Two Takes on the Possible Future of Antibiotic Resistance: Public Health Watch

Is it the best of times or the worst of times?

We don’t often have the opportunity to quote literary classics in this space, but 2 recent articles—a commentary published by The Washington Post and an analysis from The Economist—on the issue of antimicrobial resistance have left us feeling downright Dickensian.

And we’re likely not alone.

First, in her July 8 commentary in the Post, Michelle A. Williams, ScD, dean of the faculty and angelopoulos professor in public health and international development at the Harvard TH Chan School of Public Health and Harvard Kennedy School, describes mainstream media coverage of antibiotic resistance as tinged with “alarm…and helplessness.” Although she acknowledges that “[m]uch of this is warranted,” she believes “there is a clear path to reversing the situation.” You see, we’re thinking Dickens, but she’s focusing on another Charles: Darwin.

As Williams writes, humanity has faced infection-based public health challenges in the past (she cites smallpox and polio) and come out on top (think: survival of the fittest)—eventually. And she feels we can do it again when it comes to infections caused by antibiotic-resistant bacteria. To meet the challenges head on, she recommends a 3-pronged approach that includes:

1. Infection prevention through antibiotic stewardship and hospital infection-control programs and the reduction of antibiotic use in farm animals and food production.
2. Increased incentives for antibiotic development. Here she highlights CARB-X and a proposal by former Goldman Sachs exec Jim O’Neill that effectively involves nationalizing drug companies that produce novel antibiotics.
3. Considering antibiotics “public goods that should be available to all” (read: affordable and accessible to those in the developing world).

“Reversing the tide of antibiotic resistance won’t be easy,” Williams writes. “[However], [e]xperts agree that this crisis is solvable with science and with money. The time to act is now.”

The Economist piece, published in the magazine’s “The World If…” section on July 6, begins with a fictionalized assessment of the “attack of the superbugs” in 2041, and it is far less sanguine, even perhaps delving into a bit of the fear-mongering Williams argues against. It describes a world in which no new antibiotics have been introduced in more than a decade—in other words, essentially, a society that failed to heed Williams’ advice, at least not until the situation had reached crisis proportions.

Indeed, by the time leaders—in The Economists’ narrative—choose to act, industry consolidation had diluted market competition (and thus innovation) in big pharma.

“The world faced a return to the pre-antibiotic era, when anyone could die from a tiny scratch or a simple infection, and even minor surgery could entail life-threatening risks,” the magazine’s editors write.

The advent of a new antibiotic—called parvomycin—and the creation of an international task force (Global Antibiotic Science Partnership, or GASP), the fictionalized account continues, began to reverse these trends. Notably, that latter initiative is a lot like something Williams proposes.

“[T]here are 2 reasons for optimism about the future of parvomycin and any new antibiotics that follow,” The Economist editors write. “The first is that the practices that promoted drug resistance in the past have finally been phased out, after decades of dithering. The second reason is that, thanks to the work of GASP, the pipeline of new antibiotics is starting to fill up again. It took a crisis in which millions lost their lives to prompt decisive action, and the fight is still far from over. But at least there is now cause for hope that an end to the post-antibiotic nightmare is in sight.”

Will life imitate art? Or will the leaders of the world, and big pharma, follow the blueprint of Williams and others? And finally, how will the media tell the tale?

As Dickens wrote, “There is nothing so strong or safe in an emergency of life as the simple truth.” When it comes to the issue of antibiotic resistance then, we’ll have to see what constitutes our “truth” in the future.