The novel coronavirus has now spread from Wuhan, China across the planet and is affecting our pocketbooks as well as our health. While there is still so much we don’t know, the increased risk to older, especially immune-compromised people could soon be repeated on a global, more regular scale due to a different but parallel health crisis; we are referring here to the problem of the rise of infections resistant to today’s antibiotics, exacerbated by the shrinking pipeline of new, innovative drugs capable of fighting them.
Even as we cope with the current and urgent coronavirus outbreak, it is equally critical that we not lose sight of the looming crisis in antimicrobial resistance that could soon kill 10 million people every year. While we, correctly, understand the explosion of NCDs largely associated with 21st century longevity, this moment makes even more clear that we cannot let down on our guard on infectious and communicable diseases, including if we are to transform 20th century longevity to 21st century healthy longevity. Antibiotics will continue to central to achieving healthy longevity, rising to even greater prominence as we launch the Decade of Healthy Ageing.
For decades, we have taken antibiotics for granted. Between 1950 and today, these drugs became the cornerstone of modern medicine, conquering once-deadly conditions like pneumonia and tuberculosis.
During this period, the average life expectancy rose by more than a decade in North America, 16 years in Europe, a quarter century in Africa, and a staggering 30+ years in Asia — a surge of progress unparalleled in human history.
Yet, the bacteria that cause many common conditions persist. Over time, they develop resistance to widely used antibiotics. New threats constantly emerge as germs adapt and evolve to evade even the best treatments. Every therapy, even when used 100% appropriately, generates resistance over time.
This raises a fateful question: What would a world without effective antibiotics look like?
For starters, routine medical procedures that have improved the lives of millions will become risky events. Doctors are already advising against hip and knee replacements for fear patients will contract untreatable infections. Conditions once easily addressed by antibiotics — such as urinary tract infections that cause over 8 million doctor visits every year — could turn deadly. Even a simple visit to the dentist might result in an infection that can kill.
The problem becomes more urgent given a rapidly aging global population. By 2050, the number of people age 60+ will double, while those 80 and up will triple. As we age, we face far greater risk of infection because we are more likely to be exposed in hospitals, clinics, or even doctors’ offices; undergo routine surgeries; and, critically, our bodies are simply subject to more vulnerable immune systems.
In this worst-case scenario, the antibiotic crisis could begin to unravel the miracle of longevity, triggering a cascade of dire economic, health, and social consequences. Healthy aging is now recognized as a foundation of sustainable societies, which explains why the World Health Organization (WHO) just launched a decade-long effort to help the world’s more than 1 billion (and climbing) people over 60 remain active, healthy, productive members of their communities.
Solutions that focus on the over-prescription of current antibiotics are helpful, but not sufficient. The real answer must include building a robust antibiotic pipeline stocked and replenished with new innovations that can address evolving threats.
Yet today, that pipeline is nearly empty.
Globally, we have only 42 antibiotics in development, compared to approximately 1,100 medicines and vaccines to fight cancer. Just one new class of antibiotics has been discovered since the 1980s. Large pharmaceutical companies have effectively abandoned a market that lacks incentives for antibiotic advances. Too many entrepreneurial innovators — even those that develop successful new therapies — are going bankrupt or struggling to survive.
Restocking the antibiotic pipeline requires a profound shift in the marketplace that can only be achieved through sound public policy reform. This includes faster regulatory approval for new, innovative therapies; better global protection of intellectual property; robust and ongoing stewardship by innovator, provider, and government; and, a pricing and reimbursement structure that reflects the urgent need for new innovation in antibiotics, vaccines, and diagnostics.
The simple fact is the world needs more and better antibiotics, supported by a marketplace and policy environment that recognizes and rewards their immense value to society. Otherwise, the lack of innovation in the antibiotic pipeline threatens to turn back the clock nearly a century when it comes to treating infections — and generate an endless cycle of Wuhan-level crises.
John Beard is the former head of WHO Ageing and Life Course and the chair of the Global Coalition on Aging advisory council.