I grew up believing in the progress of progress in science and medicine – that human health will continue to improve as it has been for hundreds of years. As I advanced from my career in health sciences, I continued to be optimistic.
Now I have serious doubts.
Science continues to work well, but deadly obstacles hinder the path between research and progress in the field where I work: Antibiotics.
The threat to humanity is serious and worsening the day, but for reasons that go beyond my colleagues and myself, there seems to be a shocking little collective will to do a lot about it.
This week (November 12-18) is a World Antibiotic Awareness Week. We need to talk about this threat. We need to develop public-private partnership models – to promote, fund and invest in the discovery and development of antibiotic drugs.
Penicillin led to complacency
Here's the problem: about 75 years ago, science brought penicillin to public use, opening a new era in the control of infectious diseases, as well as sewage before it. Infectious diseases such as pneumonia and twitching, which had been fatally shared even on my grandparents' day, have been tamed – at least for some time.
In the next generations, life expectancy has fallen by 25 years and infectious disease has collapsed from the number one point among all the causes of human death, where it has consistently ranked higher than bullets and bombs – even during the World Wars.
With the cheap, abundant and effective antibiotics in hand, people in the developed world have become complacent about controlling infections.
But all the while, while experiencing our best, longer life, infectious diseases work for a return and today they hit the door. In fact, they have already collapsed the door.
The market will not meet demand
In a quick example of Darwinian adaptation through natural selection, bacteria and other germs evolve to survive antibiotics. They will continue to adapt and succeed if humanity does not create new levels of defense in the form of new antibiotics and other creative approaches.
World governments recognize the crisis, as confirmed at a high-level special summit of the United Nations General Assembly in 2016 and the G20 in 2017.
The worrying part is that we know what to do to create new antibiotic treatments and although the work is undoubtedly hard, there are already promising new alternatives to older drugs and many more are in progress.
Unfortunately, they are not yet available in the merchant market and can never get there if they do not change anything to make them sustainable – not as medicines but as commodities.
The critical obstacle to the production of new antibiotics is our own economic model, which trusts the market to meet demand. The invisible hand, as the philosopher and economist Adam Smith said, is not working here, and what is at stake is all the progress made by antibiotics.
Canada could lead the struggle for life in a world after the antibiotic
The public model is dangerous
This summer in the United States, two pharmaceutical companies have won FDA approval for new antibiotic compounds. Once the markets learned that these companies had created drugs that could literally save the world, their stocks fell.
It sounds counter-intuitive, is not it? It turns out that spending hundreds of millions on creating, testing and marketing a new drug is a bad risk unless the drug can gain back the investment within 20 years before the expiration of the patent.
This is difficult to do when you try to recover the cost of a 10 day prescription each time. And when you prescribe the new drug only for infections that can not be resolved with cheap, traditional antibiotics, which still work in many cases.
The only way that would make sense to create new antibiotics would be to make them astronomically expensive in the range of rare cancer drugs, and who will pay for it?
Many argue that we need to look at antibiotics in the same way we look at fire departments. As individuals, we can never have to, but we are all willing to share the costs because we expect to be there.
A public model seems to make sense, but who will take the political risk?
Hospitals under threat
Without intervention – where the public, through their governments around the world, works with the private sector to help motivate, fund, and invest in the discovery and development of antibiotic drugs – the end of effective antibiotics will be scary.
It will happen gradually, but it will surely happen. The early stages are already here in the form of infectious antibiotic-resistant drugs that threaten the basic functioning of hospitals.
We will then see common procedures such as appointments for dental hygiene and joint replacement surgery are permanently canceled due to the risk of infection.
People of all ages will start to die again from diseases that we are used to dealing with pills worth $ 10 or $ 20. Those who are not dying will get sicker more often and for much longer, increasing the cost of care.
Life expectancy could drop back to where it was in the early 1900s, and the golden age of antibiotics will prove to be just a brief, happy impetus in history.
It does not have to be this way. It leaves our awareness in action.