The drugs don't work: a global antibiotics crisis
The World Health Organisation says drug-resistant diseases already kill at least 700,000 people each year. This could be 10m deaths each year by 2050 unless new antibiotics are found. The FT's Andy Bounds visits the UK government-backed AMR Centre to report on why the world is at risk of falling back into a medical dark age
Filmed, edited and produced by Daniel Garrahan. Graphics by Russell Birkett. Additional footage by Getty
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We've got used to the fact that if you have a small infection, if you have a cut, if you need an operation, then you can use antibiotics and the infection won't be serious. Unless we get a grip on resistance to the antibiotics, people will die from these things.
The issue of anti-microbial resistance is up there with climate change.
The World Health Organisation says drug-resistant diseases already kill at least 700,000 people each year. But there could be 10m deaths each year by 2050 unless new antibiotics are found. There's a serious lack of new antibiotics under development. And the number of drug resistant bloodstream infections increased by a third from 2013 to 2017.
So NDM-1 is a resistance protein that's able to break down antibiotics and leaves them inactive. Now, originally, it came from hospitals in India, New Delhi specifically. And now we're seeing the spread of that through to countries such as Italy, where 350 cases have been reported within the last six months. And that's particularly concerning, because we're seeing the spread largely due to travel. And that's a real problem, because it means that we're all potentially affected by this issue.
The UK is leading the hunt for new antibiotics. Much of the research is taking place at the government backed AMR Centre in northwest England.
The antibiotic market is broken. There's been no new drugs for 30 years, because the reward to invest in those products just isn't there. Antibiotics are really cheap. They're a dollar a strip. The value is not there for somebody to bring a new one to market at the moment. That's part of what the AMR Centre is trying to do, is bridge that gap between discovery and proving the things in clinic.
The AMRC partly owes its existence to economist Jim O'Neill. His 2016 report for the UK government found the widescale use of antibiotics in industrial farming helped bacteria adapt and thrive. O'Neill called for a big reduction in the amount fed to animals. And he criticised the pharmaceutical industry for cutting back on antibiotics research. Even small biotechs were starting to give up.
A lot of people think it's just an issue about incentivising, and therefore, paying the big pharma. Why should governments do that? But what they ignore is the link between the chain all the way down to the earliest stage. Because the genuine risk-takers that are coming through the so-called biotech world, that are backing these very visionary, and creative, and highly risky start-ups, unless there is a takeout for them they're going to stop too.
To develop a new medicine takes 10 to 12 years and considerable investment. But importantly, it also takes expertise. You need experts continuously working on this. And that needs to be sustainable for companies. And we know there's market failure for companies researching in antibiotics. And we've seen companies not being able to carry on research into antibiotics.
The UK, at least, is making progress. Since 2014, it has cut the amount of antibiotics it uses by more than 7 per cent. And sales for use in food producing animals have dropped by 40 per cent. The UK has unveiled a plan to control AMR by 2040. But O'Neill says policymakers could do more. They need to fix the broken antibiotics market by developing what he calls a market entry reward.
Provide something in the vicinity of a billion dollars for the right producer of a new urgently needed drug. A second alternative is you just take it completely away from pharmaceutical companies and have a utility type entity or government backed entities that just do it themselves, and just say, OK, if you guys just want to live in the profit world, its none of your responsibility anymore.
After penicillin was discovered in 1928, deaths from infections plummeted and operations became routine. But Sir Alexander Fleming himself warned about the risk of microorganisms developing resistance. Ninelty years on, the world is on the brink of falling back into the medical dark ages.
A future where you die from a cut finger sounds like something you might see in a science fiction film. But the scientists here know they're in a race against time. And unless we wake up, that dystopian future will become a reality all too soon.