What happens to our bodies when antibiotics don't work?

Imagine being admitted to hospital for a routine knee surgery, confident in the professionalism of your doctors who have access to the most advanced technology and state-of-the-art facilities. And yet, everything goes wrong. What began as a straightforward operation ends in a devastating, untreatable life-threatening bacterial infection, because microbes have become resistant to one of the most revolutionary medical wonders of the 20th century: antibiotics . The danger of antimicrobial resistance (AMR), marked by World AMR Awareness Week which began last Monday, is unfortunately not science fiction. Hitherto straightforward and easy-to-treat bacterial infections have, in many instances, become a matter of life and death. Today, drug-resistant infections kill at least 1.3 million people every year and create annual losses of no less than $66 billion in direct healthcare costs alone. A recent article in The Lancet , a medical journal, estimated that over the next 25 years up to 40 million people will die of causes attributed to antimicrobial resistance. AMR threatens to upend modern medicine as we know it. Knee surgery, cancer treatments and caesarean section during childbirth all require functioning antibiotics. Without them, these procedures become a game of Russian roulette. And, unfortunately, even countries with robust, excellent and well-funded healthcare systems are threatened. If we do not act wisely, decades of improvement in health and human well being are at risk. Antimicrobial resistance occurs when dangerous bacteria evolve and mutate to become “ superbugs ” resistant to the kinds of antibiotics currently available in our arsenal. In 2005, a form of the deadly MRSA bacteria that is resistant to the drug Daptomycin was identified only two years after that drug’s approval. It was a watershed moment in the recognition of the threat that AMR poses. The mutation of microbes is a natural process, but this is accelerated by our indiscriminate use of broad-spectrum antibiotics in both healthcare and agricultural settings, leading to what some have called the “silent pandemic”. Complicating matters is the lack of research and development going into developing new antibiotics. In a genericised market, with many existing old drugs hitherto doing a good job, the pricing of and commercial opportunity for new antibiotics has not been appealing enough to spur research into new drugs. Simply put, right now, profits are low and costs are too high for developing new antibiotics. In addition, realising sufficient sales of a new antibiotic is hindered by restrain in their use by physicians, who fear creating resistance to a new compound that could be the life saver for the severest of cases. In short, the economic model for antibiotics is broken and, therefore, our arsenal of antimicrobial drugs has not been replenished at the rate that the bugs become resistant to them. Millions of tragic deaths can be mitigated if we make the right investments and fix the broken economic model that supports – or rather does not support – the development of antimicrobial drugs. There is opportunity in this area for both making wise financial investments and positively contributing to global health. Often antibiotics are prescribed when it is not necessary and when an infection is not actually a bacterial one. So, by making point-of-care (at the site of the patient) diagnostic capabilities more widely available and faster, we can minimise unnecessary antibiotic use, thus reducing the development of resistance. Second, creating economic incentives for developing new drugs and maintaining a competitive investment environment can assist in delivering treatment options for healthcare providers, mitigating the potential for resistance. One solution could be the adoption by healthcare systems of a subscription-type model (think Netflix) that ensures that developers of new drugs and vaccines receive a fixed amount per year, regardless of sales volume, thus incentivising innovation while delivering working drugs in whatever quantity needed. The UK has adopted such a model and other health systems should follow suit. The Novo Nordisk Foundation, including Novo Holdings and Novo Nordisk, have dedicated $500 million towards investing in efforts to discover novel therapeutics and vaccines – with initiatives spanning the full value chain, from early research efforts through to pre-clinical development, clinical development and commercialisation. Despite these extensive efforts, there are all too few co-investors in this area due to the unappealing economics. We are, therefore, at a crossroads. For the sake of the innovative developments already made, for the families and patients who will face this life-threatening challenge and for future generations, we must move beyond simply acknowledging the crisis to committed action. While sleeping safely in the conviction that we had found wonder drugs such as penicillin and several other agents, we have increasingly ignored that microbes constantly mutate, and that they are rapidly finding ways around our defences. The time for action is now. Kasim Kutay is chief executive of Novo Holdings Aleks Engel is a partner in Novo Holdings’ planetary health investments team