Written by: Allison Lee
While alarm spread worldwide concerning the Wuhan coronavirus pandemic, a spotlight has been shined on the prevention of transmission. However, the focus should be on an underlying factor: the failure of antibiotics. Although there is widespread panic surrounding the coronavirus, the lack of attention given to antibiotics is unsettling. The worldwide crisis that is killing millions of people is not any single virus or disease but rather a lack of research, accessibility, and focus on the field of antibiotics.
Since scientists have a very limited understanding of the functions of antibiotics, there is a widespread tendency to over prescribe medications. According to the medical director of the Sinai Health System-University Health Network Antimicrobial Stewardship Program, Andrew Morris, “For most infections, we don’t know the optimal drug, dose, or treatment duration. For many, we don’t even know if they require antibiotic treatment.” The limited knowledge about the medication has caused the overuse and misuse of antibiotics, both of which have had dire consequences. For those who have access to medication, overuse of antibiotics causes antibiotic-resistant bacteria to develop because bacteria adapts to be untreatable. The consequence of antibiotic resistance amounts to 2 million infections and 100,000 deaths annually in the United States alone.
Although the problems posed by the limited knowledge of antibiotics are grave, an additional issue is the lack of accessibility for many people living in low- and middle-income countries. According to the Center for Disease Dynamics, Economics, and Policy (CDDEP), most of the world’s annual 5.7 million deaths that could be prevented with antibiotics occur in low- and middle-income countries. Furthermore, the amount of deaths that could be treated if there were accessible antibiotics is much greater than the number of deaths caused by antibiotic-resistant infections. It has become apparent that the existence of a drug does not signify the dispersion of it to at-risk countries.
There are many barriers, both socioeconomic and systematic, that prevent the widespread accessibility of new drugs and cause a complex that prevents financially deprived areas of healthcare. Research from the CDDEP found that although 21 new antibiotics entered markets between 1999 and 2014, less than five were registered in most countries in sub-Saharan Africa. Not only are these drugs being withheld, but the lack of doctors and the abundance of falsified medication further the health crisis. For instance, India has one government doctor for every 10,189 people. Compared to the ratio of 1:1,000 recommended by the World Health Organization, this is a shortage of 600,000 doctors. Researchers from the WHO reported that “17% of substandard or falsified medicines reported to the WHO are antibiotics, and each year, more than 169,000 childhood pneumonia deaths are caused by falsified antibiotics.”
As the need for new antibiotics and treatments increases, the development of drugs has practically halted. Most of the progress made has been short term solutions and variations of the already existent antibiotics. This holistic lack of innovation is a dead end in the field of medicine, spiraling the threats of drug-resistant infections. This may be understood by the complexity of antibiotic innovation and high prices of production which causes extremely high market prices. As a result, every antibiotic on the market between 1984 and 2017 was simply a variation of an existing drug. Looking forward, this trend does not seem to be changing. WHO released a statement that predicted the approval of a mere 10 antibiotics or biologicals between 2017 and 2022. Further, the approval of these drugs will not lead to the immediate distribution of them.
Although there is a widespread need for antibiotics, it is not surprising that the pharmaceutical industry is showing a lack of interest in the development of new drugs. Society demands that antibiotics are accessible and low cost. However, clinical studies are extremely expensive and the uncertainty of the success of an antibiotic poses a risk that many companies aren’t willing to take, an essential element to overcoming the existing barriers. Further, as stated by Barry Eisenstein, senior vice-president, scientific affairs editor, antimicrobial agents and chemotherapy, for Cubist Pharmaceuticals, “The development paradox … is that one needs a large number of patients with those infections to develop new antibiotics, obviating the ability to have therapeutic solutions available in time for the epidemic.” This perspective gives light to the failures of the development process. Without refining the process to allow production before widespread disease, there is little incentive for companies to invest in research. The global health emergency caused by the overall lack of understanding of antibiotics is causing millions of deaths each year and is posing a threat to modern medicine. If current trends continue, antibacterial resistance may cause illnesses such as the common flu to be practically untreatable. The scientific community must refine the production process of antibiotics and incentivize research in order to allow the development of new drugs. Without doing so, new antibiotics will be scarce and prices will be exorbitant. The cyclical nature of the lack of funding and lack of distribution is compiling to an overarching threat of uncontrollable pandemics and superbugs. As the death count of the coronavirus rises above 1,600 in mainland China, focus must shift from the immediate development of vaccinations to the broader, systematic issues of prevention through antibiotics.