Time to wake up: the health risk that could be worse than COVID

Image Description: artistic blue, green, and purple spikey bacteria appear on a pale green background

We all know how much COVID sucks. So if I said, “hey, look, there’s an opportunity to avoid the possibility of a COVID-like event—or worse—occurring in the future”, you’d jump at it, right?

Here’s the brutal facts: we knew a pandemic was coming, we knew it presented a huge risk, and we did absolutely nothing about it. Bill Gates predicted it, Ministers were informed, and frankly we should have all seen it coming with our head start on China. Personally, that evokes a number of strong emotions in me: frustration, anger, sadness. At Johnson, at society, at myself. But here’s more brutal facts: we know antimicrobial resistance is coming, we know it presents a huge risk, and we are not doing nearly enough about it. Oh, and “Covid is not anywhere near the potential impact of AMR” says biosecurity expert Paul De Barro.

Yeah. Time to wake up.

First things first, what on earth am I talking about? Antimicrobial resistance (AMR) is when microbes become resistant to antimicrobials; this occurs en masse in microbial populations as a result of evolution by natural selection. Take, for example, antibiotics: bacteria become more resistant over time, making them more difficult to treat. This leads to ‘superbugs’: bacteria that just won’t stop. For clarification: antibiotics do not target viruses.

Why is this a problem? Basically, it means that drugs are far less likely to fight off microbes, This would bring us back to the old days before antibiotics when simple scratches could ring a death knell“the dark ages of health”. Eek. Worse still, antibiotics are crucial to major surgeries, cancer treatments, diabetes, and C-sections. So, if you want to have children… this is a serious problem. And about half of us will end up with cancer. Let me repeat: this is a very serious problem.

Here’s more brutal facts: we know antimicrobial resistance is coming, we know it presents a huge risk, and we are not doing nearly enough about it

How bad is it? Well, no new classes of antibiotics have been discovered since 1980. The WHO rates it as one of the top 10 public health threats. Antibiotic Research UK says it is “the biggest single threat facing modern medicine today”. 1.5 million people die of it every year; by 2050, 10 million people could die every year due to AMR. Dame Sally Davies—the UK’s AMR special envoy—thinks it’s as big a problem as climate change; Dr Paul De Barro goes one step further, saying it’s “the biggest human health threat, bar none”. As Otto Cars more poetically suggested, AMR is “a silent tsunami, crumbling down the pillars upon which modern medicine is built.”

This is bigger than left or right: The Guardian, The Times, The Telegraph, they’re all in agreement. This is a modern health crisis, and it could well be a lot worse than COVID.

And we have known about this problem since day one: Alexander Fleming, the father of modern antibiotics, warned us of this problem, saying it would be “the death of man”. He went on to discover penicillin (the first antibiotic) not too long after, so he probably knows what he’s talking about.

AMR is a slow burner where COVID is a spectacular bonfire

Yet barely anyone is talking about it. Indeed, because AMR is a slow burner where COVID is a spectacular bonfire, AMR is—and, will continue to be—not being talked about nearly enough. As Tim Walsh, Professor of Medical Microbiology, puts it: COVID is an earthquake, and AMR is the tsunami coming to wipe us off our feet. And, like the real risk of a pandemic for years, people will probably not talk about AMR until it’s upon us, ravaging society.

So what are we doing wrong, and how can we fix it?

One word: overuse. Two words: use less.

Frankly, this is hardly surprising in a society founded on overconsumption. But it is also a wakeup call. In the US, at least 30%—perhaps more—of prescriptions are unnecessary; in the UK 20%. Antibiotics, as our friend Lord O’Neill says, are being handed out like sweeties. And I don’t know about you, but I was always taught to be sceptical of strangers giving out sweeties.

Lord O’Neill, by the way, keeps popping up because he actually knows what he’s talking about: he was commissioned to lead a review of drug resistance. And that review concluded that over £27 billion was needed to tackle the problem over 10 years. If not, well, we’ve all seen how much COVID has cost us, in all senses. O’Neill’s 2016 report suggested it could cost £70 trillion between now and 2050. I’m no economist, but it sounds like we should probably tackle this problem – even if you only care about economics, and not human lives.

Antibiotics are being handed out like sweeties

Ok, I promise, I’m done convincing you that this is urgent: let’s talk about solutions.

1: Stop unnecessary prescriptions. 

80% of GP prescriptions for respiratory tract infections are for longer than necessary. Meanwhile, the overuse of antibiotics in fighting COVID is frightening. In the US, the White House tried to halve this figure by 2020. How did they do? Strathdee et al. (2020) writes: “Steps taken to address these targets have been uneven and, at times, contradictory.” The US aren’t limiting antibiotic use in livestock feed, have cut AMR funding, and support antibiotic usage for crops.

Basically, it’s on their radar, but at times they’re umming and ahhing. We don’t have time for that. O’Neill’s strongest recommendation is that by 2020 no antibiotic should be given out unless it has passed a special rapid diagnostic test ensuring that it’s right for the job. As O’Neill says: surprise, surprise, that’s not happened; partly because it’s really tough. But it needs to. O’Neill calls it a “market failure” (again, he was Chairman of Goldman Sachs, so he’s not someone likely to overuse that term)—we need more funding (see (3)). Others have suggested we reuse and recycle older antibiotics rather than newer ones that earn big pharma more money.

There is some good news: antibiotic use between 2014 and 2017 actually fell in the UK. And we can all do something too: don’t ask for antibiotics if you don’t need them, and don’t pressure GPs or doctors into giving them.

2: Finish them!

Always complete your course of antibiotics, don’t share them, and don’t bin unused antibiotics; if you want to learn how to dispose of them, find out here.

We need to nationalise drug development before it destroys us all

3: Provide more funding

Especially for research trying to prevent AMR. There needs to be more research into new anti-infectives, more research into finding alternatives for antibiotics to minimise usage, and more research into antibiotic resistance breakers. The government must provide more financial incentives for pharmaceuticals to invest in developing antibiotics. Financial support is required for rapid diagnostic tests which distinguish viral and bacterial infections (CRB tests). In fact, O’Neill has even suggested making drug development the responsibility of the government, not pharmaceuticals: reminder, this is former Goldman Sachs Chairman proposing that we nationalise AMR drug research. Translation: the current system is broken (as agreed upon by O’Neill as well as Pfizer medical director, Seema Patel, and Director of Antibiotic Research UK, Prof Colin Garner). We need to nationalise drug development before it destroys us all.

Some good news, though: the UK has attempted to incentivise new antibiotics in its “five-year national action plan” by “decoupling profit from volume sold”. And Oxford was recently given £100 million to tackle the issue.

4: Use far fewer antibiotics on farm animals

In fact, the UK’s intentions to strike trade-deals with the US, Australia, Canada, and New Zealand represent a willingness to support industries which are the worst offenders. 

What can you do? Oppose allowing meat from these countries into this country; support post-Brexit restrictions on antibiotics in farming (which used to be controlled by the EU); and eat less/no meat.

COVID sucks. So let’s maybe do the basics to stop something potentially worse happening? At least then there would be one positive about COVID: we learned our lesson.


Image Credit: Elena Mozhvilo | Unsplash