An­tibi­otics are fail­ing and it’s a silent cri­sis

Canada has the ex­per­tise to lead the world in de­vel­op­ing new medicines and vac­cines

The Hamilton Spectator - - COMMENT - GERRY WRIGHT AND BOB HAN­COCK Gerry Wright works at McMaster Univer­sity. Bob Han­cock works at the Univer­sity of Bri­tish Columbia. This ar­ti­cle was orig­i­nally pub­lished on The Con­ver­sa­tion. Dis­clo­sure in­for­ma­tion is avail­able on the orig­i­nal site.

In­fec­tious dis­eases that once were tamed are roar­ing back, past the last line of our an­tibi­otic de­fences. They threaten the lives of mil­lions, but where is the pub­lic out­cry?

Drug-re­sis­tant strains of gon­or­rhea, once eas­ily dis­patched with peni­cillin, are spread­ing across the globe. The re­sult: chronic pain, steril­ity and a call for new drugs by the World Health Or­ga­ni­za­tion. In North Amer­ica, peo­ple are dy­ing from in­fec­tions caused by bac­te­ria that are re­sis­tant to all avail­able drugs. And sepsis, a deadly syn­drome trig­gered by un­treat­able bac­te­rial in­fec­tions, is caus­ing mil­lions of deaths and mas­sive health-care costs among the el­derly and very young.

Where is the Canadian co-or­di­na­tion, lead­er­ship and re­solve to de­velop new an­timi­cro­bial sub­stances? To move in­no­va­tions into the mar­ket­place?

This spring, we rep­re­sented Canada at the Drug-Re­sis­tant In­fec­tions Con­fer­ence in Bris­bane, Aus­tralia — an event that fea­tured aca­demic, pub­lic health and phar­ma­ceu­ti­cal in­dus­try re­searchers from around the world. The goal of the con­fer­ence was to show­case the best re­search and de­vel­op­ment avail­able to bat­tle the an­tibi­otics cri­sis. We are proud to re­port that Canadian re­search is among the most in­no­va­tive in the world.

The time is right to launch a Canadian Anti-In­fec­tives In­no­va­tion Net­work. It is time to co­a­lesce and co-or­di­nate Canadian aca­demic, pri­vate sec­tor, not-for-profit and gov­ern­ment re­search to solve the an­tibi­otics cri­sis. Such a net­work would gal­va­nize Canadian an­tibi­otic re­search and de­vel­op­ment. It could en­sure that we play a role on the in­ter­na­tional stage com­men­su­rate with our abil­ity and prom­ise.

The in­cred­i­ble sci­en­tific ad­vances of the last cen­tury have al­lowed us to live longer and bet­ter lives by prevent­ing or treat­ing many dis­eases that were once fa­tal.

Pneu­mo­nia, blood in­fec­tions and tu­ber­cu­lo­sis were once com­mon killers. Now they are gen­er­ally cured with an­tibi­otics. Cheap and abun­dant an­tibi­otics have al­lowed us to cure ill­nesses, keep frag­ile pre-term ba­bies alive, carry out safe surg­eries and treat can­cer.

Those very ben­e­fits have lulled us into ig­nor­ing a fright­en­ing prob­lem that has been loom­ing for decades, un­der­min­ing that progress and threat­en­ing to undo those ad­vances.

While we were en­joy­ing the ben­e­fits of an­tibi­otics, the mi­crobes were fight­ing back. They were find­ing ways around the ob­sta­cles sci­ence and medicine had placed in their way. Now the mi­crobes are start­ing to win. And al­though we have good rea­son to be­lieve new weapons could beat them back again, for some rea­son the world is not mak­ing enough ef­fort to pre­serve our frag­ile safety.

We are in this sit­u­a­tion be­cause of the ever-in­creas­ing num­ber of bac­te­ria that are no longer sen­si­tive to the an­tibi­otics we dis­cov­ered decades ago. And be­cause most phar­ma­ceu­ti­cal com­pa­nies no longer see prof­itabil­ity in new an­tibi­otic drugs. The busi­ness case is not strong for in­vent­ing drugs that pa­tients will only need for a short time, com­pared to life­long pre­scrip­tions to treat heart and blood-pres­sure con­di­tions, for ex­am­ple.

But this is not a busi­ness case. This is a pub­lic health cri­sis.

We are per­ilously close to plung­ing back into a time when ill­nesses we con­sider or­di­nary could kill tens of mil­lions. For some deadly strains of bac­te­ria, we are al­ready in a post-an­tibi­otic world. Clin­i­cians are out of op­tions. Once cur­able dis­eases are in­cur­able. Six mil­lion peo­ple al­ready die of sepsis ev­ery year for want of ef­fec­tive an­tibi­otics, and the cost to the U.S. alone is $27 bil­lion an­nu­ally. Highly re­sis­tant superbugs are be­ing found on our farms.

In Septem­ber 2016, 193 mem­bers of the United Na­tions came to­gether to an­nounce that an­timi­cro­bial re­sis­tance (AMR) is the largest threat to medicine. This was reaf­firmed this month in the fi­nal state­ment from the G20 meet­ing in Ham­burg. With­out ur­gent ac­tion to over­come AMR, the UK’s Re­view On An­timi­cro­bial Re­sis­tance es­ti­mates the world could wit­ness 10 mil­lion ex­tra deaths ev­ery year by 2050. That is an in­crease of to­tal deaths by one sixth.

Even those who sur­vive drug-re­sis­tant in­fec­tions will need twice as much time in hos­pi­tal. And that is just one ex­pense flow­ing from a prob­lem that is ex­pected to cost the global econ­omy $100 tril­lion by 2050.

In a con­text of ne­glect and in­ac­tion, and the mis­con­cep­tion that an­tibi­otic dis­cov­ery is the job of the pri­vate sec­tor, no coun­try is ideally po­si­tioned to solve this prob­lem alone. Canada, how­ever, is in a po­si­tion to lead if it wants to.

Canadian re­searchers have pi­o­neered cre­ative so­lu­tions: al­ter­na­tives to an­tibi­otics that block and in­hibit re­sis­tance, in­no­va­tive drug com­bi­na­tions that boost an­tibi­otic ac­tiv­ity and en­hance host im­mu­nity to pre­vent in­fec­tion.

Canada’s nat­u­ral re­sources, in­clud­ing the Arc­tic and three oceans, have the po­ten­tial to de­liver new an­timi­cro­bial and anti-in­fec­tive sub­stances. Vac­cine de­vel­op­ment for an­i­mals and hu­mans can re­duce our need for new drugs. Our in­no­va­tive think­ing can de­liver al­ter­na­tives to re­duce de­pen­dency on an­tibi­otics.

In­no­va­tions alone won’t help. We must do more to get Canadian know-how into ac­tion im­me­di­ately. Canada is a global leader in many ar­eas of ba­sic and ap­plied re­search that can con­trib­ute to solv­ing the prob­lem. But we lack co-or­di­na­tion, com­mon ob­jec­tives and re­solve.

Canada is com­pet­ing and lead­ing in an­ti­in­fec­tive in­no­va­tion, but we are rapidly fall­ing be­hind in our abil­ity to cap­i­tal­ize on th­ese dis­cov­er­ies, fos­ter and sup­port new re­search and com­mer­cial­iza­tion in Canada.

We must act now to en­sure that we not only do our share on the in­ter­na­tional stage to solve the an­tibi­otic cri­sis, but also pro­vide a made-in-Canada in­no­va­tive ap­proach.


In­creas­ingly, an­tibi­otics like th­ese are in­ef­fec­tive in treat­ing mod­ern in­fec­tious dis­eases. Gerry Wright and Bob Han­cock ar­gue it’s time for Canada to take lead­er­ship in a global ef­fort to ad­dress the cri­sis.

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