During the first decades after the introduction of penicillin, bacterial adaptation and drug discovery jumped from each other, maintaining the ability of antibiotics to treat infections ahead of the ability of pathogens. to evade them. But by the 1970s, that exploitation of mid-century innovation had vanished. Making antibiotics is difficult: drugs must be toxic to humans but lethal to bacteria, and they must use mechanisms that dangerous bacteria have not yet developed defenses against. But switching from naturally produced antibiotics to synthesizing compounds in a lab was even harder.
Meanwhile, resistance has jumped forward. Excessive exploitation in medicine, agriculture and aquaculture has spread antibiotics into the environment and allowed microbes to adapt. Between 2000 and 2015, the use of antibiotics that were reserved for the most lethal infections almost doubled in the world. Resistance levels differ by organism, drug, and situation, but the most complete report made to date, published in June 2021 from the WHO, shows how much the situation has changed. Among the strains of bacteria that cause urinary tract infections, one of the most common health problems on the planet, some were resistant to a common antibiotic up to 90% of the time in some countries; more than 65% of bacteria that cause infections in the blood and more than 30% of bacteria that cause pneumonia also resist one or more treatments. Gonorrhea, once an easily cured infection that causes infertility if left untreated, quickly develops resistance to all the drugs used against it.
At the same time, resistance factors – the genes that control the ability of bacteria to protect themselves – are traveling around the globe. In 2008, a man of Indian origin was diagnosed in a hospital in Sweden with a strain of bacteria that carry a group of genes that allow him to resist almost all existing antibiotics. In 2015, British and Chinese researchers identified a genetic element in pigs, pork in markets and hospitalized patients in China that allowed the bacteria to spread a drug called colistin, known as the last resort antibiotic for its disease. ability to deal with superb bugs. Both of these genetic elements, hitchhiking from one battery to another, have been spread around the world.
Despite the difficult economy of drug development, antibiotic research has not kept up. In March, Pew Charitable Trusts evaluated the global pipeline of new antibiotic compounds. Although the group found 43 somewhere in the preclinical or clinical research phases, it determined that only 13 were in phase 3, only two-thirds of those will be likely to pass the bachelor’s degree – and none possessed the molecular architecture. to work against pathogens that are already the most difficult to treat.
Warp Speed lessons
So what would be a Warp Speed Operation for antibiotic resistance?
The antibiotic pipeline needs a push in several key areas: baseline research, trial design, and post-approval incentives. Fortunately, the global response to the covid has set precedents for all three.
The first step would be to support basic research in the long run. Modern and Pfizer-BioNTech vaccines were ready to go less than a year after the first recognition of human infections. But this preparation came from 10 years of basic research without any specific disease in mind. Once the covid appeared, Warp Speed brought the Modern vaccine to the finish line with additional research funding. (Pfizer has not received research support from Warp Speed, but both companies have secured funding for manufacturing and production.)