to respond to such pressure.

In January, 83 pharmaceutical companies including Pfizer Inc., Merck & Co. Inc., Johnson & Johnson and GlaxoSmithKline PLC signed a declaration calling on governments to boost that incentive by funding antibiotic research and establishing stable markets for new drugs.

John Prescott, a retired professor with the University of Guelph’s veterinary college who has been lobbying for action against anti-microbial resistance for decades, said these are all signs the world is finally starting to take the issue seriously.

He said it’s been hard to understand why it took so long, but believes exciting advances in genome sequencing and drugs that target specific bacteria are on the horizon.

“I think we’re entering the golden age of microbiology,” Prescott said. “It’s exciting. Anti-microbial resistance has really grabbed attention at the highest levels.”

But Mount Sinai Hospital’s Morris said it is not time to start congratulating anyone just yet. He said public awareness of antibioticresistant superbugs such as C. difficile is much lower than it is for diseases like SARS and HIV even though the former kills far more people.

Morris said his colleagues in the oncology ward are treating their cancer patients with antibiotics that represent the last line of defence against resistant bacteria. Those drugs, too, risk failing before something new is developed to replace them.

“If we lose those, we’re in trouble,” Morris said. “We’re already there. We’re at a public health crisis.”

HANDOUT / NIAID