HEALTHY LIVING

The Age Of The Superbug Is Already Here

The U.N. is convening a landmark meeting this week on antibiotic resistance, but scientists are concerned the action may be too late.

21/09/2016 12:03 AM AEST | Updated 21/09/2016 12:14 AM AEST
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When the United Nations General Assembly convenes a high-level meeting about a health issue, it’s clear there’s a crisis that requires our immediate attention. And this is one of those times.

The assembly has only held a handful of such meetings in its history. It gathered in 2011 to discuss eradicating HIV and AIDS. Later that year, it met to examine another health emergency: non-communicable diseases, including cancer and diabetes. In 2014, it met to discuss how to stop the spread of Ebola.

Now, the General Assembly is meeting to tackle a global health crisis that’s estimated to “kill more people than cancer” does now in the coming decades. Antibiotic resistance causes the deaths of at least 700,000 people annually. That number is expected to balloon to 10 million by 2050.

The all-day high-level meeting this Wednesday in New York City is expected to result in the first-ever U.N. resolution focused on combating the health threat of antibiotic resistance.

“This is only the fourth time the General Assembly has addressed a health issue, and the others rose to the level of HIV and Ebola,” Keiji Fukuda, the special representative for antimicrobial resistance for the director-general of the World Health Organization, told National Geographic this month. “Hopefully what will be achieved is to have the highest-level decision-makers in the world acknowledge that we have a major issue that has to be addressed, and also have that level acknowledge that certain actions are needed.”

Associated Press
This scanning electron micrograph image shows an antibiotic-resistant strain of the E. coli bacteria

‘Victims Of Their Own Success’

When antibiotics rose in popularity in the mid-20th century, they were celebrated as a miracle that could cure all. Some scientists even hailed the end of infectious diseases. But they were sorely mistaken.

Every year, in the United States alone, at least 2 million people are infected with bacteria that cannot be killed with antibiotics. More than 23,000 of these patients die annually in the U.S. of these infections.

These numbers are estimated to shoot up in the next decade. “We’re either entering or have already entered a post-antibiotic era in many nations where there are no antibiotic treatments available for people who really need them,” said Otto Cars, a professor of infectious diseases at Sweden’s Uppsala University. “And we are going to be seeing more and more of these cases in the next five to 10 years.” 

Just last month, the WHO warned that the sexually transmitted infection gonorrhea was becoming “untreatable” because of antibiotic resistance. And researchersin the U.S. discovered in May a strain of E. coli bacteria resistant to antibiotics of last resort.

“We’re losing decades of medical progress,” Cars told The Huffington Post in an August interview.

The medicine’s sheer popularity assured the demise of these “miracle” drugs, according to Cars, one of the world’s leading voices in the fight against antibiotic resistance.

“Antibiotics have been victims of their own success,” he said. “It’s really sad how we’ve misused them in human medicine and animal husbandry. We’ve deceived ourselves, thinking that this ‘magic’ medicine would always be around.” 

The excessive, often unnecessary, “take-it-just-in-case” use of antibiotics over the decades has resulted in the exponential rise of so-called “superbugs,” or bacteria that’s resistant to multiple antibiotic strains, said Dr. Jean Patel, deputy director of the office of antimicrobial resistance at the Centers for Disease Control and Prevention.

“We used to use antibiotics for everything,” she said. “We really took it for granted that antibiotics would always work, and if they stopped working, we figured we’d just use new antibiotics. But that strategy has fallen apart.”

Part of the challenge is that antibiotics can’t just be whipped up in a lab at one’s whim and fancy. At least not initially.

Antibiotics are based on chemicals that exist in the natural world, produced by organisms like soil bacteria and, in the case of penicillin, fungi. These organisms need to first be found in nature before scientists can figure out how to synthesize them in a test-tube.

Unfortunately, it seems almost all the “easy” antibiotics have already been discovered and researchers have not found many new ones in recent decades. (That’s why when you hear about new antibiotics being found today, it’s in places like under the sea, or in remote deserts, or even hidden in human noses.)

We need to keep finding new antibiotics because bacteria are incredibly good at evolving and are very adaptable, according to Patel. Bacteria will change to protect themselves from the antibiotic. “One thing we’ve learned about them is that anytime an antibiotic is introduced, resistance follows very quickly.” 

A Post-Antibiotic World

Signs of an impending superbug crisis have been emerging for years — but the issue was long shrugged off, mistakenly believed to be a problem that could be easily resolved with improved technology or pharmaceutical innovation, according to Cars. 

“That’s not the case. Big Pharma has been trying to get new antibiotics for many, many years — and it’s not just because of a lack of investment or financial return that’s stopped them,” he said. “The scientific challenge is enormous. Medical chemists have simply not been able to keep up with bacteria’s ingenuity.”

Antibiotic discovery, though critical, is thus only one solution to this health scourge. Equally important is the need to significantly reduce the use of the drugs and to find alternatives to them, health experts believe.

“Ultimately, we need to avoid all unnecessary use of antibiotics,” Cars said. 

Better diagnostic tools and improved infection prevention will be crucial in this effort, as will the sequestering of antibiotics for use in only the most urgent cases. 

“People need to understand that antibiotics are not a harmless drug,” Patel said. “Patients have to be ready to have a conversation with their doctor about whether or not an antibiotic is really needed.”

Research into alternative treatments will also be key. There has recently, for example, been enhanced interest in the benefits of phage therapy, or the use of particular viruses that can kill bacteria. 

Other more unusual treatments are being investigated, too. Patel pointed to how doctors are using fecal matter transplants to treat certain gastrointestinal infections which usually need antibiotics. 

Associated Press
United Nations Secretary-General Ban Ki-moon addresses the General Assembly at UN headquarters in New York on September 19, 2016. The assembly will convene a high-level meeting on antibiotic resistance on Wednesday.

To tackle antibiotic resistance effectively, an “unprecedented global effort” will be required, Cars said . 

Fortunately, it seems the world is finally starting to awaken to the urgency of the crisis. 

Scientists and health professionals have pointed to this week’s General Assembly meeting as a clear signal that the issue is hitting home ― a little too late, though still potentially pivotal, according to some experts, including Cars.

“I’m really happy that this issue is finally coming to the attention of governments, but having said that, we are far too late with this,” Cars said. “We’re already in this period of crisis and no one knows how deep this valley will be or how long it will take for us to back on our feet again.”

Still, “if there wasn’t this global attention, this problem would get much worse very fast,” Patel said.

“This is not a problem that’s ever going to go away,” she added. For as long as humans need antibiotics — and it continues to be an important treatment for many ailments — we are going to need to figure out a way to use them in a very different, much more responsible way. 

“These are life-saving therapies,” Patel said. “We need them.” 

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