We are losing the battle against resistant bacteria

Resistant bacteria are a ticking time bomb for global public health. By 2050, more people will die from antibiotic-resistant bacterial infections than from cancer. WHO predicts this, having updated their list of bacteria threatening public health. Unsurprisingly, all 15 bacteria on the list are resistant, meaning they cannot be killed by the antibiotics we use to treat them.

Updated WHO list of drug-resistant bacteria

Denmark is not among the countries with the highest resistance problems. However, like everywhere else in the world, everyone in Denmark is at risk of being infected with resistant bacteria. If the immune system is weak, such as in chemo patients, the infection can become serious and potentially fatal. Danes undergoing surgical procedures are also at risk due to the high likelihood of infection during and after surgery, affecting both major operations and minor ones like mole removal or wisdom tooth extraction.

Many of us live with the risk of infection

Many people in Denmark have immune systems weakened for short or long periods, and most of us will undergo surgery at some point. Thus, a large proportion of us live with the risk of infection.

Shortly after Alexander Fleming discovered penicillin — transforming previously deadly infections into minor issues fixable with an antibiotic course — he warned in 1945 that overuse of antibiotics would lead to resistant bacteria.

Yet, we have since liberally spread antibiotics worldwide, not only for sick people but also for animals in meat production. In Denmark, we are relatively restrictive, but in 2021 we still used 72.3 tonnes of antibiotics in pig farms, double the amount used for humans. This is too much and must be stopped. Every time we use antibiotics, we push bacteria towards resistance. Part of the solution to the resistance crisis is to use less antibiotics.

The worst scenario for a pharmaceutical company

Why have we not developed new effective alternatives to antibiotics, given that we have anticipated the resistance crisis for decades?

Part of the answer lies in economic interests—or the lack thereof. Pharmaceutical companies need a financial incentive to embark on the long and costly process of developing a new drug. It costs about $1 billion to develop a new drug. An infection drug used briefly by a patient (typically less than two weeks) yields little profit. There's even less profit from a drug that may only work for a short period before bacteria become resistant. The worst scenario for a pharmaceutical company is developing a new antibiotic alternative that authorities then forbid for general use, perhaps classifying it as a drug of last resort.

These factors make it a poor business for pharmaceutical companies, thus diminishing their interest in developing new antibiotics.

What to do

There are various ways to address the resistance crisis, and I believe a range of actions is needed. Here are some of the most obvious:

• Limit the prescription of antibiotics. Antibiotics should only be prescribed by individual doctors for serious cases, and their use in livestock should be excluded or strictly limited.
  
  
• Research alternatives to antibiotics. We must be open to entirely different ways of combating infections. Some researchers are working on uncovering bacterial pathogenic properties to neutralize them. It's about finding a way to coexist peacefully with resistant bacteria instead of trying to eradicate them. The more we press bacteria, the faster they develop new resistance, leading to an endless race we can never win. Others are developing vaccines and bacteriophages—viruses that can infect bacteria.
  
  
• Utilize new AI possibilities to search for new antibiotics. AI, specifically deep learning, can suggest entirely new and different molecules effective against resistant bacteria. There are already promising examples of this new strategy, and with a new Danish AI supercomputer, Gefion, the potential for Danish research in this area is enormous.
  
  
• Create better incentives for pharmaceutical companies. One approach could be selling antibiotics through a subscription model, known as the Netflix model. In this model, health authorities pay continuously for the right to use the new medicine when needed, ensuring the pharmaceutical manufacturer a predictable income.

The alarming development in antibiotic resistance is often described as a slow pandemic—a term referring to its slower spread compared to viral pandemics like COVID-19. The slower development does not make the problem any less severe, and we have every reason to take the situation seriously.