How can we solve the antibiotic resistance crisis? - Gerry Wright

Summary

Antibiotics are crucial for modern medicine, yet we face the threat of antibiotic resistance due to overuse and lack of new discoveries. Originating with penicillin, the issue has escalated as bacteria evolve to resist our drugs. The pharmaceutical industry's shift to more profitable, long-term medications has left antibiotics behind. Solutions include controlling antibiotic use, developing new ones, and exploring alternatives like phages and vaccines. However, inadequate funding and the challenge of profitability hinder progress in combating resistance.

Takeaways

• 💊 Antibiotics are essential for modern medicine, treating infections and supporting procedures like surgery and organ transplants.
• 🛡️ The risk of losing the effectiveness of antibiotics due to bacterial resistance poses a significant threat to healthcare.
• 🔬 Alexander Fleming discovered penicillin in 1928 and warned about the potential for bacterial resistance in his Nobel Prize acceptance speech.
• 📉 Pharmaceutical companies once found new antibiotics to counter resistance but have since reduced efforts due to lower profitability.
• 🌱 The discovery of new antibiotics has slowed, with no new chemical classes found since the mid-1980s.
• 🌿 Agriculture is a major consumer of antibiotics, contributing to resistance through overuse and the potential for human infection via the food chain.
• 🔬 Nature offers a promising source for new antibiotic compounds, with organisms like microbes and fungi having evolved to compete against bacteria.
• 🛡️ Combining antibiotics with molecules that inhibit resistance can help overcome bacterial resistance mechanisms.
• 🦠 Phages, viruses that attack bacteria, are a novel approach to fighting bacterial infections without affecting humans.
• 💉 Developing vaccines for common infections can prevent diseases and reduce the need for antibiotic use.
• 💸 Funding is a significant challenge in antibiotic development, with profitability concerns leading to reduced investment by pharmaceutical companies.
• 🏛️ Alternative funding models, such as subscription-based purchasing by healthcare providers, are being explored to incentivize antibiotic development.

Q & A

What is the role of antibiotics in modern medicine?

Antibiotics are essential in modern medicine for treating infectious diseases and for safely facilitating procedures such as surgery, chemotherapy, and organ transplants. Without them, routine medical procedures could lead to life-threatening infections.

Why are we at risk of losing the effectiveness of antibiotics?

The risk of losing the effectiveness of antibiotics is due to the development of bacterial resistance to all currently available antibiotics and the cessation of discovering new ones.

Who discovered the first widely used antibiotic and when?

Alexander Fleming discovered the first widely used antibiotic, penicillin, in 1928.

What warning did Alexander Fleming give in his 1945 Nobel Prize acceptance speech?

Fleming warned that bacterial resistance had the potential to ruin the miracle of antibiotics.

How did the pharmaceutical industry initially respond to bacterial resistance in the 1940s and 50s?

In the 1940s and 50s, pharmaceutical companies countered the problem of resistance by discovering many new antibiotics, which was a highly successful and profitable enterprise at first.

What changed in the discovery of new antibiotics over time?

Over time, newly discovered antibiotics became less profitable as they were often only effective for a narrow spectrum of infections, compared to the first ones which were broadly applicable.

Why did the overprescription of antibiotics initially occur?

Antibiotics were heavily overprescribed in the early days, including for viral infections they had no effect on, due to a lack of understanding of their specific use and potential for resistance.

What shift in pharmaceutical company focus contributed to the decrease in new antibiotic development?

Companies shifted focus to developing drugs for chronic conditions like blood pressure and cholesterol medications, which are taken indefinitely and are more profitable than antibiotics.

Why are bacteria becoming resistant to many antibiotics?

Bacteria continue to acquire resistance and pass it along by sharing genetic information between individual bacteria and even across species.

What are some strategies to combat antibiotic resistance and find new ways to fight bacterial infections?

Strategies include controlling the use of existing antibiotics, creating new ones, combating resistance to new and existing drugs, and finding alternative treatments such as phages and vaccines.

What is the largest consumer of antibiotics and how does this contribute to resistance?

Agriculture is the largest consumer of antibiotics, using them to treat infections and promote the growth of food animals. This increases bacteria's exposure to antibiotics, giving them more opportunities to develop resistance.

What is one innovative approach to packaging antibiotics to combat resistance?

One approach is to package antibiotics with molecules that inhibit resistance, such as molecules that block the proteins bacteria use to degrade the drug.

How can vaccines contribute to the fight against bacterial infections?

Vaccines can help prevent diseases in the first place, reducing the need for antibiotic use and thereby helping to control the spread of antibiotic resistance.

What is the biggest challenge in developing new antibiotics and alternative treatments?

The biggest challenge is funding, as antibiotics and new therapeutic techniques are often unprofitable, leading to a lack of investment in their development.

What is one potential solution proposed to incentivize the development of new antibiotics?

Shifting profits away from the volume of antibiotics sold, such as the United Kingdom's model of healthcare providers purchasing antibiotic subscriptions, could incentivize development.

Outlines

00:00

💊 The Importance and Crisis of Antibiotics

This paragraph discusses the vital role of antibiotics in modern medicine, from curing infections to enabling surgeries and organ transplants. It highlights the growing problem of antibiotic resistance, traced back to the discovery of penicillin and the subsequent rise of resistant bacteria. The narrative outlines how the pharmaceutical industry's shift from broad-spectrum antibiotics to narrow-spectrum ones, coupled with overprescription and a focus on more profitable, long-term medications, has contributed to the scarcity of new antibiotic discoveries since the mid-1980s. The paragraph concludes by emphasizing the urgency of controlling antibiotic use, developing new drugs, combating resistance, and exploring alternative treatments to address this crisis.

05:00

🌱 Innovative Solutions and Challenges in Antibiotic Development

The second paragraph delves into potential solutions to the antibiotic resistance crisis, such as controlling antibiotic use in agriculture, where overuse accelerates resistance development. It underscores the promise of natural compounds from organisms like microbes and fungi as sources of new antibiotics. The paragraph also discusses strategies to inhibit bacterial resistance, such as combining antibiotics with molecules that neutralize bacterial degradation proteins. It mentions the potential of phages—viruses that target bacteria without harming humans—as a novel treatment approach. Furthermore, it highlights the importance of vaccines in preventing infections and the financial challenges that hinder antibiotic development due to their limited use and low profitability. The paragraph concludes by suggesting a shift in profit models, such as subscription-based purchasing of antibiotics, as a way to incentivize development while acknowledging that more global investment is necessary to overcome resistance.

Keywords

💡Antibiotics

Antibiotics are substances that inhibit the growth of or destroy bacteria. They are crucial for treating a variety of bacterial infections and are integral to modern medicine, as mentioned in the script. The theme of the video revolves around the importance of antibiotics and the challenges faced due to bacterial resistance. An example from the script is the mention of how 'antibiotics enable much of modern medicine' and the risks associated with the loss of their effectiveness.

💡Bacterial Resistance

Bacterial resistance refers to the ability of bacteria to withstand the effects of antibiotics, rendering them ineffective. This is a central issue in the video, as it discusses the evolution of this resistance over time and its implications for public health. The script illustrates this with the statement 'some bacteria have become resistant to all currently available antibiotics', highlighting the urgency of the problem.

💡Penicillin

Penicillin is the first widely used antibiotic, discovered by Alexander Fleming in 1928. It marks the beginning of the antibiotic era and is used in the script to set the historical context of antibiotic use and resistance. The script mentions Fleming's Nobel Prize acceptance speech, where he warned about the potential ruin of the miracle of antibiotics due to bacterial resistance.

💡Pharmaceutical Companies

These are businesses that develop, produce, and market drugs and medicines. In the context of the video, pharmaceutical companies played a key role in discovering new antibiotics to combat resistance. However, the script also points out that over time, the profitability of antibiotics has decreased, leading to a decline in new antibiotic development.

💡Narrow Spectrum Antibiotics

Narrow spectrum antibiotics are those that are effective against a limited range of bacteria. The script contrasts these with the earlier, broad-spectrum antibiotics, which could treat a wider variety of infections. The shift towards narrow spectrum antibiotics has implications for profitability and the strategy for treating bacterial infections.

💡Overprescription

Overprescription refers to the practice of prescribing medications, such as antibiotics, more often than necessary. The script notes that in the early days of antibiotic use, they were heavily overprescribed, even for viral infections where they are ineffective, contributing to the problem of antibiotic resistance.

💡Chronic Medications

Chronic medications are drugs that are taken over a patient's lifetime for long-term conditions such as high blood pressure or cholesterol. The script indicates that pharmaceutical companies shifted focus towards developing these types of drugs because they are more profitable than antibiotics, which are typically used for shorter periods.

💡Genetic Information Sharing

This concept refers to the process by which bacteria can share genetic information, including resistance genes, with each other. The script explains that this sharing can occur between individual bacteria and even across species, contributing to the spread of antibiotic resistance.

💡Agriculture

The script identifies agriculture as the largest consumer of antibiotics, often using them not only to treat infections but also to promote the growth of food animals. This widespread use in agriculture increases the exposure of bacteria to antibiotics, accelerating the development of resistance.

💡Phages

Phages are viruses that infect and kill bacteria but are harmless to humans. The script presents phages as a promising new avenue for combating bacterial infections, as an alternative to traditional antibiotics.

💡Vaccines

Vaccines are biological preparations that improve immunity to a particular disease. The script suggests that developing vaccines for common infections can help prevent diseases and reduce the reliance on antibiotics, thereby helping to combat resistance.

💡Funding

Funding, as discussed in the script, is a critical challenge for antibiotic development. It highlights the unprofitability of antibiotics, which has led many pharmaceutical companies to cease development efforts. The script calls for increased investment in antibiotic development and controlled use of existing drugs to address the issue of resistance.

Highlights

Antibiotics are essential for modern medicine, enabling treatments from surgery to chemotherapy and organ transplants.

Routine medical procedures can lead to life-threatening infections without antibiotics.

There is a risk of losing the effectiveness of antibiotics due to bacterial resistance.

The discovery of penicillin by Alexander Fleming in 1928 marked the beginning of the antibiotic era.

Fleming warned about the potential ruin of antibiotics due to bacterial resistance in his 1945 Nobel Prize acceptance speech.

Resistant bacteria began to appear in the 1940s and 50s, despite the discovery of new antibiotics.

The profitability of antibiotics declined as newly discovered ones were effective for a narrower range of infections.

Overprescription of antibiotics in the early days contributed to the rise of resistance.

Pharmaceutical companies shifted focus to developing drugs for chronic conditions due to their profitability.

No new chemical classes of antibiotics were discovered by the mid-1980s, while bacterial resistance continued to grow.

Bacteria can share resistance across species, leading to the rise of multi-drug resistant strains.

Controlling the use of existing antibiotics and creating new ones is crucial to combat resistance.

Agriculture is the largest consumer of antibiotics, contributing to the development of resistance.

Drug-resistant bacteria from animals can infect humans through the food chain and global networks.

Nature offers promising sources for new antibiotic compounds, such as microbes and fungi.

Combining antibiotics with molecules that inhibit resistance can enhance their effectiveness.

Phages, viruses that attack bacteria, are a promising new method to combat bacterial infections.

Developing vaccines for common infections can help prevent diseases and reduce the need for antibiotics.

Funding is a significant challenge for antibiotic development due to their limited profitability.

Shifting profits away from the volume of antibiotics sold could incentivize development and controlled use.

Governments and healthcare providers are exploring new models to support antibiotic development and responsible use.

Transcripts

Antibiotics: behind the scenes, they enable much of modern medicine.

We use them to cure infectious diseases,

but also to safely facilitate everything from surgery to chemotherapy

to organ transplants.

Without antibiotics,

even routine medical procedures can lead to life-threatening infections.

And we’re at risk of losing them.

Antibiotics are chemicals that prevent the growth of bacteria.

Unfortunately, some bacteria have become resistant

to all currently available antibiotics.

At the same time, we’ve stopped discovering new ones.

Still, there’s hope that we can get ahead of the problem.

But first, how did we get into this situation?

The first widely used antibiotic was penicillin,

discovered in 1928 by Alexander Fleming.

In his 1945 Nobel Prize acceptance speech,

Fleming warned that bacterial resistance had the potential to ruin

the miracle of antibiotics.

He was right: in the 1940s and 50s,

resistant bacteria already began to appear.

From then until the 1980s,

pharmaceutical companies countered the problem of resistance

by discovering many new antibiotics.

At first this was a highly successful— and highly profitable— enterprise.

Over time, a couple things changed.

Newly discovered antibiotics were often only effective

for a narrow spectrum of infections,

whereas the first ones had been broadly applicable.

This isn’t a problem in itself,

but it does mean that fewer doses of these drugs could be sold—

making them less profitable.

In the early days, antibiotics were heavily overprescribed,

including for viral infections they had no effect on.

Scrutiny around prescriptions increased, which is good, but also lowered sales.

At the same time, companies began to develop more drugs

that are taken over a patient’s lifetime,

like blood pressure and cholesterol medications,

and later anti-depressants and anti-anxiety medications.

Because they are taken indefinitely, these drugs more profitable.

By the mid-1980s, no new chemical classes of antibiotics were discovered.

But bacteria continued to acquire resistance and pass it along

by sharing genetic information between individual bacteria

and even across species.

Now bacteria that are resistant to many antibiotics are common,

and increasingly some strains are resistant to all our current drugs.

So, what can we do about this?

We need to control the use of existing antibiotics, create new ones,

combat resistance to new and existing drugs,

and find new ways to fight bacterial infections.

The largest consumer of antibiotics is agriculture,

which uses antibiotics not only to treat infections

but to promote the growth of food animals.

Using large volumes of antibiotics

increases the bacteria’s exposure to the antibiotics

and therefore their opportunity to develop resistance.

Many bacteria that are common in animals, like salmonella, can also infect humans,

and drug-resistant versions can pass to us through the food chain

and spread through international trade and travel networks.

In terms of finding new antibiotics,

nature offers the most promising new compounds.

Organisms like other microbes and fungi have evolved over millions of years

to live in competitive environments—

meaning they often contain antibiotic compounds

to give them a survival advantage over certain bacteria.

We can also package antibiotics with molecules that inhibit resistance.

One way bacteria develop resistance is through proteins of their own

that degrade the drug.

By packaging the antibiotic with molecules that block the degraders,

the antibiotic can do its job.

Phages, viruses that attack bacteria but don’t affect humans,

are one promising new avenue to combat bacterial infections.

Developing vaccines for common infections, meanwhile,

can help prevent disease in the first place.

The biggest challenge to all these approaches is funding,

which is woefully inadequate across the globe.

Antibiotics are so unprofitable that many large pharmaceutical companies

have stopped trying to develop them.

Meanwhile, smaller companies that successfully bring new antibiotics

to market often still go bankrupt, like the American start up Achaogen.

New therapeutic techniques like phages and vaccines

face the same fundamental problem as traditional antibiotics:

if they’re working well, they’re used just once,

which makes it difficult to make money.

And to successfully counteract resistance in the long term,

we’ll need to use new antibiotics sparingly—

lowering the profits for their creators even further.

One possible solution is to shift profits away from the volume of antibiotics sold.

For example, the United Kingdom is testing a model

where healthcare providers purchase antibiotic subscriptions.

While governments are looking for ways to incentivize antibiotic development,

these programs are still in the early stages.

Countries around the world will need to do much more—

but with enough investment in antibiotic development

and controlled use of our current drugs,

we can still get ahead of resistance.