Plague and the quarantine flag: every sailor’s worst nightmare come true. It’s not like a storm: there’s no pumping or reefing to do, no double watches to stand, no lookout to keep for shoals or surf. There’s nowhere to run, no sea-room to claw out, no haven to slip into. Just the idle flap of the sails, the hacking cough of the man in the hammock at your shoulder, and the ever-pressing question: am I next?
The yellow and black scrap of canvas at the maintop means no mail, no friendly ships to commiserate with, just a lonely, feverish slide into oblivion, or, if you, by chance or constitution, manage to pull through, a hurried sea-burial for half the ship’s complement, and the herculean task of working back to port with too few hands, too few officers, and too few friends.
Such were the bad old days of plague death aboard ship, in the ghettoes, or in any other closely contained population a century and a half ago. But the world has changed, cholera and related bacterial scourges have been laid to rest, along with any number of equally vicious viral enemies.
Unfortunately, the WHO’s most recent report on antibiotic resistance has raised the specter of widespread mortality caused by simple bacterial infection from a shallow, seventy-year grave. The predictable crisis-mining headlines have splashed across the net, and, just as predictably, will vanish upon the arrival of the next journalistic novelty. Such is (and has long been) the way of news media, which must necessarily pander to a capricious and inconstant readership. But the rise of antibiotic resistant bacteria is not one more localized outbreak of some dread jungle disease or discovery of a terrifying new species of venomous spider for the internet to froth over for a day and then forget. Such incidents generate similar headlines, but they tend to threaten only small, high-risk populations. They may lead to devastating personal tragedies, but not to statistically significant changes in global mortality patterns. Antibiotic resistance threatens to significantly raise mortality rates worldwide.
In other words, if you have a short-list of problems that demonstrably threaten not just the welfare, but the very survival of you and (more importantly) your offspring, this needs to be on it. Call your congressperson, get out your checkbook, send an email to your influential friends in the NIH, and generally start raising a ruckus. If you happen to be an expert in this field and are looking for funding, come see me. I don’t have much money, but I will probably give you some anyway, because unlike tornados, or axe-murderers, or great white sharks, bacteria represent an existential threat, not just to affected individuals, but to the entire population. That means me, you, your parents, your son or daughter...
Don’t get me wrong. I am not proclaiming the end of the world. Antibiotic-resistant bacteria most likely do not represent extinction-level threats like supernovae and world-killing comets, but they do represent population-level threats at a far, far higher probability. Consider this:
"In 1900, the three leading causes of death were pneumonia, tuberculosis (TB), and diarrhea and enteritis, which (together with diphtheria) caused one third of all deaths (Figure 2). Of these deaths, 40% were among children aged less than 5 years (1)." (emphasis mine)
In other words, largely bacterial threats carried more souls into the other world than any other cause by a large margin, preying particularly upon the young. To say that antibiotic resistant bacteria will ultimately lead to similar mortality rates would be a gross exaggeration. Advances in sanitation alone are responsible for much of the decline in infant mortality since the nineteenth century, and we can expect to retain those benefits. Nevertheless, the fact remains that bacterial infections will lead to much higher mortality rates than we are experiencing now and certainly much higher rates than we are comfortable with unless we come up with a new treatment regimes.
Unfortunately, funding for research into new antibiotic treatments is not easy to come by. Other medicines are more profitable to market, and the antibiotics we have now work well in many cases. Nevertheless, the number of cases in which they are not effective is rising quickly, and very few new antibiotics are being produced. In the unending evolutionary race between drug treatment and microbial resistance, humanity is flagging, and microbes are putting on speed. We do not, however, have to fall behind. The problem of developing new treatments is by no means insoluble, but it does require a great deal of time, attention, and money. Furthermore, it will never cease to require those things (at least, in any case, in the forseeable future). If we wish to keep mortality rates as low as they have been for the last fifty years, we must recognize that significant sums must indefinitely be invested in keeping microbes on the back foot. Call it defense spending.
It doesn’t really matter where this time, effort, and money come from. Government, charity, and privately funded labs alike have much to contribute. However, in this case, waiting for the inevitable market response to a surge in demand for new drugs when mortality rates start to rise is not the best policy. Preventing the need for a (death-driven) market response would be far more humane and much farther-sighted. So, today is the day to call up your favorite charity, legislator, or genius friend who works in a research lab, to let them know that, if they have an interest in pursuing a project in new antibacterial treatment, you have money, or at least a vote, to back it. I know I will.