An infectious world

Forget terrorism, forget natural disasters, forget civil unrest, the greatest threat to human security over the next 50 years could quite possibly be antibiotic resistance and the resurgence of infectious disease.

Today the number of global deaths which stem from antibiotic resistance far outstrips the number caused by terrorist attacks and natural disasters. According to the WHO multi-drug resistant TB causes more than 150,000 deaths every year to which must be added the hundreds of thousands who die around the world every year from antibiotic resistant infections.

Antibiotics were once the wonder drug heralding a new phase of public health. Now there seems little doubt that we are teetering on the brink of a medical catastrophe as we head towards a new post antibiotic era.

Every day there are reports of new cases of antibiotic resistant superbugs as well as evidence of the growing resistance of long-established infections to available antibiotic drugs.

Quite possibly we may soon be facing a situation whereby people could die from common infections like strep throats. It will be like taking a massive step back into the past, back to a pre-antibiotic age where common infections ruled the roost, where life expectancy was around 50-55 and where a third of all deaths were children aged less than five years largely because of exposure to infectious disease.

Drug resistance has been known for decades and usually arises when antibiotic drugs knock out susceptible infections, sometimes leaving active strains behind. These can multiply and become extremely resilient.

In the past this did not prove much of a problem as new antibiotics always appeared. What we are now facing is that the supply of new antibiotics has dried up. No new antibiotic drugs are on the horizon. Big Pharma has virtually abandoned the search for new drugs.

Only a tiny number of international companies are still interested in developing new drugs and in most cases it takes up to 10 years before a new drug hits the market. Many pharmaceutical companies are not at all interested in antibiotics and see their future in providing drugs for an ageing population largely to combat things like obesity, high blood pressure, and diabetes.

Another problem is that infestation with multiple drug resistant bacteria was usually harmless to healthy individuals with unimpaired immune systems. As the population continues to age and more and more people are surviving into their 80s and beyond, human immune systems become less resilient and more susceptible to infectious disease. It is a chilling scenario.

Once antibiotic resistant infections were restricted to a limited number of encounters occurring in hospitals. No longer. Now we are all becoming more at risk. In an age when more and more Australians and New Zealanders are travelling the world many in pursuit of a holiday in an exotic location in Asia, Africa or Latin America, many run the risk of picking up a local infection either through local food or water or via the intervention of a mosquito or other insect.

In addition, more and more people are seeking medical interventions in countries like Asia where the risk of contracting a multi-resistant infection is high. The result is increasing exposure to a wide range of so-called "new" infections as well as to a variety of older well established infectious diseases.

What we need to realize is that antibacterial effectiveness is one of our most precious resources. It needs the same care and protection that we offer to clean water and air and to our forests. While there has been some attempt to rein in our overuse of antibiotic drugs, there really hasn't been a concentrated campaign to do the same for the use of antibiotics in our livestock and foodstuffs.

Factory farming in particular has much to answer for. The larger the undertaking the more antibiotics are administered to animals. We must also recognize that we will never win the battle against our microbial foe. Microbes reveal an adaptability and dynamism that confirms the strength of evolution in the natural world. They are selected for survival, mutation and change are facts of life, and they change in accordance with changes in their environment and of that of their host's environment.

But what will happen if antibiotics no longer work or are no longer available?

Transplant surgery for one thing will become virtually impossible, pneumonia will once again become 'the old man's friend', appendix operations will become a thing of the past, TB will become incurable, sexually transmitted infections will become very difficult to treat and many childhood infections will resurge.

The consequences of our over-use of antibiotics and our failure to produce new drugs could well prove disastrous.

The ready availability of effective antibiotics transformed our world. They allowed major advances in surgery, in hospital and home care, transformed childhood infections and revolutionized the treatment of injuries. In many ways there were responsible for the health and life expectancy we enjoy today. The question is – are we really ready for a world without antibiotics?