To paint a picture of a post-antibiotic apocalypse, it is necessary to understand the history.
We do not need to go back far—just to the beginning of the last century, before the discovery of our miracle drugs, antibiotics, along with preventative vaccines.
Before these truly revolutionary medical leaps, life was very different. Infections regularly killed or caused significant disabilities, many of the operations we now consider routine did not exist and the powerful drugs we use to treat cancer were unthinkable.
In particular, I want to share one key statistic—in this time before antibiotics and vaccines, around 40% of deaths were due to infections. Now, that number is just 7%.
These developments, including Sir Alexander Fleming’s discovery of the first antibiotic—penicillin—have underpinned countless medical advances since. They have allowed us to treat basic infections so surgical procedures like caesarean sections can take place safely and patients can receive chemotherapy.
People are now living longer and healthier than ever before. I think it is grossly overlooked how much of our current quality of life is down to these key achievements in medicine. Indeed antibiotics add, on average, twenty years to our lives.
But even as Sir Alexander Fleming accepted his Nobel Prize for this discovery, he foresaw a troubling future. In his acceptance speech he flagged that he was already seeing bacteria in the laboratory that developed resistance and therefore survived, and urged people to get ahead of this threat before it occurred more widely.
And here we stand, more than 70 years later, having made little progress in addressing this threat. It continues to grow globally—and this inaction seriously risks us returning to the dark ages of medicine.
Again, I do not think people fully appreciate just how much our quality of life hinges on antibiotics being effective. We are so familiar with these wonder drugs that we take them for granted. The truth is that we have been abusing antibiotics—as patients, as doctors, as travellers, as farmers and food producers globally, for short term personal gain without thinking about the future.
Many people demand them of our doctors when they simply do not need them. Surveys suggest that one in five people expect a prescription for antibiotics incorrectly believing they will treat coughs and colds caused by viruses.
Doctors have to make difficult decisions and sometimes prescribe antibiotics when they may not be needed, often because they do not have the tools to diagnose quickly and definitively. Estimates suggest that as many as half of all patients who visit their GP with a cough or cold leave with a prescription for antibiotics.
Some countries feed them to animals in huge numbers to promote growth and as a crude form of infection control. In some countries, antibiotics can be bought without prescription or online, and poor quality or fake medicines can exacerbate the problem, as well as causing harm and fatalities.
Added to that, there are many countries which we simply do not know how many antibiotics are being used and what bugs are becoming resistant, due to the lack of surveillance.
To compound these issues, we have not developed any new classes of antibiotics since the 1980s as both the public and private sector disinvested in this area and the science is challenging. Drug companies say they are too expensive to develop when they sell for such a low price.
Because of the growing threat of resistance, we are trying to limit their inappropriate use—making it far less profitable than developing drugs for other therapeutic areas such as cancer. Given the failure rate is high and it can take 10-20 years to bring an antibiotic from discovery to market, developing new antibiotics also becomes too high risk for industry due to the lack of a return on investment.
All of these failures to act are collectively driving bugs that cannot be treated by any medicines we have on this earth. Already four in 10 patients with an E.coli bloodstream infection in England cannot be treated with the commonest antibiotic (co-amoxiclav) used in hospitals. In addition, almost one in five of these bacteria were resistant to at least one of five other key antibiotics
This truly is the doomsday scenario we fear in medicine. Our apocalypse is a return to these dark ages, where people regularly died in childbirth, from stomach bugs, from simple cuts and abrasions.
The risk is worrying enough that the UK Government put this issue on its national risk register—up there with security threats, floods and pandemic flu.
And already we are seeing horror cases worthy of this classification. In the United States earlier this year, we saw a tragic case where a woman died after contracting an infection that we simply did not have the medicine to treat.
All 14 kinds of antibiotics the hospital had on hand did not work. Even more stark—none of the 26 antibiotics available in the United States would have worked either.
Yet, this is just one example and it is important to stress that this is not just a future threat—it is happening now. Already, it is estimated that 700,000 people across the world die from drug-resistant infections.
And indeed the full scale of potential future doom has been forecast. Lord O’Neill’s Independent Review on this topic predicted that without action, by 2050 the world could see 10 million people dying per year from drug resistant infections, at a cost of more than $100 trillion to the global economy. That’s one person every three seconds. It is also predicted to push an additional 28.3 million people into extreme poverty.
Now you know how bad it could get—so what are we doing about it you might ask? Thankfully, the answer is quite a lot.
I have made it a personal mission to bring this issue to the attention of the world, and we are beginning to see progress.
In 2016 we brought this issue to the United Nations and secured a landmark declaration from all 193 countries. They all pledged to take action to curb this threat. I am now part of a global group driving forward this work.
We have kept it high on the political agenda though Germany’s G20 Presidency and most recently through a declaration at the UN Environment Assembly—the world’s highest-level decision-making body on the environment. This now commits the 193 UN Member States to not only take action in humans and animals but also to protect our environment and address the contribution the environment has to play on the emergence and spread of drug resistance.
This issue has the attention of some of our brightest minds in academic and the private sector, and important charitable organisations like the Bill and Melinda Gates Foundation and Wellcome Trust.
I am also very proud that the UK is truly leading the way, spending over £615 million on research, awareness raising work, and supporting developing countries. This includes a £265 million investment to support these countries to develop and improve their surveillance of antibiotic use and spread of resistance. Our human and animal health professionals have made huge strides in reducing our use and sales of antibiotics and have committed to do more.
While global progress is far too slow for my liking, this work is good news and its complex nature means it is a long-term problem that we must find sustainable solutions to. But the good news is that we can all do our bit to halt the rise of drug-resistant infections.
Simple things like good hygiene and hand-washing stop the spread of infections. Even better, get the vaccines that are offered to you. And also please do not ask your healthcare professionals for antibiotics—they will know best, so please listen to them and follow their instructions when they do prescribe. It is vital they are there and used appropriately when you or a loved one needs them.
While this post-antibiotic apocalypse looks dark, there is certainly hope. But much more needs to be done at all levels and across all sectors to avoid passing this doomsday scenario on to our children and grandchildren.
HuffPost UK Tech has launched HuffPost-Apocalypse, a project that aims to investigate what an apocalypse would mean for humanity, how we can best delay the end of the world, what the world will look like after we’re gone and what the best viable options for survival will be for anyone left. Join in the conversation with #HuffPostApocalypse on Twitter. To read more from the series, visit our dedicated page.