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The Guardian
2 days ago
- Health
- The Guardian
Why antibiotics are like fossil fuels
In 1954, just a few years after the widespread introduction of antibiotics, doctors were already aware of the problem of resistance. Natural selection meant that using these new medicines gave an advantage to the microbes that could survive the assault – and a treatment that worked today could become ineffective tomorrow. A British doctor put the challenge in military terms: 'We may run clean out of effective ammunition. Then how the bacteria and moulds will lord it.' More than 70 years later, that concern looks prescient. The UN has called antibiotic resistance 'one of the most urgent global health threats'. Researchers estimate that resistance already kills more than a million people a year, with that number forecast to grow. And new antibiotics are not being discovered fast enough; many that are essential today were discovered more than 60 years ago. The thing to remember is that antibiotics are quite unlike other medicines. Most drugs work by manipulating human biology: paracetamol relieves your headache by dampening the chemical signals of pain; caffeine blocks adenosine receptors and as a result prevents drowsiness taking hold. Antibiotics, meanwhile, target bacteria. And, because bacteria spread between people, the challenge of resistance is social: it's as if every time you took a painkiller for your headache, you increased the chance that somebody else might have to undergo an operation without anaesthetic. That makes resistance more than simply a technological problem. But like that British doctor in 1954, we still often talk as if it is: we need to invent new 'weapons' to better defend ourselves. What this framing overlooks is that the extraordinary power of antibiotics is not due to human ingenuity. In fact, the majority of them derive from substances originally made by bacteria and fungi, evolved millions of years ago in a process of microbial competition. This is where I can't help thinking about another natural resource that helped create the modern world but has also been dangerously overused: fossil fuels. Just as Earth's geological forces turned dead plants from the Carboniferous era into layers of coal and oil that we could burn for energy, so evolution created molecules that scientists in the 20th century were able to recruit to keep us alive. Both have offered an illusory promise of cheap, miraculous and never-ending power over nature – a promise that is now coming to an end. If we thought of antibiotics as the 'fossil fuels' of modern medicine, might that change how we use them? And could it help us think of ways to make the fight against life-threatening infections more sustainable? The antibiotic era is less than a century old. Alexander Fleming first noticed the activity of a strange mould against bacteria in 1928, but it wasn't until the late 1930s that the active ingredient – penicillin – was isolated. A daily dose was just 60mg, about the same as a pinch of salt. For several years it was so scarce it was worth more than gold. But after production was scaled up during the second world war, it ended up costing less than the bottle it came in. This abundance did more than tackle infectious diseases. Just as the energy from fossil fuels transformed society, antibiotics allowed the entire edifice of modern medicine to be built. Consider surgery: cutting people open and breaking the protective barrier of the skin gives bacteria the chance to swarm into the body's internal tissues. Before antibiotics, even the simplest procedures frequently resulted in fatal blood poisoning. After them, so much more became possible: heart surgery, intestinal surgery, transplantation. Then there's cancer: chemotherapy suppresses the immune system, making bacterial infections one of the most widespread complications of treatment. The effects of antibiotics have rippled out even further: they made factory farming possible, both by reducing disease among animals kept in close quarters, and by increasing their weight through complex effects on metabolism. They're one of the reasons for the huge increase in meat consumption since the 1950s, with all its concomitant welfare and environmental effects. Despite the crisis of resistance, antibiotics remain cheap compared with other medicines. Partly – as with fossil fuels – this is because the negative consequences of their use (so-called externalities) are not priced in. And like coal, oil and gas, antibiotics lead to pollution. One recent study estimated that 31% of the 40 most used antibiotics worldwide enter rivers. Once they're out there, they increase levels of resistance in environmental bacteria: one study of soil from the Netherlands showed that the incidence of some antibiotic-resistant genes had increased by more than 15 times since the 1970s. Another source of pollution is manufacturing, particularly in countries such as India. In Hyderabad, where factories produce huge amounts of antibiotics for the global market, scientists have found that the wastewater contains levels of some antibiotics that are a million times higher than elsewhere. Like the climate crisis, antibiotic resistance has laid global inequalities bare. Some high-income countries have taken steps to decrease antibiotic use, but only after benefiting from their abundance in the past. That makes it hard for them to take a moral stand against their use in other places, a dilemma that mirrors the situation faced by post-industrial nations urging developing nations to forgo the economic benefits of cheap energy. This may be where the similarities end. While we look forward to the day when fossil fuels are phased out completely, that's clearly not the case with antibiotics, which are always going to be part of medicine's 'energy mix'. After all, most deaths from bacterial disease worldwide are due to lack of access to antibiotics, not resistance. What we are going to need to do is make our approach to development and use much more sustainable. Currently, many pharmaceutical companies have abandoned the search for new antibiotics: it's hard to imagine a more perfect anti-capitalist commodity than a product whose value depletes every time you use it. That means we need alternative models. One proposal is for governments to fund an international institute that develops publicly owned antibiotics, rather than relying on the private sector; another is to incentivise development with generously funded prizes for antibiotic discovery. And to address the issue of overuse, economists have suggested that health authorities could run 'subscription' models that remove the incentive to sell lots of antibiotics. In one pilot scheme in England, two companies are being paid a set amount per year by the NHS, regardless of how much of their product is actually used. Finally, we have to remember that antibiotics aren't the only game in town. Supporting other, 'renewable' approaches means we get to use the ones we do have for longer. Vaccines are vital to disease prevention – with every meningitis, diphtheria or whooping cough vaccine meaning a potential course of antibiotics forgone. And the 20th century's largest reductions in infectious disease occurred not because of antibiotics, but thanks to better sanitation and public health. (Even in the 2000s, the threat of MRSA was addressed with tried-and-tested methods such as handwashing and cleaning protocols – not new antibiotics.) Given that antibiotics themselves emerged unexpectedly, we should also be investing more in blue-skies research. Just as we no longer burn coal without a thought for the consequences, the era of carefree antibiotic use is now firmly in the past. In both cases, the idea that there wouldn't be a reckoning was always an illusion. But as with our slow waking up to the reality of the climate crisis, coming to appreciate the limits of our love affair with antibiotics may ultimately be no bad thing. Liam Shaw is a biologist at the University of Oxford, and author of Dangerous Miracle (Bodley Head). Being Mortal: Medicine and What Matters in the End by Atul Gawande (Profile, £11.99) Infectious: Pathogens and How We Fight Them by John S Tregoning (Oneworld, £10.99) Deadly Companions: How Microbes Shaped our History by Dorothy H Crawford (Oxford, £12.49)
The Guardian
2 days ago
- Health
- The Guardian
Why antibiotics are like fossil fuels
In 1954, just a few years after the widespread introduction of antibiotics, doctors were already aware of the problem of resistance. Natural selection meant that using these new medicines gave an advantage to the microbes that could survive the assault – and a treatment that worked today could become ineffective tomorrow. A British doctor put the challenge in military terms: 'We may run clean out of effective ammunition. Then how the bacteria and moulds will lord it.' More than 70 years later, that concern looks prescient. The UN has called antibiotic resistance 'one of the most urgent global health threats'. Researchers estimate that resistance already kills more than a million people a year, with that number forecast to grow. And new antibiotics are not being discovered fast enough; many that are essential today were discovered more than 60 years ago. The thing to remember is that antibiotics are quite unlike other medicines. Most drugs work by manipulating human biology: paracetamol relieves your headache by dampening the chemical signals of pain; caffeine blocks adenosine receptors and as a result prevents drowsiness taking hold. Antibiotics, meanwhile, target bacteria. And, because bacteria spread between people, the challenge of resistance is social: it's as if every time you took a painkiller for your headache, you increased the chance that somebody else might have to undergo an operation without anaesthetic. That makes resistance more than simply a technological problem. But like that British doctor in 1954, we still often talk as if it is: we need to invent new 'weapons' to better defend ourselves. What this framing overlooks is that the extraordinary power of antibiotics is not due to human ingenuity. In fact, the majority of them derive from substances originally made by bacteria and fungi, evolved millions of years ago in a process of microbial competition. This is where I can't help thinking about another natural resource that helped create the modern world but has also been dangerously overused: fossil fuels. Just as Earth's geological forces turned dead plants from the Carboniferous era into layers of coal and oil that we could burn for energy, so evolution created molecules that scientists in the 20th century were able to recruit to keep us alive. Both have offered an illusory promise of cheap, miraculous and never-ending power over nature – a promise that is now coming to an end. If we thought of antibiotics as the 'fossil fuels' of modern medicine, might that change how we use them? And could it help us think of ways to make the fight against life-threatening infections more sustainable? The antibiotic era is less than a century old. Alexander Fleming first noticed the activity of a strange mould against bacteria in 1928, but it wasn't until the late 1930s that the active ingredient – penicillin – was isolated. A daily dose was just 60mg, about the same as a pinch of salt. For several years it was so scarce it was worth more than gold. But after production was scaled up during the second world war, it ended up costing less than the bottle it came in. This abundance did more than tackle infectious diseases. Just as the energy from fossil fuels transformed society, antibiotics allowed the entire edifice of modern medicine to be built. Consider surgery: cutting people open and breaking the protective barrier of the skin gives bacteria the chance to swarm into the body's internal tissues. Before antibiotics, even the simplest procedures frequently resulted in fatal blood poisoning. After them, so much more became possible: heart surgery, intestinal surgery, transplantation. Then there's cancer: chemotherapy suppresses the immune system, making bacterial infections one of the most widespread complications of treatment. The effects of antibiotics have rippled out even further: they made factory farming possible, both by reducing disease among animals kept in close quarters, and by increasing their weight through complex effects on metabolism. They're one of the reasons for the huge increase in meat consumption since the 1950s, with all its concomitant welfare and environmental effects. Despite the crisis of resistance, antibiotics remain cheap compared with other medicines. Partly – as with fossil fuels – this is because the negative consequences of their use (so-called externalities) are not priced in. And like coal, oil and gas, antibiotics lead to pollution. One recent study estimated that 31% of the 40 most used antibiotics worldwide enter rivers. Once they're out there, they increase levels of resistance in environmental bacteria: one study of soil from the Netherlands showed that the incidence of some antibiotic-resistant genes had increased by more than 15 times since the 1970s. Another source of pollution is manufacturing, particularly in countries such as India. In Hyderabad, where factories produce huge amounts of antibiotics for the global market, scientists have found that the wastewater contains levels of some antibiotics that are a million times higher than elsewhere. Like the climate crisis, antibiotic resistance has laid global inequalities bare. Some high-income countries have taken steps to decrease antibiotic use, but only after benefiting from their abundance in the past. That makes it hard for them to take a moral stand against their use in other places, a dilemma that mirrors the situation faced by post-industrial nations urging developing nations to forgo the economic benefits of cheap energy. This may be where the similarities end. While we look forward to the day when fossil fuels are phased out completely, that's clearly not the case with antibiotics, which are always going to be part of medicine's 'energy mix'. After all, most deaths from bacterial disease worldwide are due to lack of access to antibiotics, not resistance. What we are going to need to do is make our approach to development and use much more sustainable. Currently, many pharmaceutical companies have abandoned the search for new antibiotics: it's hard to imagine a more perfect anti-capitalist commodity than a product whose value depletes every time you use it. That means we need alternative models. One proposal is for governments to fund an international institute that develops publicly owned antibiotics, rather than relying on the private sector; another is to incentivise development with generously funded prizes for antibiotic discovery. And to address the issue of overuse, economists have suggested that health authorities could run 'subscription' models that remove the incentive to sell lots of antibiotics. In one pilot scheme in England, two companies are being paid a set amount per year by the NHS, regardless of how much of their product is actually used. Finally, we have to remember that antibiotics aren't the only game in town. Supporting other, 'renewable' approaches means we get to use the ones we do have for longer. Vaccines are vital to disease prevention – with every meningitis, diphtheria or whooping cough vaccine meaning a potential course of antibiotics forgone. And the 20th century's largest reductions in infectious disease occurred not because of antibiotics, but thanks to better sanitation and public health. (Even in the 2000s, the threat of MRSA was addressed with tried-and-tested methods such as handwashing and cleaning protocols – not new antibiotics.) Given that antibiotics themselves emerged unexpectedly, we should also be investing more in blue-skies research. Just as we no longer burn coal without a thought for the consequences, the era of carefree antibiotic use is now firmly in the past. In both cases, the idea that there wouldn't be a reckoning was always an illusion. But as with our slow waking up to the reality of the climate crisis, coming to appreciate the limits of our love affair with antibiotics may ultimately be no bad thing. Liam Shaw is a biologist at the University of Oxford, and author of Dangerous Miracle (Bodley Head). Being Mortal: Medicine and What Matters in the End by Atul Gawande (Profile, £11.99) Infectious: Pathogens and How We Fight Them by John S Tregoning (Oneworld, £10.99) Deadly Companions: How Microbes Shaped our History by Dorothy H Crawford (Oxford, £12.49)
Forbes
06-08-2025
- Health
- Forbes
USAID And PEPFAR Cuts Could Lead To Massive Loss Of Life Overseas
A Lancet paper published in July evaluates data to illustrate the importance of roughly two decades of American humanitarian aid offered through the United States Agency for International Development and the President's Emergency Plan for AIDS Relief. The piece subsequently projects what the future could look like in light of the steep cuts imposed by President Trump to USAID and PEPFAR. Authors estimate that USAID-funded programs have helped prevent more than 91 million deaths globally in the past 20 years, including 30 million fatalities among children. Projections suggest that ongoing deep funding cuts—combined with the dismantling of the agency—could result in more than 14 million additional deaths by 2030. On inauguration day, President Trump ordered a sweeping 90-day spending freeze on virtually all U.S. foreign aid, including many forms of health and food assistance. An independent agency, USAID, was largely gutted. The USAID undertakes a wide range of activities, which include among other things food aid and distribution (often in conflict zones), clean water provision, maternal and infant health support, mass administration of rehydration salts for children suffering from diarrhea, malaria prevention and treatments and polio vaccinations in countries where the disease is still endemic. The agency was established under President John F. Kennedy in the early 1960s to administer humanitarian aid programs around the world. Congress appropriates funds for USAID's operations. The agency employed roughly 10,000 people, two-thirds of whom worked overseas. In fiscal year 2024, the agency received more than $44 billion in federal funding. Most of that money was spent in Asia, sub-Saharan Africa and Europe (primarily on humanitarian efforts in Ukraine). While a considerable sum, it merely accounts for 0.4% of the entire federal budget. The Trump administration has slashed 86% of USAID funding. Only a small fraction of aid programs remains in place. The employee head count is now under 500. As carried out by successive administrations since Bush, including the first Trump administration, PEPFAR represented the largest commitment in history by any nation to address a single disease, HIV/AIDS. But gradually the second Trump administration is unraveling this initiative, too. KFF reported that while PEPFAR received a limited waiver on Feb. 1, allowing it to continue certain 'life-saving HIV services,' the waiver doesn't include essential pre-exposure prophylaxis for anyone other than pregnant and breastfeeding women. The State Department has sought $2.9 billion in funding to continue HIV-AIDS programs in the next fiscal year—considerably lower than PEPFAR's current budget of $4.1 billion. Moreover, USAID was the main agency working on behalf of PEPFAR. Without USAID and its staff, PEPFAR's implementation capacity has been seriously affected. Going forward, the Trump administration intends to transform PEPFAR from an aid program to one that is aligned with its 'America First' priorities. The plan, as described by the New York Times, outlines the administration's intentions to 'transition' countries off of PEPFAR, in some cases within two years. The program would in essence no longer be involved in aid and saving lives overseas. Rather, it would focus on detecting outbreaks that could threaten the U.S. and at the same time create new markets for American drugs and technologies. On the ground, journalists are painting a grim picture of the implications of the drastic curtailment in U.S. aid. A story in America Magazine, for example, describes in detail the local impact in Eswatini, a country in Southern Africa, of the gutting of USAID and reductions in PEPFAR. Cuts have severely limited access to HIV treatments and testing in clinics. During the height of the HIV/AIDS pandemic, the population of Eswatini plummeted, and life expectancy dropped from 61 in 1988 to 44 by 2003. It reverted to 61 in 2023, thanks in large part to USAID and PEPFAR. But now the gains in health outcomes are in jeopardy. The ramifications of a greatly diminished U.S. presence in health aid, international development and disaster assistance could be profound, specifically around the global humanitarian programs which rely on USAID. In terms of international assistance, the U.S. was by far the world's largest donor. The U.S. spent $68 billion on international aid in 2023. And the Trump administration's actions are also affecting what is termed the President's Malaria Initiative, an organization also founded by former President Bush. Through the work of this entity, the U.S. had become the global leader in donating to anti-malaria programs and research. According to the New York Times, one of Trump's executive orders has led to two-thirds of the staff being let go from the Malaria Initiative. And by pulling out of the World Health Organization, Trump further diminishes the critical role the U.S. plays in combating neglected tropical diseases, such as leishmaniasis, river blindness, Dengue fever and trachoma. These preventable and mostly treatable infectious diseases affect millions of people in tropical regions of the world, causing severe health problems, including anemia, blindness, chronic pain, infertility and bodily disfigurement. Historically, despite the large burden imposed by neglected tropical diseases on many people, they've received a relatively small portion of resources for drug development and treatment distribution. U.S. aid agencies had been filling some of the void. Until now.
Telegraph
05-08-2025
- Health
- Telegraph
Labour's decision to close the Fleming Fund is a false economy that puts our national security at risk
Health emergencies rarely respect borders or budgets. As I write, the world is facing an antibiotic emergency, with bacteria rapidly evolving resistance to the treatments we depend on to counter infectious diseases. Without effective antibiotic treatments, global health and the global economy are defenceless against the likes of pneumonia and sepsis. Antibiotics are the infrastructure of modern medicine, making chemotherapy, caesarean sections and hip replacements possible. More than 1.1million people die across the world every year because of antibiotic resistance, including 35,000 in the UK alone. These trends are increasing and inter-generational, with deaths in children tripling in the last three years. For the last decade, the UK has been at the forefront of global efforts to tackle the wider threat posed by antimicrobial resistance (AMR). While antibiotic resistance poses the single biggest threat to modern medicine, AMR points to a serious problem for all types of antimicrobial agents – antifungals, antivirals, and antiparasitics – threatening to reverse all the significant gains we've made against HIV, malaria, and tuberculosis. The UK's Fleming Fund has been a bulwark against such threats: building laboratory capacity in 25 low- and-middle-countries to detect emerging AMR outbreaks, allowing for proactive, data-driven responses before they escalate into global crises. Among many other things, the Fleming Fund has tripled the genomic sequencing capacity across the entire African continent – which even pivoted to detect Covid-19 variants. The UK government's decision to shut down the Fleming Fund is a false economy and directly puts our national security at risk. It will cost lives, as well as precious GDP that could be spent on frontline NHS services. If we are to learn any lessons at all from Covid-19, it should be that we cannot afford to cut corners when it comes to preventing and preparing for inevitable pathogenic threats. Bold investment to protect against AMR Decisions made today will directly impact our ability to counter and contain AMR pandemics in the very near future. When I was Chancellor in 2023, the Treasury recognised the economic health ramifications of AMR, and the UK government commissioned economic studies to better understand the risks and opportunities. The Institute of Health Metrics and Evaluation found that if AMR resistance accelerates in line with poorer-performing countries, the world faces an additional seven million deaths globally by 2050. The Center for Global Development then estimated that economically, this would wipe $1.7 trillion annually off global GDP by 2050 and it will cost $175 billion extra a year for health systems to treat people. Country-level estimates released recently estimate that the British economy would be $59 billion smaller in this scenario and the UK would spend an additional $2.8 billion a year treating superbugs. $296 billion and $188 billion would be wiped off the US and EU economies respectively. In contrast, this research shows that there would be large economic benefits to the UK and elsewhere if we invest in improving the treatment of infections. With the UK economy facing significant challenges and the NHS workforce facing rising pressures, now is the time to act boldly and invest proactively to protect against AMR. Whilst the UK alone cannot solve AMR, the UK can and should leverage its world-leading technical expertise and diplomatic leadership through the Fleming Fund, its Special Envoy on AMR, Dame Sally Davies, and other global investments in AMR. Even in a world where only 0.3 per cent of gross national income (GNI) is earmarked for international aid funding, there must be a budget line for AMR. If we are to drive economic growth and build resilience against health threats at home and abroad, we need decisive action with investments that put health security first. With an evolved Fleming Fund, we can mitigate against the worst effects of AMR by supporting research and development of new antibiotics, increasing access to treatments in countries where lack of access accelerates resistance, embedding large-scale education and training programmes to ensure the sustainable and responsible use of existing antibiotics, and harnessing AI for diagnostic tests and surveillance for the UK and the countries most severely impacted by AMR. A world without the Fleming Fund puts even greater pressure on UK government and the life sciences sector to find new ways to prepare for the pandemics we already detect and those we are yet to detect, to safeguard UK health and economic security. Now is the time for the government to step up.
