Anna Dumitriu, bioartists who grew bacteria for the Superbugs exhibition © The Board of Trustees of the Science Museum
WE might as well be Martians, the way we’re burning through our antibiotic defences; certainly, we’re losing the evolutionary ‘arms race’ with microbes.
As is so often the case, the real enemy is our own complacency. We’re top of the food chain, masters of our technological domain, and arrogant of our assumptions. Combine those traits with a certain degree of greed and we’re facing a slow-burn killer mix. We ought to know better.
“We share our world with bacteria,” the UK's Science Museum points out, with its latest exhibition: The Fight For Our Lives. “Trillions live on and inside you, and although many are harmless they can also cause infection and death. Thanks to antibiotics, millions of people each year are cured of previously untreatable bacterial diseases. But bacteria have fought back, evolving into superbugs resistant to even our most powerful antibiotics.”
Nature will take its course, but we haven't helped matters. Our careless and profligate use of antibiotics since they first became widely used in the 1940s has primed evolution to breed resistance into this menagerie of superbugs. When the last antibiotic fails, we’ll be at the mercy of the microbes, and we’ll find them every bit as hard a master as did our pre-penicillin-era ancestors.
Okay, so we’re not going to die off like the interplanetary invaders depicted in HG Wells’s famous novel, The War of the Worlds (well, we hope not). But we’re sure going to find life on Earth becomes decidedly unpleasant, as aspects of modern life we take for granted follow antibiotics into obsolescence – and yes, a lot of people are going to die. Well, what did you expect? Dame Nature plays for high stakes.
“Many of the medical advances in recent years, for example organ transplantation and cancer chemotherapy, need antibiotics to prevent and treat bacterial infections that can be caused by treatment,” according to the Department of Health. “Without effective antibiotics, even minor surgery and routine operations could become high-risk procedures if serious infections can’t be treated.”
Indeed, even everyday infections – a minor inconvenience today – could become ruthless killers in the post-antibiotic age. And this world out of the history books might be too close for comfort, unless we start to heed the advice of those urging us to change our ways. It’s not for a want of trying by those in the know.
Last year, for example, the World Health Organisation (WHO) issued an ominous warning – we are running out of viable antibiotics. It’s not just that micro-organisms are evolving resistance to the drugs; we're not investing enough time and resources into restocking the medicinal arsenal sufficient to stay ahead of the resistance race.
Most of the drugs currently in the “clinical pipeline” are just modified versions of existing classes of antibiotics, the organisation says; as such these form only a temporary redoubt against the bugs. In its report, WHO said it had found few potential treatment options for those antibiotic resistant infections the organisation had identified as posing the greatest threat to health. This includes drug-resistant tuberculosis, which kills around 250,000 people each year.
Enterobacter cloacae, Enterococcus faecalis, Staphylococcus epidermidis & Escherichia coli from the Superbugs exhibition 2 © The Board of Trustees of the Science Museum
“Antimicrobial resistance is a global health emergency that will seriously jeopardise progress in modern medicine,” said Dr Tedros Adhanom Ghebreysesus, director general of WHO. “There is an urgent need for more investment in research and development for antibiotic-resistant infections, including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery.”
TB isn't the only resurgent killer. WHO has identified 12 classes of what it calls priority pathogens that are increasingly resistant to existing antibiotics and urgently need new treatments. Some of these cause common infections, such as pneumonia or urinary tract infections; easily treated today, but potentially major killers in a post-antibiotic age.
There are 51 new antibiotics in development to treat priority bugs, including TB and the sometimes deadly diarrhoeal infection Clostridium difficile, but only eight of these are classed by WHO as innovative treatments that will “add value” to the existing arsenal of antibiotics. We're barely holding ground, then. There's a “serious lack” of treatment options for multi-drug resistant and extensively drug resistant pathogens.
“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” said Dr Suzanne Hill, director of WHO's Department of Essential Medicines.
Dr Mario Raviglione, director of WHO's Global Tuberculosis Programme, added: “Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug resistant TB having reached the market in over 70 years. If we are to end TB, more than US$800 million per year is urgently needed to fund research for new anti-tuberculosis medicines.”
By 2050, it is estimated that superbug infections will kill 10 million people worldwide, if we fail to tackle antibiotic resistance. Little wonder, then, that the UK's Science Museum titled its exhibitions The Fight For Our Lives. There, we can 'meet' some of our coming microbial overlords.
Visitors can see 12 real bacterial colonies, including nine bacteria that WHO classifies as a significant threat to human health. The colonies were grown by bio-artist Anna Dumitriu, and include Staphylococcus aureus – one of the earliest superbugs identified – and Neisseria gonorrhoeae, which now has several resistant strains. Penicillin mould, recently grown from samples used by Alexander Fleming in his 1928 discovery of the first antibiotic is also on display.
“With the resurgence of diseases once thought banished to history books, this exhibition shines a light on the remarkable scientific research that could stop the spread of the superbugs,” said Ian Blatchford, the Science Museum's director.
The exhibition, which is running until Spring 2019, takes a look at antibiotic resistance in the round, as it were; it takes us from the microscopic scale, through to the human impact, to its ramifications on a global scale. It's not all doom and gloom either, with plenty of material examining the scientific research that is under way to try and keep us one step ahead of the bugs.
“Drug resistant infections are one of the biggest public health threats of our time and if we do not act now, the consequences will be catastrophic,” said Professor Dame Sally Davies, chief medical officer. “Already superbugs are killing at least 5,000 people each year in England – but a key part of tackling this issue is increasing public awareness and working together to find common solutions.
“This exhibition clearly highlights some of the key issues we're trying to address, and crucially, tells stories about real people. People cannot connect with this threat without seeing how it affects them or those around them. I strongly encourage people to visit and find out more about superbugs, and how they can help tackle the issue.”
It really is up to us. For too many years, meat production has relied on dosing farm animals with antibiotics. On the personal level, we're too ready to dose ourselves up to nil effect when it comes to colds and flu: about as much use against a virus as a cough sweet. All told, we're simply helping nature breed our comeuppance.
The war is far from over – indeed, it’s a war than can never really end – but in truth it's not a battle against the superbugs; no, we're fighting our own stupidity – and that's a far hardier opponent to overcome. So let's try not to be the Martians.
18 February 2018
First published on Medium. Copyright © February 2018. All Rights Reserved.