COMMENT | Through the looking glass: A new reality of antibiotic resistance

Morpheous:  “So, Neo, we are in this Matrix thingy, you are a battery and I am not really here.  With me so far?  I cannot actually show you the Matrix thingy, as the pill I was going give to you to meet Alice and her rabbit doesn’t work any more. 

So I want you to think happy thoughts so we can find you, drag you out of your nice warm bath and stick needles in you, ok?”

Neo: “Matrix thingy? Rabbit? Alice? Battery?  Are you on drugs?”

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Fig 1 – (www.thematrix101.com)

Agreed, it would not have made such a cool effects-laden film, but today the human race has taken the final step towards a precipice and started to look into the void.  A future where a pill, as Morpheus is forced to admit to Neo above, doesn’t work anymore.

Antibiotic resistant bacteria are now emerging as realistic chimeras as the world enters a new era; one in which there could be conversation as confusing as the one above for Neo.  For the past half-century, we have become used to the comforting familiarity of a simple, white pill.  An object, so powerful, that it has revolutionised medicine in the 20th Century and provided a comfort blanket of defence against all of natures nasty viruses.  A rock of stability on which we can branch forward into any number of previously deadly adventures, confident we can return to health once we complete the full course of antibiotics.  Don’t stop the course of antibiotics too early, is the constant message, or else you won’t get better.

But imagine a scenario where Morpheous is a Doctor trying to explain to Neo, a father, why there are no pills to save his sick daughter Alice, now unable to fight off the infection which will eventually become too much and overwhelm her.  It would make as much sense to Neo as the Matrix thingy he cannot see.

The antibiotic pill is fundamental to our daily lives; it is based on being able to pull a proverbial rabbit out of a medical hat.  The trouble is all the rabbits have been busy multiplying themselves to such an extent that all the white bunnies are so familiar to the bacteria they have been sent to eradicate, the bacteria have adapted, in every sense it has become a disobedient object.

This is a global situation, which does not respect borders or states; wealthy or poor, it does not matter; today over 50,000 lives are lost to infections resistant to antibiotics in Europe and US alone.  Globally, it is estimated that 700,000 lives are lost.  By 2050, the estimated number of lives lost will be in the region of 10 million per year (approximately 300 million over the next 35 years), eclipsing established mortality events such as cancer (see figures 2 and 3).

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Fig 2 – (HM Government and The Wellcome Trust)

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Fig 3 – (HM Government and The Wellcome Trust)

In addition, the economic cost to the world will be measured in trillions of dollars by 2050 (see figure 4).

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Fig 4 – (HM Government and The Wellcome Trust)

As the spread of antibiotic use has continued unabated throughout the latter part of the 20th and early 21st Centuries as access to cheap medicines (ironically encouraged to eliminate mass deaths) has become the norm, the end result is a phalanx of reduced effectiveness.  Children born in the 2nd quarter of the 21st Century may face the possibility of a future with greater insecurity and medical ineffectiveness than their great-grandparents.  Reversing the trends of over a century worth of medical advancements.

This is becoming a global threat to humanity; its impact has now been forced into the preparedness for national emergencies.  However, the imagined threat in the majority of these scenarios involves the preparation, distribution and administration of drugs to mitigate events such as a pandemic.  With antibiotic resistance, the drugs themselves are the problem; the solution is normally logistical, infrastructure investment and training to ensure those most in need are treated.  Thinking happy thoughts and waiting to be rescued by a white pill isn’t going to work anymore.

Antony Mullin

Antony joined the Royal Holloway MSc in Geopolitics and Security in 2015, after twelve years at BG Group in a variety of senior roles. His research interests are in global energy security.


Bibliography
Lakoff, A. (2008) ‘The generic biothreat, or, how we became unprepared.’ Cultural Anthropology, 23 (3), pp. 399-428
O’Neil, J. (2014) ‘Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations’. AMR Review paper. HM Government and Wellcome Trust [online], Available at: http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf [Accessed on 5 January 2016].
Walker, J. & Cooper, M. (2011) ‘Genealogies of resilience: From systems ecology to the political economy of crisis adaptation’, Security Dialogue, 2011, 42: 143, pp. 143-160.
Figures
Figure 1: The Matrix 101 (2015) The Matrix Synopsis [online]. The Matrix 101.  Available at: http://thematrix101.com/matrix/synopsis.php
Figure 2: O’Neil, J. (2014) ‘Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations’. AMR Review paper. HM Government and Wellcome Trust [online], Available at: http://amr-review.org/sites/default‹/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf [Accessed on 5 January 2016].
Figure 3: O’Neil, J. (2014) ‘Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations’. AMR Review paper. HM Government and Wellcome Trust [online], Available at: http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf [Accessed on 5 January 2016].
Figure 4: O’Neil, J. (2014) ‘Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations’. AMR Review paper. HM Government and Wellcome Trust [online], Available at: http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf [Accessed on 5 January 2016].
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