You Ain’t Seen Nothing Yet

I’ve been writing about this subject off an on for decades. If you think the death, disease, and panic over COVID-19 has been something, wait until there’s a major outbreak of a drug-resistant “superbug” which is inevitable. Here’s a report by Kevin Outterson at STAT:

Failing to plan, it’s been said, is planning to fail. By this standard, the United States and other countries are planning for failure when it comes to preparing for the next public health crises, one of which will certainly be antimicrobial resistance, the phenomenon in which bacteria and fungi evolve to resist even the strongest treatments.

Covid-19 has demonstrated the catastrophic result of a virus catching the world unprepared. But over human history, bacteria have been our most dangerous foe. So it doesn’t make sense to me that the Biden administration recently released a pandemic preparedness plan that mentions the threat of antimicrobial resistance just once, and then only in passing.

This omission is ominous. Drug-resistant “superbugs” sicken nearly 3 million Americans each year and kill 35,000. Some experts estimate the real toll is much higher, with up to 162,000 Americans dying each year from antimicrobial resistance. An influential report commissioned by the Prime Minister of the United Kingdom and the Wellcome Trust estimated this scourge could kill as many as 10 million people each year around the globe.

While I agree that such a catastrophic eventuality is inevitable, there are things that can be done to minimize it and/or postpone it. The first thing is to reduce the profligate use of antibiotics both here and abroad. Countries in which antibiotics are available over-the-counter are commonplace whether de jure or de facto. In India antibiotics for human use are available over-the-counter without a prescription. In China and Indonesia in theory a prescription is required but in practice they are widely available over the counter. That accounts for a third of the world’s population right there.

Closer to home while in theory antibiotics for human consumption in Mexico require a prescription, in practice they are still readily available over-the-counter. Here in the U. S. antibiotics for use by animals, particularly farm animals, are available over-the-counter and that has risks all its own. Not only should we be tightening up on restrictions here, we should be providing incentives for other countries to tighten their own restrictions not just in theory but in practice and restrict travel to countries that don’t do so.

6 comments… add one
  • steve Link

    Don’t really think we have much of a chance of addressing this. The “do your own research” folks have decided that this is not really a problem. We would be placing restrictions just to increase government power.


  • Drew Link

    I suspect the regulatory capture issue is at work and will preclude restrictions. Further, as we have demonstrated the last two years, we currently are not good at cost benefit or balanced analysis, but excellent at politicizing events.

    This is not an area in which I have done much reading, but are there realistic scenarios for mass casualty events?

  • bob sykes Link

    One thing that could be done is remove some older antibiotics from the market, perhaps penicillin. Bacteria develop antibiotic resistance when they are exposed to any clinically effective dose, regardless of how widespread the usage is. Wider usage means faster evolution. On the other hand, bacteria will lose their resistance if the antibiotic disappears for a while, a while being indeterminate. So after a while, the banned antibiotic is once again effective. This is a cycle, and our very poorly educated elites probably won’t understand it.

    Governments can also help by subsidizing the development of new antibiotics. We just subsidized several covid vaccines, and granted the manufacturers immunity from liability suits. That’s a good model for antibiotics, too.

    Regulatory capture is a problem, especially when you propose to ban a widely used, cheap to manufacture substance like penicillin. But a bigger problem is getting governments to coordinate any antibiotic ban, even though the ban would be for only several years or a decade or so.

  • Grey Shambler Link

    I would imagine another disease fast emerging in the third world lays fertile ground for bacterial infections, diabetes.
    Suger in the blood, bladder, and urinary tract encourage growth, and require antibiotics to treat. On a large population scale , that is a recipe for emergent resistance.
    I had a battle with MERSA a few years ago, I know not whence it came,
    ( though it was a day after a flight to Seattle, spread very quickly ( hours) and took several minor surgeries and lots of antibiotics. It rebounded twice and now I hope gone for good.
    I have no doubt that without medication I would have lost at least a leg.
    Serious stuff.

  • PD Shaw Link

    Over the last several years, the FDA has implemented policies on use of antimicrobials in food-producing animals (cattle, chicken, pigs, etc.), which I think is meant to restrict or eliminate its use for non-medical purposes, put use under veterinarian supervision of single animals, and prefer drugs that are not important for human medical needs.

    BTW/ this was Gottlieb’s imprint when he headed the FDA and for awhile after he left to join a private equity company to promote investment in antibiotics and alternatives. He thinks markets are skittish because of the inherent rationing in such drugs (don’t want to use them too much).

  • steve Link

    PD- Yes. If someone were to develop a new and effective antibiotic their concern would be that it might be limited in its usage to try to prevent resistance developing too fast. Drug companies want blockbuster that everyone uses. Makes for poor incentives. Then throw in the political angle where there is opposition to limiting the use of drugs for any reason. We just have to hope that there is some kind of Moore’s law for antibiotics. Of course Moores Law isn’t really a law, just an historical observation so there is no guarantee even if there was one for antibiotics.


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