Return to the pre antibiotic era

Before sinking due to Brexit, the British Government was launched in a commendable and unprecedented effort to attract the attention of the international scientific community and the political and economic decision-makers on the danger of the growing resistance to antibiotics. This theme was the subject of several reports. Organization and final synthesis were entrusted to the Economist and former President of asset management at Goldman Sachs, Jim O'Neill, the idea being that the only public health consequences appear insufficient to attract attention to policies, which each time they hear the word “health” fear additional costs,  but they would be perhaps more attentive if an economist showed them the economic consequences. On this point, the final report of Jim O'Neill (Tackling drug-resistant infections globally: final report and recommendations, should not disappoint them:

10 million deaths a year

Resistance to antibiotics is already the cause of a "very shocking" number of 700,000 victims per year.

It could cause 10 million additional deaths per year by 2050, or one death every three seconds. More than cancer !

The cost by 2050 would represent 100 million million $

And the authors note that during the 18 months of drafting their report, they witnessed the emergence of resistance which they did not they would appear as early, for example resistance to colistin, one of the antibiotics of last resort, end 2015 (in China, in India and the USA), one of the causes being the use of this antibiotic in a pig farm in China). The Chinese begin to worry so much the situation they helped (but not only) to establish that they were the first with the British to agree to establish a fund dedicated to innovation in this area, for $ 72 million each.

The recommendations

-an international public campaign of sensitization on the impact of the emergence of resistance to antibiotics

- Reduce drastically the use of antibiotics in livestock. We need improve global monitoring, to determine the extent of the use of antibiotics in agriculture in every part of the world. Reduction targets will have to be proposed by each Government, leaving some flexibility for decay. However, we should move forward much more quickly in the prohibition or restriction in animals of antibiotics vital to human health... The report also proposes to promote the development and use of vaccines and other alternatives;

- Encourage innovation and changing economy of antibiotic therapy

No new classes of antibiotics has emerged for decades (with the exception of linezolid). The market of antibiotics is not at all attractive for a pharmaceutical company. If the overall market is quite large (40 billion), sales of products under patent are only about 7 billion $, which is the sale of a single blockbuster in the field of cancer. There is also the difficulty of research and the fact that the initial market will be small, since a new antibiotic will be reserved for hospital use (what is a healthy measure).

The Group therefore considered the need of new and better incentives to promote investment in the field of antibiotic research. He proposed a system of entry ticket up to 1 billion $ for any discovery of a new antibiotic active on resistant pathogens, whether it belongs to a new family or not, provided that it will be made available in any region of the world where it is needed, and that its use will be limited to the treatment of resistant infections (including TB, gonorrhea, pathogenic gram negative and some fungal infections, which are badly needed are particularly urgent.

This idea was to be discussed at an upcoming G20 in September, to be implemented at the international level. It would be a pity that the current turbulence of Britain, leader in this area,  could delay the implementation of this recommendation

- Promote new diagnostics tools

We need  better description of  existing antibiotics. The group found amazing that doctors continue to prescribe antibiotics only on their immediate assessment of the patient symptoms, just as they do since the invention of antibiotics... When an assay is used for the diagnosis, it is often based on very slow technology that has not changed significantly since the 1860s...; Development of rapid diagnostics would enable significant progress. I would add that recommendations which lead to prescribe fewer antibiotics as blindly as they are prescribed are hardly satisfactory: it is not necessarily to prescribe less, but better.

- Promoting the anti-infective industry

It is necessary to increase the number of researchers, physicians and medical staff working in infectious diseases as well as the remuneration and career profiles. The report notes that doctors working in infectious diseases are less well paid than other 25 medical specialties in the USA, and the picture is similar for nurses and hospital practitioners. Careers are less attractive financially and in terms of prestige

It would be a pity that the adventures of the Brexit endanger this program to fight antibiotic resistance, in particular the financing of research and the 1 billion ticket for the discovery of new antibiotics active on resistant threatening strains. If the British Government now has other worries, Europe should take on board.