Antimicrobials and antibacterials revolutionised medicine from the mid 20th century after Alexander Fleming made his amazing discovery of identifying penicillin.
But antibiotics themselves are not new, indeed traces of tetracycline (an antibiotic still in use today) were found in skeletons from ancient Nubians (350-550 AD) as well as in the guts of ancient mummies. So for as long as antibiotics have existed, so too has bacterial resistance, but not on the scale that the world is seeing today.
Penicillin was heralded as a miracle drug – as indeed it was and still is – and was heavily used in World War II to treat Allied troops, despite Fleming’s warning that overuse could lead to mutant bacteria. Use of antibiotics in animals first came about post-war when a British-American biologist Thomas Jukes discovered that in-feed use of tetracycline could help advance the growth of chickens.
By the mid 1950s, Fleming’s warning had become a self-fulfilling prophecy as resistance to penicillin in humans had gradually built up due to the wide availability of the drug. By the turn of the millennium the world was aware of the prevalence of antibiotic resistance with the WHO publishing a global strategy for its containment as early as 2001.
By 2015, the Global Action Plan on Antimicrobial Resistance (AMR) was adopted at the 68th World Health Assembly in Geneva.
When Lord O’Neill published his report into ‘Tackling drug-resistant infections globally’ in May 2016, he claimed one of the first priorities was a global public awareness campaign – including children and young people – and educating them about the problem of drug resistance.
Building awareness is the first step in addressing the public’s behaviour and it seems from Wellcome Trust research that there is much work to be done in that area. Further research carried out by the Wellcome Trust to explore a consumer perspective on antimicrobial resistance completed in June 2015 revealed that the issue is still widely misunderstood.
Behaviour change is also critical in the farming sector, and much has been done over the past five years to create this. More updates about UK farming’s actions to reduce antibiotics use in News & Updates (link).
The importance of other countries recognising the threat and acting to curb use is so significant, the UK has decided to adopt a global leadership role in the issue. In 2016 this resulted in an historic United Nations declaration on antimicrobial resistance.
In July 2016 ReAct Europe published a development dialogue paper in which it concluded that there is no single ‘silver bullet’ to address AMR. It said what was needed was an adaptive, multi-pronged approach that operates across the sustainable development goals, involving many stakeholders. It claimed that the world could not just look to the biomedical or health sectors for solutions, that AMR is a systems failure requiring a cross-sectoral response.
One of the main challenges is addressing the pipeline of supplying new antibiotics. In this subsection of his bigger report, O’Neill set out proposals to make antibiotics R&D more sustainable but it requires global political leadership to ensure such interventions work. Developing a new class of antibiotic is only the start, it needs around 50 to 300 hospitals to be enrolled to trialling such drugs. The Wellcome Trust published a report in October 2016 on how a clinical trial network could help in this process.
Finally, between 2010 and 2030, the global consumption of antimicrobials is predicted to increase by 67%, from 63,151 ± 1,560 tons to 105,596 ± 3,605 tons. Up to a third of the expected increase in livestock is based on a prediction that routine use of antibiotics for disease prevention or growth promotion will rise in many middle-income countries. In Europe, use of antibiotics for growth promotion has been banned since 2006.