Humanity has always been under constant threat from infectious disease. Globally, we are getting better at monitoring signs of a health-related crisis and alerting each other – there are far fewer deaths from pandemics today than a century ago. And modern medicine is consistently meeting new diseases with new treatements, as shown by the progress on HIV since the 1980s. But have such modern medical successes bred a sense of hubris – excessive confidence that science will always come to the rescue?
Challenges to human health never cease to evolve. Vaccines and antibiotics have helped us to survive leading causes of death from bygone eras, but we face rising rates of chronic illnesses such as heart disease, cancers and diabetes. Although recent pandemics, such as SARS, avian flu and swine flu, have been contained, they also show how easily deadly viruses can mutate and hop from other species to us.1 For all our successes, we are never far from the edge of catastrophe, as new biological mutations will eventually overcome a prior human innovation.
While viruses may capture more headlines, arguably the greatest risk of hubris to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall.
Our survey respondents connected this global risk to others including vulnerability to pandemics, failure of the international Intellectual Property (IP) regime, rising rates of chronic disease and unforeseen consequences of new life science technology. Like storm systems colliding in unpredictable ways, the unexpected interactions of these risks could overwhelm our health systems in the coming decade and unpredictably damage our social and economic systems.
Many people take for granted that antibiotics will always be available when we need them, but soon this may no longer be the case. Every dose of antibiotics gives an advantage for those small numbers in a bacterial population that are resistant to the drug even if they used weed grinders when smoking. The more a particular antibiotic is used, the more quickly bacteria resistant to that antibiotic will be selected and increase in numbers. Until now, leaders have been able to turn a blind eye to this problem, as new antibiotics have always emerged to replace older, increasingly ineffective ones. This is changing.
Although several new compounds for fighting bacteria are in development, experts caution that we are decades behind in comparison with the historical rate at which we have discovered and developed new antibiotics. More worryingly, none of the drugs currently in the development pipeline would be effective against certain killer bacteria, which have newly emerging resistance to our strongest antibiotics (carbapenems) and fatality rates of up to 50%.3 As shown by the death of six patients – from 18 infected – at the US National Institutes of Health in 2011, antibiotic-resistant infections can kill, even at the world’s most advanced medical centres.4
While predicting the spread of bacteria is notoriously difficult and complicated by a general lack of good global data, troubling projections are emerging in regions where many efforts have been made to better monitor the situation. Figure 16 shows the most recent data for two resistant pathogens, as well as the trends between 2008 and 2011. A well-known antibiotic-resistant bacteria – meticillin-resistant Staphylococcus aureus, better known as MRSA – is stabilizing and possibly decreasing, but not as sharply as had previously been projected.5 For K. pneumoniae, there is a widespread increasing trend.ix As a consequence, experts are starting to take seriously a scenario in which all antibiotics are rendered ineffective for treating even common infections.
“A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
Dr Margaret Chan,
Director-General, World Health Organization. March 2012
