I grew up believing in the advance path of advancement in science and medicine, that human health would continue to improve as it had for hundreds of years. As I progressed through my own career in health sciences, I was still optimistic.
Now I have serious doubts.
Science is still working well, but deadly obstacles are blocking the path between research and progress in the field in which you work: antibiotics.
The threat to humanity is serious and worsening the day, but for reasons that escapes my colleagues and me, there seems to be a little collective and scandalous desire to do much about it.
This week (12-18 November) is the World Antibiotic Awareness Week. We need to talk about this threat. We need to develop models of public-private cooperation: encourage, finance and invest in the discovery and development of antibiotic medications.
Penicillin led to compassion
Here's the problem: about 75 years ago, science introduced penicillin into public use, opening a new era in the control of infectious diseases, such as what had previously been sanitation. Infectious diseases, such as pneumonia and streptococci, which were commonly killed even on my grandparents' day, were tamed, at least for a while.
In the generations that followed, the life expectancy jumped for 25 years and the infectious disease fell from its point n. 1 among all the causes of human death, where he was constantly higher than bullets and bombs, even during the World War.
With cheap, abundant and effective antibiotics on hand, people in the developed world are complacent in controlling the infection.
But all this time, while we are living our best and longest lives, infectious diseases have been working on a return and today they are knocking at the door. In fact, they are already breaking the door.
The market will not meet the demand
In a quick example of Darwinian adaptation through natural selection, bacteria and other microbes are evolving to survive antibiotics. They will continue to adapt and will succeed unless humanity builds new layers of defense in the form of new antibiotics and other creative approaches.
The governments of the world recognize the crisis, as stated in a special high level meeting of the United Nations General Assembly in 2016 and the G20 in 2017.
The worrying part is that we know what we have to do to create new antibiotic therapies and, although the work is undeniably difficult, there are already some new and promising alternatives to older drugs and more are being monitored.
Unfortunately, they are not yet available in the commercial market and they will never arrive unless something changes to make them viable, not as drugs, but as merchandise.
The critical impediment to producing new antibiotics turns out to be our own economic model, which trusts the market to satisfy the demand. The invisible hand, as named by the philosopher and economist Adam Smith, does not work here and what is in danger is the progress that antibiotics made possible.
Canada could lead the fight for life in a post-antibiotic world
The public model is risky
This past summer in the United States, two pharmaceutical companies have obtained the approval of the FDA for new antibiotic compounds. As soon as the markets learned that the companies created medicines that literally could save the world, their actions fell.
It seems counterintuitive, is not it? It turns out that spending hundreds of millions to create, try and market a new drug is a bad risk unless the drug can recover the investment within the 20 years prior to the expiration of its patent.
This is difficult to do when you are recovering the cost of a 10-day recipe at the same time. And when you are prescribing the new drug only for infections that can not be resolved with cheap and traditional antibiotics, they still work in many cases.
The only way to make the business sense create new antibiotics would be to make them astronomically expensive, in the range of rare cancer medications and who would pay for it?
Many argue that we should see antibiotics in the same way that we see departments of firefighters. As individuals, we never need them, but we are all willing to share the cost, because we hope they are there.
It seems that a public model makes sense, but who will take the political risk?
Hospitals under threat
Without intervention, where the public, through its governments around the world, cooperates with the private sector to help encourage, finance and invest in the discovery and development of antibiotic medications: the end of effective antibiotics will be scary.
It will happen gradually, but surely it will happen. The first stages are already here in the form of infections with multiple antibiotics that threaten the basic function of the hospitals.
Next, we will see common procedures such as dental hygiene appointments and joint replacement surgeries permanently canceled due to the risk of infection.
People of all ages will begin to die again from diseases that we get used to dealing with a value of $ 10 or $ 20 per pills. Those who do not die will be sick more frequently and for a much longer period, increasing the cost of care.
Life expectancy could fall to where it was in the early 1900s, and the golden age of antibiotics would prove to be a happy and happy story in history.
It does not have to be that way. It allows us to turn our consciousness into action.