Technology

The next pandemic is already here. Covid can teach us how to stop it.


During the first few decades after the introduction of penicillin, bacterial adaptation and drug discovery jumped each other, keeping the ability of antibiotics to treat infections ahead of pathogens’ skill at evading them. But by the 1970s, that mid-century wave of innovation had faded away. Antibiotics are hard to make: drugs must be nontoxic to humans but lethal to bacteria, and they must use mechanisms against which dangerous bacteria have not yet developed defenses. But the transition from antibiotics produced in nature to the manufacture of compounds in the laboratory has been more difficult.

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Meanwhile, the resistance jumped forward. Overuse of medicine, agriculture and aquaculture spreads antibiotics into the environment and allows microbes to adapt. Between 2000 and 2015, the use of antibiotics earmarked for the deadliest infections nearly doubled worldwide. Levels of resistance vary by organism, drug, and site, but the most comprehensive report made to date, Posted in June 2021 From the World Health Organization, it shows how quickly the situation is changing. Among the strains of bacteria that cause urinary tract infections, one of the most common health problems on the planet, some have been resistant to common antibiotics up to 90% of the time in some countries; More than 65% of bacteria that cause bloodstream infections and more than 30% of bacteria that cause pneumonia are also resistant to one or more treatments. Gonorrhea, once an easy-to-cure infection that caused sterility if left untreated, is rapidly developing resistance to all the drugs used against it.

At the same time, resistance factors — the genes that control bacteria’s ability to protect themselves — travel around the world. In 2008, a man of Indian origin was diagnosed in a hospital in Sweden with a strain of bacteria that carried a genetic set that allowed it to resist almost all existing antibiotics. In 2015, British and Chinese researchers identified a genetic component in pigs and pork in markets and hospital patients in China that allowed bacteria to defuse a drug called colistin, known as the antibiotic of last resort for its ability to tackle the worst resistant germs. Both of these genetic elements, passed from one bacterium to another, have been spreading across the world ever since.

Faced with the challenging economics of drug development, antibiotic research has not kept pace. In March, the Pew Charitable Trusts evaluated the global pipeline of new antibiotic compounds. Although the group found 43 somewhere in preclinical or preclinical research stages, it determined that only 13 were in stage 3, and only two-thirds of those likely had access to licensing – and none of them possessed the molecular structure to act against pathogens. Which is already the most difficult treatment.

Lessons from Warp Speed

So what would Operation Warp Speed ​​look like for antibiotic resistance?

The antibiotic pipeline needs strengthening in several key areas: basic research, trial design, and post-approval incentives. Fortunately, the global response to the coronavirus has set precedents for each of these three.

The first step would be to support basic research over the long term. The Moderna and Pfizer-BioNTech vaccines were ready less than a year after the first detection of human infection. But that predisposition came from 10 years of basic research with no disease specific in mind. Once covid emerged, Warp Speed ​​brought the Moderna vaccine to the finish line with additional research funding. (Pfizer did not receive research support from Warp Speed, but both companies did get funds for manufacturing and production.)



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