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Without action on antibiotics, medicine will return to the dark ages...

Without action on antibiotics, medicine will

return to the dark ages
Ed Whiting
Continued overprescribing and abuse could lead to more people dying of resistant
infections than cancer. Only global cooperation can solve the problem

It will take at least a decade to produce new antibiotics that are safe for human use. Photograph: Murdo Macleod for the

Friday 19 May 2017 11.24BST

hen Prof Sally Davies published The Drugs Dont Work in 2013, it wasnt some
allusion to a Verve number from the 1990s, but a sombre warning of the
growing threat posed by bacteria evolving resistance to life-saving antibiotics.
If this were left unaddressed, she argued, it would lead to the erosion of
modern medicine as we know it.

That was four years ago. Doctors and scientists had long warned of the problem, but few
outside medicine were taking real heed. Consumption of antibiotics rose 36% between
2000 and 2010. When I started working at No 10, the words antimicrobial resistance
were certainly not on the lips of those walking the corridors of Whitehall.

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It was Davies who pushed the agenda meeting the then prime minister David Cameron,
to urge the government to wake up to the fact that, without eective antibiotics, we
could see an end to life-saving transplants, chemotherapy and routine operations such
as caesareans and hip replacements; and that continued misuse and overuse of
antibiotics could, within a generation, see the global death toll from drug-resistant
infections rise from 700,000 today to 10 million more than currently die of cancer.

As soon as we understood the scale of the challenge in Downing Street, it became an

international priority. Cameron raised it at every bilateral meeting with world leaders for
about a year, and in 2014 he announced the launch of Jim ONeills International Review
on Antimicrobial Resistance, which was supported by the Wellcome Trust.

A year ago this week that review was published, oering the world a 10-point action plan
to prevent healthcare returning to the dark ages. The world is now listening. Leaders
accept whats at stake and that the solution lies in global unity. But 12 months on from
the review, talk is yet to turn to action.

We urgently need new antibiotics. No new classes of antibiotics have been approved
since the early 1980s. Between 1940 and 1962 about 20 classes were produced, but
industry backing has decreased signicantly since that golden age. The pipeline of new
treatments is all but dry, the void fast exploited by resistant bacteria. A concerning
number are now resistant to drugs reserved as the last line of defence, and the most
vulnerable are in greatest danger the young, old and critically ill. Blood infections
caused by drug-resistant microbes kill more than 200,000 newborn babies each year.

The reason for the lack of interest from the pharmaceutical industry is simple: the
economics dont add up. Developing new antibiotics is scientically challenging,
time-consuming and costly. The medicines we so badly need cannot be allowed to be
sold in volume; they must be conserved for real need, with fair access guaranteed. This
limits their retail value. Many early-stage projects will fail, making them a risky bet.
Even those that are successful will take at least a decade to produce medicines that are
safe for human use.

A new public-private partnership, CARB-X, led by Wellcome and the US government, is

beginning to address this seemingly intractable problem. Over the next ve years, up to
$450m in funding will be given to biotech rms and research teams to develop
promising antibiotics and diagnostics to combat the most dicult and deadly multi-
drug-resistant pathogens.

CARB-X is an answer to the global action called for by the ONeill review. But it will not
be enough on its own. We need concerted action on many fronts, and on all ONeill

Fixing the broken antibiotic market, but also ensuring fair access to new, and existing,

medicines particularly in low and middle-income countries where need is greatest.

More hospitals implementing measures to stop infection spread.

Better sanitation and basic hygiene in communities to prevent infection taking hold in

the rst place.

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Better understanding of the environmental impact of antibiotic-resistant bacteria.

Stopping antibiotic pollution.

Robust national plans to reduce the spread of drug-resistant infections.

Restrictions on the use of antibiotics in farming and agriculture.

The clock ticks on all of these. Since last years ONeill review, political will has rallied.
But the world cannot wait any longer for decisive action.

Last September the UN general assembly committed itself to ghting the problem
together, followed by the announcement this year of a taskforce to address the issue. It
needs to gain momentum fast and draw in the disparate groups across human and
animal health, food and environment.

At Julys G20 summit and the next UN general assembly is September, the opportunity
must not be missed for those who have listened and have shown intent to now act boldly
in the ght against drug-resistant infections.

Health policy
Drug resistance

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