The post-antibiotic era is here

Nov 14, 2019 by


In the US, one person dies every 15 minutes because of drug resistance.

Three glass medicine jars with lids.
Drug resistance is a reaction to our overuse of antibiotics.
 UIG via Getty Images

Every 15 minutes, one person in the US dies because of an infection that antibiotics can no longer treat effectively.

That’s 35,000 deaths a year.

This striking estimate comes from a major new report, released Wednesday by the Centers for Disease Control and Prevention (CDC), on the urgent problem of antibiotic resistance.

Although the report focuses on the US, this is a global crisis: 700,000 people around the world die of drug-resistant diseases each year. And if we don’t make a radical change now, that could rise to 10 million by 2050.

Drug resistance is what happens when we overuse antibiotics in the treatment of humans, animals, and crops. When a new antibiotic is introduced, it can have great, even life-saving results — for a while. But then the bacteria adapt. Gradually, the antibiotic becomes less effective and we’re left with a disease that we don’t know how to treat.

And it’s not just diseases like tuberculosis. Common problems like STDs and urinary tract infections are also becoming more resistant to treatment. Routine hospital procedures like C-sections and joint replacements could become more dangerous, too, as the risk associated with infection increases. Two of the most urgent current threats are C. difficile (an infection sometimes brought on by antibiotic use) and drug-resistant N. gonorrhoeae (sometimes dubbed “super gonorrhea”).

Experts have been warning for years that we’re approaching a post-antibiotic era — a time when our antibiotics are pretty much useless and drug-resistant superbugs can all too easily decimate our health. Yet we continue to dole out too many antibiotics, driving the resistance. Doctors prescribe antibiotics for conditions that don’t require them and don’t even benefit from them, like colds and flus. And animal farmers use them copiously on livestock and poultry, sometimes to compensate for poor industrial farming conditions.

It’s not all bad news. Some professionals, especially in hospitals, have heeded experts’ warnings — with encouraging results. Take staph infections, for example. The report notes that rates of methicillin-resistant Staphylococcus aureus (MRSA) have dropped. Vancomycin-resistant Staphylococcus aureus (VRSA) is no longer considered a threat. Overall, deaths caused by drug resistance decreased by 18 percent since the CDC’s landmark 2013 report on this issue.

But even if deaths are down, this is still very much an emergency.

“Stop referring to a coming post-antibiotic era — it’s already here,” the CDC report says. “You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy.”

Doctors like Amy Mathers, who directs the University of Virginia’s Sink Lab, have seen this firsthand. She told me that over the past decade there’s been a surge of US patients infected with bacteria for which there’s no effective antibiotic. “Ten years ago, that was a rarity,” she said. And now? “I see that once a month.”

Here’s what the CDC experts recommend we all do

The report emphasizes three main ways to curb the problem. They apply to professionals like health care providers and veterinarians, and they also apply to you, even if you don’t work with sick people or animals.

1) Preventing infections in the first place

Prevention is the best medicine — it’s a cliché for a reason. Doctors should ask patients if they recently received care in another hospital or traveled to another country (germs can be spread easily across borders) and make sure patients receive recommended vaccines.

You, as an individual, can help prevent infections by cleaning your hands, practicing safe sex, and, if you’re going to be traveling, getting the appropriate vaccines and sticking to food and drinks that are unlikely to be contaminated.

2) Slowing the development of resistance through improved antibiotic use

The CDC estimates that US doctors’ offices and emergency departments prescribe 47 million antibiotic courses each year — for infections that don’t need antibiotics. That’s 30 percent of all antibiotics prescribed at these sites. Health care providers, as well as people in the agriculture industry, can slow resistance by using antibiotics only when necessary.

The same goes for you, too. If you’ve got a nasty cold, flu, traveler’s diarrhea, or something that’s likely to go away on its own in a few days, ask your doctor whether your symptoms merit taking antibiotics or whether you’ll be fine if you go without.

3) Stopping the spread of resistance when it does develop

Health care providers should learn when to report cases to the health department to identify unusual resistance and deploy a containment strategy if needed.

For example, earlier this year, a patient in Orange County, California, tested positive for C. auris, a multidrug-resistant yeast that can cause invasive infection and death. An extensive, aggressive containment response followed that involved screening hundreds of patients, according to the CDC report. When a new patient was identified as carrying or infected with C. auris, they were immediately put under special precautions. That helped prevent spread to hundreds of vulnerable patients.

At this point, you may be wondering why we don’t just develop new antibiotics if our old ones stop working. The CDC experts say we can’t count on that. As a result of scientific obstacles and limited business incentives, between 1962 and 2000, no new major classes of antibiotics were approved to treat common and lethal infections. And since 1990, 78 percent of major drug companies have scaled back antibiotic research — or cut it altogether. To understand why that’s the case, we need to dig into the companies’ financial incentives.

Companies could research and develop new antibiotics. Why don’t they?

The problem of drug resistance could be addressed really cheaply. If each person in high- and middle-income countries invested $2 a year in this cause, we could research new drugs and implement effective measures to reduce the threat of resistance, according to an important UN report released in May.

“For the US, the total cost to fix the broken antibiotics model is $1.5-2 billion per year,” Kevin Outterson, a Boston University professor who specializes in antibiotic resistance, told me. “It’s the equivalent of what we spend on toilet paper every few months.”

What’s more, unlike climate change, this is an issue on which there’s both scientific and political consensus — it’s not as though the right and the left disagree as to whether the problem is real.

Which raises the question: If there’s a cost-effective way to solve such a high-impact problem and it’s ideologically uncontroversial, why aren’t we all over it?

Unfortunately, it takes many years and lots of funding to do the research and development needed to bring a new antibiotic to market. Most new compounds fail. Even when they succeed, the payoff is small: An antibiotic — which is, at least in theory, a drug of last resort — doesn’t sell as well as a drug that needs to be taken daily. So for biotech companies, the financial incentive just isn’t there.

Although drug resistance affects high-income and low-income countries alike, wealthy Western countries may be better equipped to respond to a health crisis and thus feel less urgency about tackling the problem proactively.

The UN report and a number of outside experts have argued that to solve this issue, we need to stop treating antibiotics as though they’re any other product on the free market. Instead, we should think of antibiotics as public goods that are crucial to a functioning society — like infrastructure or national security. And the government should fund their research and development.

“This is a product where we want to sell as little as possible,” Outterson explained. “The ideal would be an amazing antibiotic that just sits on a shelf for decades, waiting for when we need it. That’s great for public health, but it’s a freaking disaster for a company.”

This mismatch with the pharmaceutical industry’s profit-making imperative is why the government (and ideally also the private sector and civil society) needs to step in, according to the UN report. That could include incentives like grant funding and tax credits to support early-stage research. The report also urged wealthy countries to help poorer nations improve their health systems, and recommended the creation of a major new intergovernmental panel — like the one on climate change, but for drug resistance.

Yet for governments to mobilize around this issue, the public may first have to push it as a priority — and it’s not clear that enough Americans see it as such.

“I do not think the political will or even the knowledge base is present in the US to make this a high-enough priority to solve the problem today,” Mathers told me. She believes the first thing we need is more public education to bring this threat into focus for the average American.

Outterson, for his part, told me he fears the death toll may have to climb very high before a critical mass of people start noticing, caring, and mobilizing. “We will eventually respond,” he said. “The question is how many people will have to die before we start that response.”

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