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Scientists warned of an imminent global crisis. But the medical, agricultural, and pharmaceutical industries have failed to listen. Now, the spread of deadly, drug-resistant disease is upon us.
Since the discovery of penicillin in 1928, antibiotics have played an essential role in destroying bacteria and combating infections. Antibiotics have undoubtedly saved tens of millions of lives, helped to extend life expectancy, and removed communicable diseases as the leading cause of death in the developed world. But as with all medical breakthroughs, there are risks.
The 1950s to the 1970s marked the golden era of antibiotic discovery; virtually all antibiotics in use today derive from the antibiotic classes discovered back then. But as antibiotics became more specialized and more accessible, we began to see the evolution of antibiotic resistance. Bacteria became resistant to the drugs that had previously contained them.
This began a vicious cycle in which antibiotics are administered more extensively to combat resistant bacteria. Doctors then turn to more specialized antimicrobials to combat new strains of resistant bacteria. Eventually, overexposure to antibiotics results in “super bacteria” that can no longer be treated with antibiotics.
These ultra-resistant bacteria are often deadly.
Currently, drug-resistant infections, or “superbugs,” kill about 700,000 people every year. According to the Interagency Coordination Group on Antimicrobial Resistance (IACG), the overuse of antimicrobial drugs is poised to cause “a global crisis” that could have a severe and lasting impact. If we don’t act now, the death toll could increase by more than 1400%, resulting in 10 million fatalities each year.
Antibiotics in Medicine
Antimicrobials are one of the most commonly prescribed drugs in the world. In 2015, U.S. pharmacies dispensed nearly 270 million doses of antibiotics – enough for five out of every six Americans to receive antibiotics every year. The CDC reported that at least 30% of these prescriptions were unnecessary.
The pharmaceutical industry plays a major role in influencing physician behavior and prescription trends. And since the drug lobby largely controls the curricula in medical schools, doctors are learning from a biased perspective that emphasizes drugs and surgical intervention as the standard of care. These smart and well-intentioned professionals simply aren’t getting all the information they need.
Many doctors prescribe broad-spectrum antibiotics for almost any infection because that’s what they were taught in medical school. Making doctors aware of the serious threat of drug-resistant pathogens is absolutely vital if we’re going to reduce the use of antibiotics in medicine.
But patient use is merely the tip of the iceberg.
Antibiotics in Agriculture
Antimicrobials are also used liberally in plants and animals to help prevent disease and stimulate growth. But a 2012 review published in Public Health Reports found that the agricultural use of antibiotics is “one of the major contributors to the development of resistant organisms that result in life-threatening human infections.” We need to drastically reduce or eliminate the agricultural use of these drugs in order to avoid a catastrophic global health crisis.
Unfortunately, the problem is not being addressed. In fact, poor medical education and the influence of the agricultural and pharmaceutical industries have made the problem worse.
Currently, bacterial infection is decimating the American citrus industry. In a last-ditch effort to save their crops, farmers are turning to antibiotics. The most commonly used drugs include streptomycin and oxytetracycline, though many countries, including the entire European Union, have banned the agricultural use of these antibiotics to promote animal growth.
Streptomycin and oxytetracycline are used in humans to treat illnesses like tuberculosis and syphilis. Tuberculosis has developed resistance to most antimicrobial treatments and is responsible for around 230,000 deaths every year.
The EPA recently approved the use of these antibiotics in several citrus-producing states, despite strong condemnation from both the FDA and the CDC. Scientists agree unequivocally that the overuse of antibiotics in agriculture will lead to a surge in drug-resistant bacteria that would put millions of lives at risk. Farmers concerned with profits and production are contributing to a global crisis that could become the leading cause of death within a single generation.
The Role of Big Pharma
But the agricultural industry is not solely to blame. Despite recent efforts to reduce the use of antibiotics in livestock, it’s estimated that up to 80% of the antibiotics sold in the U.S. are used to that end. And the companies that manufacture these drugs are actively promoting their use – even in healthy animals.
In 2017, the WHO released a press statement titled: “Stop using antibiotics in healthy animals to prevent the spread of antibiotic resistance.” The science-based community pleaded with farmers to reduce the use of antibiotics on livestock, citing the Global Action Plan on Antimicrobial Resistance adopted by the World Health Assembly in 2015 and the Declaration of the High-Level Meeting of the United Nations General Assembly on Antimicrobial Resistance, adopted in 2016.
These documents warn of a global health crisis that requires immediate action and cites “the inappropriate use of antimicrobial medicines in the public health, animal, food, agriculture and aquaculture sectors” as a primary cause of antimicrobial resistance.
But despite the urgent pleas of the global scientific community, drug makers continue to push their products.
According to The New York Times, manufacturers are continuing to push the regular use of antibiotics in healthy livestock. At the World Pork Expo in Des Moines, Iowa, pharmaceutical giant Elanco spread brochures and hung pamphlets encouraging farmers to administer antibiotics to every pig in their herds, rather than waiting for a disease outbreak. They referred to the first diseased animal as “Pig Zero.”
The rise of drug-resistant germs, caused by overuse of antibiotics, is one of the world’s most nettlesome health predicaments. Excessive use of the medicines has allowed germs to develop defenses against them, rendering a growing number of drugs ineffective for people and animals. The practices of livestock farmers, who for decades have used huge quantities of the drugs deemed important to humans, have long been viewed as one of the roots of the problem, but the role of the companies that make the drugs has received less scrutiny.
Antibiotics continue to be an important part of the business of companies like Elanco, which spun off from Eli Lilly in September, its share price soaring to $33 from $24. While Elanco is developing antibiotic alternatives for animals, like vaccines and enzymes, the antibiotics promoted by the Pig Zero campaign are exactly the kinds that global public health officials are trying to curb. And Elanco is no outlier — its rivals are also urging aggressive use of their own antibiotic cocktails.”
Elanco CEO Jeffrey Simmons said the company stopped distributing the brochures after inquiries by The New York Times.
Still, the unwillingness of the agricultural and pharmaceutical industries to drastically curb the use of antibiotics has worsened a looming crisis that had already reached critical mass. Although the IACG doesn’t expect the devastation of drug-resistant bacteria to reach its pinnacle until 2030, there’s evidence that pending catastrophe is already underway.
The Rise of the Superbug: A Battle We Can’t Win
In 2009, a Japanese woman was diagnosed with a drug-resistant fungal infection in her ear. The previously unknown fungal strain was named Candida auris (candida is a fungal genus and “auris” is Latin for “ear”). But unlike the more commonly known Candida albicans, C. auris is dangerous and deadly. Since its discovery, there have been more than 650 cases in the U.S. alone.
The disease is most commonly found in hospitals and elderly care facilities, particularly impacting those with weakened immune systems. In addition to the hundreds of clinical cases, over 1200 patients were found to be colonized with the disease, meaning the fungus was found on the body but had not yet resulted in illness.
C. auris is extremely communicable. Its spores have been known to stick to walls and ceiling tiles and are exceedingly difficult to clean from medical equipment, clothing, and bedding. The fungus may even be spread through the air.
What’s worse, Candida auris is extremely resistant to antifungal drugs. Of the 3 classes of antifungal drugs, 90% of C. auris strains are resistant to at least 1, while 30% are resistant to 2 or more. The CDC recently confirmed the first U.S. cases of pan-resistant strains, which are resistant to all antifungals. The germ is adapting quickly to treatment, making it stronger and more lethal.
Of those who have contracted Candida auris, nearly half have died within 90 days. And while the CDC has clarified that not all of these deaths can be directly attributed to the disease, one thing is certain: Candida auris is extremely resilient and becoming harder to treat.
This is the type of drug-resistant germ that the world’s scientific community has warned us about. If we don’t make drastic changes now, illnesses like this could become extremely common.
The new killer fungus has been especially prevalent in New York, New Jersey, and Illinois, resulting in a disaster that is confounding the medical community and exhausting public resources. In New York, which has seen over 350 confirmed cases, state and federal health officials are working frantically to find a solution.
Nearly 60 hospital officials met with the New York state health commissioner and an expert from the CDC to find a solution to the growing pandemic. But the proposed guidelines could be a huge burden on the hospitals. Screening efforts, quarantine, lab testing, and sanitation efforts would be expensive and labor-intensive, and may be more than some institutions can bear.
Dangerous and uncontained microbial illness has not been a major problem in the developed world for nearly a hundred years, but experts warn that we could see serious ramifications if the overuse of antibiotics continues. An article published in the Annals of Ibadan Postgraduate Medicine explains:
Prior to the beginning of the 20th Century, infectious diseases accounted for high morbidity and mortality worldwide. The average life expectancy at birth was 47 years (46 and 48 years for men and women respectively) even in the industrialized world. Infectious diseases such as smallpox, cholera, diphtheria, pneumonia, typhoid fever, plaque, tuberculosis, typhus, syphilis, etc. were rampant…
The inappropriate use of antibiotics in the agricultural sector must be regulated. Antibiotics must be given to animals under veterinary supervision and avoided for growth promotion or to prevent diseases… There should be promotion and application of good practices at all steps of production and processing of foods from animal and plant sources. Farmers must improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.
The threat of antibiotic resistance is real. Therefore, all the stakeholders must employ strategies to prevent and control antibiotic resistance in order to prevent an imminent post-antibiotic era, a condition that may be worse than pre-antibiotic era.” (emphasis added)
This is one of the most pressing global issues facing our generation. If we don’t make changes now, the next generation will live in a world ravaged by deadly bacterial disease. We need to reduce overuse of antibiotics in patients and eliminate agricultural use in order to keep these drugs effective. We’re already seeing the global spread of dangerous new germs.
But there’s yet ANOTHER obstacle to overcome if we want to prevent cataclysmic suffering: transparency.
An Attitude of Apathy
Too often, drug-resistant infections go unreported by health institutions, putting patients at risk. And while the CDC often issues warnings about these fatal outbreaks abroad, it is prohibited from identifying hospitals within U.S. borders. The New York Times journalists Andrew Jacobs and Matt Richtel say that hospitals are resistant to disclosure, fearing that the information may deter people from seeking medical care.
In the article, Jacobs and Richtel elaborated:
Those pushing for increased transparency say they are up against powerful medical institutions eager to protect their reputations, as well as state health officials who also shield hospitals from public scrutiny.
In California, State Senator Jerry Hill, a Democrat and longtime advocate for tougher restrictions on antibiotic use, found himself stymied in his effort to improve the industry’s reporting on drug-resistant infections. A bill he introduced in the State Legislature would have required hospitals to regularly disclose resistant infections and deaths. In 2017 the Senate passed the bill, 40 to 0, but it had powerful opponents, including the California Hospital Association, the Infectious Disease Association of California and the state’s Department of Health. The bill then moved to the Assembly, where last year it stalled for lack of support.
Federal legislation that seeks to combat antibiotic resistance through stronger surveillance and better data collection has also stalled. The bill, introduced by Senator Sherrod Brown, Democrat of Ohio, has yet to emerge from a Senate health committee. ‘We’ve ignored this looming crisis by doing nothing,’ Senator Brown said.”
In a free society, citizens should not be put unknowingly in harm’s way. As we march toward global calamity, it is essential that we introduce absolute transparency. There may still be time to avert the scourge of antimicrobial resistance, but we need to act decisively, and we need to act NOW. Otherwise, it will be too late.
The Clock Has Run Out
Global experts have been exceedingly clear about the potential devastation humanity faces if we don’t make significant changes. Some of these warnings may sound like alarmism, but the threat is very real. According to the recent report to the Secretary General of the United Nations:
Antimicrobial resistance is a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals. There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation.” (emphasis added)
A U.N. resolution acknowledges that:
Due to antimicrobial resistance, there will be fewer options for the protection of people most vulnerable to serious life-threatening infections, especially women giving birth, newborns, patients with certain chronic diseases or those undergoing chemotherapy or surgery.” (emphasis added)
The work required to thwart this disaster will require a global effort. Doctors will need to utilize alternative modalities for addressing minor illness and preventing infection. Agricultural stakeholders will need to improve biosecurity and hygiene, relying on preventative measures other than antibiotics and abandoning the use of these drugs to promote growth.
Most importantly, the companies which manufacture and profit from the sale of these drugs will need to resign themselves to a major drop in revenue, sacrificing financial gains for the greater good. According to the IACG, the cost of delaying these changes may far exceed the cost of making them now.
In higher-income countries, a package of simple interventions to address antimicrobial resistance could pay for itself due to costs averted.”
We have a substantial opportunity to make our mark in history as the generation that saved hundreds of millions of lives. Our children still have a chance to live in a world where communicable disease is not a leading cause of death, and where the detrimental impact of excessive antibiotic use is a thing of the past.
We can ensure that future generations can undergo routine surgeries and childbirth without substantial risk of death. We can be the ones who made the sacrifices necessary to prevent the common cold from becoming a death sentence for our children and grandchildren.
Or we can do nothing.