It’s vanishingly unusual for all hundred and ninety-three member states of the United Nations to agree on anything, but they’ve just done so.
Every last one of them. It’s a resolution to tackle a threat that, they were told, could take global health ‘back to the dark ages’. The threat comes from the growth of super bugs resistant to even the most powerful antibiotics. But, encouraging though the UN unanimity is, it’s not political leaders who will save us from the dangers. It’s down to us. Are we ready and willing to renounce our love affair with antibiotics?
The UN resolution follows an initiative taken by Britain. David Cameron, the former prime minister, was so concerned about the issue that he set up a review under the former Goldman Sachs chief economist, Jim (now Lord) O’Neill, to work out what to do about the growing threat to global health caused by the increased resistance of bacterial and some other infections to treatment by antibiotics. The crisis has arisen because of our overuse of antibiotics not just in treating humans, but also animals. Bacteria have mutated in response to this overuse into strains that have become resistant to existing antibiotics.
This is not a danger some way off in the future. It is already having catastrophic effects. It has been estimated that around 700,000 people worldwide are already dying prematurely as a result of what is known as antimicrobial resistance (AMR). A study by Rand Europe and KPMG reckons that by 2050 the figure could rise to ten million a year, unless something is done. The prospect has been referred to as the ‘antibiotic apocalypse’.
Infections that have already started to become resistant are the hospital superbug, MRSA, some forms of gonorrhoea and some strains of tuberculosis. It has been suggested that what are now routine operations, such as hip replacements or childbirth by Caesarean section, could become too dangerous to perform.
Part of the problem is that no new class of antibiotics has been discovered since the 1980s. So Lord O’Neill proposed a global innovation fund of $2bn by 2020 to tackle AMR, part of which would be used to offer incentives to pharmaceutical companies to come up with new drugs. Britain has already committed £369m to such a fund over the last two years.
The UN vote this week sees the scheme go global. The resolution declared that without action, antibiotic-resistant infections would ‘cause massive social, economic and global public health repercussions’.
The UN’s decision was welcomed by Britain’s chief medical officer, Professor Dame Sally Davies. She said; ‘I am extremely proud that every UN member state is now engaged in the enormous task of tackling the greatest future threat to our civilisation. Drug-resistant infections are firmly on the global agenda but now the real work begins. We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine.’
The agricultural sector is key. Farmers used to inject their livestock with antibiotics routinely simply to fatten them up. Although this is now more tightly regulated it is far from clear how effective enforcement is. The problem is that overuse in the agricultural sector has the same effect as in human medicine of encouraging resistant strains of infection which then get passed on to humans through the food chain.
But it is how we humans use antibiotics on ourselves that matters most. As Lord O’Neill put it: ‘it’s crucial we stop treating our antibiotics like sweets. If we don’t solve the problem we’re heading to the dark ages.’
Part of the challenge is that many people don’t really understand what the problem actually is. It seems that most of us think that if we use antibiotics too often ourselves they will cease to be effective on us, and won’t affect anyone else. But that’s not the case. It is the health of every human being that is ultimately at risk because the overuse by anyone increases the opportunities of the bugs to mutate into forms that are resistant to drugs by everyone.
Similarly, many of us seem to think antibiotics are a cure-all for any infection – this is what Lord O’Neill meant by talking about treating them as ‘sweets’. But antibiotics are effective only for bacterial and some other specific infections. They are quite useless for viral infections, like flu or the common cold. Yet people with colds and flu regularly troop off to the doctor in search of antibiotics to treat them and won’t be satisfied unless they are prescribed. Some doctors are stupid enough to go along with the demand – often because they just want to get overbearing patients off their backs.
Even those who are prescribed antibiotics for legitimate infections can make the global problem worse by not completing their course of treatment. That’s because under-treated bacteria can then survive and mutate into drug-resistant bacteria.
Britain has set itself targets to try to deal with these problems. It aims to cut inappropriate prescriptions and the incidence of high-risk bacterial infections in hospitals (like MRSA) by 50% by 2020, and to cut the level of antibiotic use in agriculture to 50mg/kg by the same date.
In the end the effectiveness of any campaign to deal with this global threat will be not so much at government level as at our own. We have been used to thinking that technology (in this case, the pharmaceutical industry) will get us out of all our scrapes and relieve us of the need to change our behaviour. But that may not happen this time. The real test is whether we (and our doctors) are prepared to change our whole attitude to antibiotics and realise that they are not a cure-all for all our ills and, if we are not careful, may soon become a cure for nothing at all. Being careful means showing restraint. Are you prepared to do so? And do you think other people will be?