The greatest threat OF OUR TIME
If our antibiotics lose their effectiveness, chemotherapy and knee replacements will be effectively impossible. Skin infections will be life-threatening
The world — including Canada — is finally waking up to the worst public health threat of our times. Last week, the World Health Organization and Canada’s Auditor-General independently issued similar warnings: that everyone must do much more to fight antimicrobial resistance.
Their voices join a chorus that had already included the Government of Canada and the White House, which have announced plans of their own in the past month, and the British government, which launched a plan in 2013. And so they should. The antibiotics that we have come to take for granted are quickly losing their power to stop deadly diseases and infections. The end of antibiotics is right on our doorstep, and everyone is at risk.
Imagine a world without antibiotics. We’d return to a time when a skin infection had a one in 10 chance of causing death. When tuberculosis would again rage. When the very idea of a kidney transplant, a knee replacement, or beating cancer with chemotherapy would be unthinkable.
Arguably antibiotics are the greatest medical discoveries of the 20th century. Yet we are in danger of losing them to rapidly growing resistance to every class of existing antibiotics, giving rise to so-called “superbugs.”
To win this fight, we need to be vigilant and inventive, protecting the antibiotic resources we have and inventing new antibiotic therapies. Nowhere in the world are we doing any of these things well.
The resistance problem is influenced by many factors. First, resistance is inevitable. Microbes will always find a way around these drugs. Second, we use antibiotics too freely. Doctors and patients need to use these drugs wisely and respect them as precious and limited resources. They are unlike any other drug class.
We need to be mindful of the impact of using antibiotics in feed to fatten livestock more quickly, which dwarfs medical use and results in literally tons of drugs entering the environment, accelerating resistance.
Third, we need to remember that wherever they crop up, infectious diseases and antibiotic resistance are only a plane ride away from Canada.
The crisis demands bold action, and that’s why we welcome increased attention from the Auditor-General of Canada, whose call for a clear and comprehensive pan-Canadian strategy to address antimicrobial resistance lends urgency to the Federal Action Plan on Antimicrobial Resistance and Use. Canada’s plan aligns well with similar efforts in Europe and the U.S. and has three pillars: surveillance, stewardship and innovation.
We need to know what bugs are out there and what resistance genes are circu- lating in our hospitals and communities. Genomics gives us the power to map the spread of resistance microbes and ensure we use the right drugs. This surveillance is well within the purview of government and public health agencies and we’re confident it will succeed.
Stewardship is equally important. We need to preserve and respect existing drugs. We can’t afford to lose their power due to poor practice in the clinic or on the farm.
Innovation is the most challenging. Despite the critical need for new drugs, the pharmaceutical industry has steadily retreated from antibiotic research and development for well over a decade.
New antibiotic discovery programs have been shut down in companies around the globe. In 1990, there were 18 large drug companies searching for new antibiotics. Now there are fewer than four.
The reasons are complex, but there are some key issues: antibiotics, which users take for days, don’t generate much profit compared to blood-pressure drugs, for example, which users take for months or years; clinical trials are expensive and routinely encounter regulatory hurdles, and there are challenging scientific barriers to new antibiotic discovery.
Governments around the world are changing policies to resolve the profit and regulatory issues. The scientific challenges, though, are significant. Universities, research institutes and smaller biotech companies need to take the lead now that pharmaceutical companies have exited the field.
We need to accelerate discoveries that will overcome resistance to existing drugs. We need to flip our thinking, try new approaches and attract the brightest scientific minds.
Given the societal needs and the lack of investment by “big pharma,” we need investment in small companies that will take on the risk of antibiotic discovery and development. Public-private partnerships in antibiotic research are being deployed in Europe and we should look for lessons there as we implement a Canadian strategy.
We need to do all we can, while we can. We need to rally doctors, patients, parents, farmers and public-health workers, along with the biotech, pharmaceutical and investment sectors.
We have the opportunity to bring Canadians better health through new technologies and innovations in this all-important battle against superbugs and antibiotic resistance. Together we need to make sure the benefits we’ve enjoyed for the past 70 years of the antibiotic era are not lost. Gerard Wright is Canada Research Chair in Antibiotic Biochemistry and Eric Brown is Canada Research Chair in Microbial Chemical Biology. Both are based at the Michael G. DeGroote Institute for Infectious Disease Research at McMaster University.