Beware the dreaded hyperbole. That is always in the forefront of my mind when writing for you. But it is, I’ll admit, hard to avoid when it comes to antimicrobial resistance. As existential threats go, it’s a doozey.
We’ve all heard talk of the calamity that awaits. Routine surgeries no longer available because of the danger of infection, simple cuts on a child’s finger resulting in disaster... it is the stuff of nightmares. Yet, it is far from fiction.
Our understandable addiction to antibiotics – those near-miraculous little medical interventions which have saved incalculable lives – has essentially honed natural selection to a fine point. We have recklessly created multitudes armed to the proverbial teeth with molecular modifications rendering our go-to weapons as pea-shooters against a Panzer (...I did mention it was hard to avoid).
And we can’t say we weren’t warned. Sir Alexander Fleming himself was stark in his predictions: “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
And so it proved to be. Now the question is, of course, what to do about it? And while that is a question occupying many, there is a notable absence. Big Pharma. In the 1980s, 25 drug companies had active antibiotic discovery programmes. Today that figure has dwindled to just three: Pfizer, MSD and GSK.
Why? Because Big Pharma isn’t a charity. It will not do anything without at least the chance of making a profit, and the low returns on investment for antibiotics currently means it just isn’t worth their time. And yes, we can rail against it and we can tut and grow despondent at the cold power of revenue. We can even entertain ideas of renationalisation – for many, a deeply appealing way to rescue the endeavour from the shackles of the profit and loss sheet – but for this to actually happen, politics will be the ultimate variable.
This is something the Labour Party are banking on. Jeremy Corbyn has announced they would establish a state-funded generic drug manufacturer to make medicines affordable to all, should they take the reins. Whether their plans extend beyond generics to development is not clear.
What is clear however is that while the turbulent political waters bubble over, people are dying because we don’t have a solution. The invisible hand of the market can’t be left un-guided here. In the end we will need to influence the capitalist nature of drug development – something even the Conservatives know. Back in 2016 Cameron commissioned former economist, Lord Jim O’Neill, to examine the economic repercussions of AMR. You know Tories are getting serious when they invite the money men to have a look.
Now, as the findings of that report are being put into practice with a reformed NHS payment model for antibiotics, we have to hope that the silver we cross their palms with will tempt Big Pharma to up their game.