How much would you pay for an antibiotic to save your life, or that of a close family member or friend, £10, £100, £1,000, £10,000, even more? It’s a question we’ve not had to consider before because effective antibiotics have been available for the cost of a doctor’s prescription whenever we needed them – as well as rather too often when we haven’t actually needed them.
But this is a question we will all need to consider very soon, if predictions about the increasingly rapid rise of antibiotic resistance prove to be correct. A 49-year old woman in Pennsylvannia has just become the first person in the US to have an infection (in her case a urinary tract infection – a type of infection which affects about one million people every year in the UK), which is resistant to all antibiotics, including colistin. When such infections do not respond to antibiotics, all that is left is for the body’s immune system to fight them as best it can, and if that fails then it will progress to a kidney infection, blood poisoning, sepsis and death.
The toxic antibiotic colistin has increasingly become the drug of last resort because resistance to all the mainstream antibiotics has developed and spread. Fortunately, it is still quite rare for infections to be resistant to all antibiotics but the problem is undoubtedly increasing, with strains of E. coli, enterococci, gonorrhea, klebsiella and acinetobacter being amongst those that are now untreatable with antibiotics.
UK Prime Minister David Cameron is setting targets for the UK to reduce antibiotic use in human and veterinary medicine, but how much impact will this have? And more to the point is he, and are we, actually willing to face up to what’s needed to keep antibiotics working into the future? The question about how much we might be willing to pay arises for three very different reasons.
What would we pay to get new antibiotics?
The last genuinely new class of antibiotics, the carbapenems, was developed in the mid-1980s. Since then there have been lots of new antibiotics but they’ve all been related to existing drug families. Antibiotics in the same family are usually cross-resistant. This usually means that if bacteria develop resistance to one member of the family them none of them will cure the infection. Pharmaceutical companies have been putting little money and effort into developing new types of antibiotics since then, because the task has become more expensive. Companies can make more profit by investing in the development of drugs for chronic conditions, such as high blood pressure or Parkinson’s Disease which need to be taken every day, than they can from a new antibiotic that is reserved just to treat the (so far) relatively small proportion of patients that need it. Lord O’Neill has called for the drug companies to ‘pay or play’, in other words start investing in antibiotic research or pay a penalty, and the UK is going to put £50 million (less than £4 for a typical family from the taxes we pay) into a fund to help stimulate research
Of the new antibiotics currently under development, only three have the potential to treat the types of resistant infections currently causing most concern and there is no certainty that any of these will get through the potentially 10-year process of development and be safe enough to license. Because of this the Antibiotic Resistance Coalition (of which the SFT is a founding member) argues that we also need to use public funds to help with the development of new antibiotics, but recoup that investment over time by limiting the amount of profit the companies can make from such new drugs. Lord O’Neill has calculated that we need to spend $1.6 billion a year globally for the next 10 years to develop 15 new antibiotics, and in total he estimates “that the world can avert the worst of AMR by investing three to four billion USD a year to take global action.” “This is tiny in comparison to the cost of inaction,” he says.
The cost of treatment
While headlines normally focus on the number of people who will die from antibiotic resistant infections, the main costs to society come from those of us who get a resistant infection but don’t die, or at least not straightaway, but need longer in hospital, sometimes in isolation units for months at a time. This is where the big numbers come from that add up to the estimated cost to the global economy of $100 trillion by 2050.
According to Lord O’Neill’s report, “Of the 10 million people whom it is predicted may die from drug-resistant infections each year by 2050, more than three million will lose their lives to one bacterial infection: drug-resistant E. coli. This would also account for more than 40% of the cumulative $100 trillion lost from world production over the next 35 years.”
The cost of food
Another sign of why our success in tackling antibiotic resistance will depend on how highly we value them, has just come in the form of a recommendation from the European Medicines Agency on the use of colistin on farms. There are hopes the UK will ban this as farming bodies have already agreed in the UK to a voluntary suspension. But the EMA has only recommended a 65% reduction in use and there is no indication of how this is to be achieved or over what timescale. Annual use of colistin on farms in some EU countries is very high: Spain 177 tonnes, Italy 135 tonnes, Germany 125 tonnes, France 50 tonnes, compared with the UK which has been using one tonne per year. But we import about three quarters of our pork from the EU, and a significant amount of this from Germany.
The real answer is that we should be producing much more pork here in the UK, and producing it in well-designed extensive systems that need antibiotics only rarely. But even the UK’s intensive pig herd has fallen to new lows because consumers continue to buy the cheapest imported meat and farmers can’t make a living at current prices. So ultimately it’s in our hands. Would you be willing for more of your taxes to go on the development of new antibiotics and to pay a few pence more per kilo for organic or genuine free-range pork to save your bacon in the future?