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How the pandemic screwed up our antibiotics

Antibiotic resistance was already a crisis. Covid-19 made it an emergency.

Three small glass jars with screw-top lids containing Mycetoma cultivation samples used in antibiotic testing.
Drug resistance is a reaction to our overuse of antibiotics.
UIG via Getty Images
Sigal Samuel is a senior reporter for Vox’s Future Perfect and co-host of the Future Perfect podcast. She writes primarily about the future of consciousness, tracking advances in artificial intelligence and neuroscience and their staggering ethical implications. Before joining Vox, Sigal was the religion editor at the Atlantic.

Since antibiotics were discovered over a century ago, they’ve improved our lives dramatically. Research suggests they’ve even extended average human life expectancy by more than 20 years. But if we’re not very careful now, humanity may backslide into a world where our antibiotics become useless — and the common infections they used to treat cut our lives short.

The Covid-19 pandemic has made that danger worse. According to a new report from the Centers for Disease Control and Prevention (CDC), during the first year of the pandemic, the problem of drug resistance only intensified.

Drug resistance is what happens when we overuse antibiotics in the treatment of humans, animals, or crops. When a new antibiotic is introduced, it can have great, lifesaving results — for a while. But then the bacteria adapt. Gradually, the antibiotic becomes less effective, and we’re left with diseases we’re less able to treat.

Even before Covid-19, experts had been warning that we’re approaching a post-antibiotic era — a time when our antibiotics would become largely useless against health problems ranging from tuberculosis to STIs to urinary tract infections. They noted that routine hospital procedures like C-sections and joint replacements could become more dangerous, too, as the risk associated with infection — especially infections acquired in hospitals — increases.

Some professionals, especially in hospitals, had heeded the experts’ warnings, and we’d seen some progress as a result. Take staph infections, for example. A 2019 CDC report noted that rates of methicillin-resistant Staphylococcus aureus (MRSA) had dropped. And overall, deaths caused by drug resistance had decreased by 18 percent since 2013.

But the Covid-19 pandemic has reversed years of hard-won progress. Drug-resistant hospital-related deaths and infections from seven pathogens grew 15 percent from 2019 to 2020, including a 13 percent increase for MRSA infections, which can be deadly.

One reason for that is that hospitals overprescribed antibiotics, according to the CDC. From March through October 2020, almost 80 percent of Covid-19 patients who were hospitalized were given antibiotics. As a viral illness, Covid-19 isn’t affected by antibiotics, but doctors may have been keen to prescribe them to cure or protect against secondary infections, especially given that hospital stays for Covid-19 can be long and intensive.

“This setback can and must be temporary,” Michael Craig, the director of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in a statement. “The best way to avert a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe.”

Obviously, the last thing we want is for the Covid-19 pandemic to pave the way for a new pandemic caused by some drug-resistant pathogen.

Drug resistance is a solvable problem. Why aren’t we solving it?

The good news is that we can absolutely address the problem of drug resistance. In its new report, the CDC calls for doubling down on strategies we know work, like preventing hospital-acquired infections in the first place and training medical professionals on when it is and isn’t appropriate to dole out antibiotics.

But there’s more that we could do — and cheaply, too. Most notably, drug companies could research and develop new antibiotics for us to use if our old ones stop working.

“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.”

Or as a 2019 UN report put it, 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.

Unfortunately, companies are just not incentivized to create new antibiotics. Since 1990, 78 percent of major drug companies have scaled back antibiotic research — or cut it altogether. They know it takes many years to do the research and development needed to bring a new antibiotic to market. Most new compounds fail. And 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 companies, the financial incentive just isn’t there.

A number of 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 2019 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 an urgent priority, and it’s not clear that enough Americans see it as such.

Outterson 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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