By Danielle Edwards
Antibiotics are considered one of the greatest breakthroughs in modern medicine. But in the United States, 35,000 people die a year after succumbing to germs that have evolved the ability to fend off the drugs designed to kill them. It’s why two reports from the Centres for Disease Control (CDC) and an expert panel commissioned by the Council of Canadian Academies (CCA) have rung the alarm on antibiotic resistance, saying that millions of lives worldwide are at risk. Here’s what you need to know about the rise of superbugs and why some experts are calling it the world’s deadliest health crisis.
How are antibiotics made?
Antibiotics are actually created naturally by bacteria to kill off neighbouring predatory organisms in an ecosystem.
In fact, Alexander Fleming made his world-changing discovery of penicillin in 1928 after observing a type of mould had antibiotic properties.
Scientists would go on to harvest soil samples to isolate more germ-killing medicine from microbes that organically evolved defence mechanisms.
Brett Finlay, a microbiology professor at the University of British Columbia, said it’s a simple process of natural selection.
“When you put a selection pressure on any microbe, a small number of them are going to figure out how to avoid it if they can,” he said.
Finlay, who sat as the chair for the CCA panel, added that microbes could evolve to reinforce their outer shells. The problem, he said, starts when those resistant microbes start to multiply.
What’s causes antibiotic resistance?
Mass antibiotic use started in earnest during the Second World War, and with large-scale usage came faster resistance rates. Finlay explained that, unlike humans, bacteria can much more effectively swap genetic information.
“Once you have a resistance gene, which then resists these antibiotics in the population, it then spreads from microbe to microbe quite easily,” he said.
The drugs are now used in several sectors. Though the CCA report stressed there was no one area to blame, it did list factors that have contributed to the weakening of antibiotic treatments.
The CDC estimates doctors prescribe 47 million courses of antibiotics yearly for infections that don’t need them in the U.S.
The bulk of antibiotics in Canada — 78 per cent — are used in the production of livestock, some of them the same drugs used to treat human pathogens, which ups the chances of those germs developing resistance, as well.
What’s the worst-case scenario?
Both the reports warn of the wide-reaching effects of antibiotic resistance, like lower food production, increased hospital costs and the onset of millions of infections with no way to treat them.
“Stop referring to a coming post-antibiotic era — it’s already here,” CDC Director Robert Redfield said in a letter accompanying the organization’s report. “You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy.”
Bacteria that cause illnesses like urinary tract infections and gonorrhea are some of the microbes researchers are most concerned about, especially since it’s becoming nearly impossible to develop new antibiotics, Finlay said.
Financial and scientific obstacles meant that no new major classes of antibiotics were approved to treat infections between 1962 and 2000.
In 2018, 26 per cent of diagnosed infections in Canada required further treatment and that number could jump to 40 per cent by 2050.
While the CDC said the number of infection-related deaths has decreased since it released a 2013 report on the resistance phenomenon, more than 2.8 million antibiotic-resistant infections are diagnosed in the U.S. every year.
There could be an enormous economic cost, as well. The CCA report projected the phenomenon could reduce Canada’s GDP by up to $ 21 billion per year and rack up $ 8 billion in healthcare costs over the next thirty years.
Fighting antibiotics with antibiotics isn’t the answer, the reports note. But they both say infection prevention, which includes good old handwashing, is one of the best ways to cut down on antibiotic use. Fewer infections means less need to prescribe the germ-killing drugs.
And medical innovations, like phage therapy which uses viruses to kill bacteria, could mean the end of our dependence on antibiotics.
Finlay said one of the biggest ways to slow the increase in resistance is stewardship — making sure antibiotics are only used when they’re absolutely necessary.
“You don’t need antibiotic-containing detergents (that) you’re using on your countertops to clean them. You don’t have to use hand sanitizer every time you go out the door,” he said.
It’s not all bad news. There have been government efforts to lower antibiotic use (Health Canada announced last year the drugs could only be used for livestock with a valid prescription), but Finlay said it will take combined efforts from the healthcare sector and governments to take on the threat.
“It’s going to affect everyone, no one is immune from this,” said Finlay. “Whatever station in life you are, you get infections, and you need antibiotics. And if they’re not there, you suffer.”