Around 700,000 people globally, mainly in underdeveloped countries, die every year due to drug-resistant infections including tuberculosis, HIV and malaria. Public Health England (PHE) says a failure to address the problem of antibiotic or antimicrobial resistance (AMR) could result in an estimated 10 million people dying every year by 2050. Resistance has steadily increased since systemic antibiotics were introduced in the 1930s and 1940s. What is new is the breadth of AMR and the dearth of new antibiotics being licensed. No new classes of antibiotics have been developed since 1987, and none are in the pipeline across the world, except for a small number of new individual antibiotics. The pursuit of profit by Big Pharma and the corrupt politicians who let them get away with it are responsible for the deaths from AMR and the coming ‘antibiotics apocalypse’. Charles Chinweizu reports.
Antibiotic resistance
Around 5,000 patients a year in the UK are dying from bloodstream infections, half of them caused by drug-resistant organisms. There are 300,000 healthcare-acquired infections in England every year. Across Europe, especially in the Baltic states and parts of eastern Europe, around 25,000 people die each year as a result of hospital infections caused by resistant bacteria (Chief Medical Officer’s Report, 2011).
In the US, antibiotic-resistant bacteria account for at least two million serious infections and 23,000 deaths a year. Routine surgery, joint replacements, caesarean sections and chemotherapy depend on antibiotics, and such patients will also be at risk; even a scraped knee or common infection could lead to death. In Britain, although hospital infections from bugs such as MRSA (methicillin-resistant Staphylococcus aureus) and Clostridium difficile have fallen, they are being replaced by other bacteria such as E. coli and Klebsiella pneumoniae, now the most frequent agents of hospital-acquired infection. K. pneumoniae, a common intestinal bacteria, is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.
In addition, following the ‘extremely disturbing’ discovery of drug-resistant bugs in food in 2014, the risk of exposure in the public goes beyond people with travel histories or those who have been previously hospitalised. In some parts of Africa, as many as 80% of S. aureus infections are resistant to methicillin (MRSA), meaning treatment with standard antibiotics does not work. In parts of the Americas the figure is up to 90% (World Health Organisation (WHO), 2014).
In 2013, the British government’s Chief Medical Officer, Professor Dame Sally Davies, warned about the coming ‘apocalyptic scenario of widespread antimicrobial resistance’. The threat of antibiotic drugs becoming useless through resistance is so great that if it is not tackled, in 20 years’ time routine surgery might involve a serious risk of death, and Britain would have a health system comparable to that of 200 years ago (The Independent, 12 March 2013). Days later, Thomas Frieden, director of the US Centers for Disease Control and Prevention (CDC) in Atlanta, said: ‘We have a very serious problem, and we need to sound an alarm.’ The CDC said the US faced ‘potentially catastrophic consequences’ if it didn’t act quickly. Professor Davies and the Health Protection Agency called for antibiotic resistance to be treated as a major national risk on a par with climate change or terrorism. She highlighted the ‘discovery void’ of new antibiotics being developed to take the place of ineffective ones and called the under-provision of new antibiotics a ‘market failure’ caused by ‘pharmaceutical companies allocating scarce resources to maximise profits’.
How the problem is presented by the ruling class
The British government, sections of the media, the WHO and even Davies have joined in the chorus of assigning blame for AMR to the over-use of antibiotics in clinical settings. Patients demanding antibiotics from their GPs are said to be primarily to blame. The government complains that many patients have been ‘inappropriately prescribed antibiotics, most commonly to treat coughs and colds, sore throats, ear infections…[and] estimates suggest that as many as half of all patients who visit their GP with a cough or cold leave with a prescription for antibiotics’. PHE is urging healthcare professionals and members of the public to become ‘Antibiotic Guardians’ to help overcome AMR. This is complete nonsense. What about the role of inequality, poverty, Big Pharma, poor quality housing and healthcare? Globalisation? The global food market? Capitalism?
Although over-use, over-prescription and lack of control, surveillance and stewardship of antibiotics is a problem in developed countries, and action needs to be taken to address and improve these factors, antibiotic use is not limited to humans or to clinical settings. A large quantity of antimicrobials are used every year in veterinary practice and the fishing and farming industries, mainly as growth supplements and to produce larger yields. The number of intensive farms in the UK has risen by a quarter since 2011, with many so big they fit the definition of a US mega-farm. There are now nearly 800 of these throughout the UK. The biggest house more than a million chickens, 20,000 pigs or 2,000 dairy cows in sprawling factory units where most animals are confined indoors. Just five companies, Faccenda, Moy Park, Cargill, 2 Sisters and Banham Poultry control nearly all poultry meat production in the UK. 70% of all antibiotics sold in the US are intended for use in animal agriculture to make food animals grow faster or to compensate for overcrowded and dirty living conditions. This breeds drug-resistant bacteria. Davies says that ‘while the current evidence suggests that this is not a major cause of resistance in bacteria that affect human health (at least in the UK), it does provide a further vehicle for the development of antimicrobial resistance’.
However, according to Dr Lee Ventola of AstraZeneca R&D: ‘Antibiotics used in livestock are ingested by humans when they consume food. The transfer of resistant bacteria to humans by farm animals was first noted more than 35 years ago. Resistant bacteria in farm animals reach consumers through meat products… through the following sequence of events: 1) antibiotic use in food-producing animals kills or suppresses susceptible bacteria, allowing antibiotic-resistant bacteria to thrive; 2) resistant bacteria are transmitted to humans through the food supply; 3) these bacteria can cause infections in humans that may lead to adverse health consequences. In addition, the agricultural use of antibiotics also affects the environmental microbiome, excreted in urine and stool, then widely dispersed through fertilizer, groundwater, and surface runoff’ (Pharmacy and Therapeutics, May 2015). The use of antimicrobials then through natural selection favours resistant organisms, allowing them to proliferate while sensitive ones are killed. Over time, resistant bacteria come to dominate and treatments are lost.
Furthermore, ‘the elimination of antibiotics for growth promotion alone will not substantially reduce antibiotic use in food animal production: both the animal pharmaceutical industry and the FDA estimate that growth promotion use accounts for no more than 10-15% of all antibiotics sold for use in animals, and many of the same antibiotics sold for use as growth promoters are also FDA-approved and labelled for the purpose of disease prevention’ (Lance B Price, August 2017). Animals must be raised in a way that promotes their health and where antibiotics are used to treat disease rather than being used to compensate for inadequate husbandry.
The real solutions
Infectious diseases are a marker for social and economic disadvantage and have been historically. Poor diet, substandard or overcrowded housing and environmental conditions, exposure to pests and vectors, lack of access to good healthcare and low incomes are all features of low socioeconomic status that predispose people to the acquisition and transmission of infectious diseases, according to Davies. For instance, tuberculosis (TB) rates have increased over the past decade. Most of this rise has been associated with people not born in the UK, mostly originating from South Asia or sub-Saharan Africa, homeless people, drug or alcohol users and prisoners. In 2010 the proportion of TB cases among those born outside the UK rose to 73% and the rate of TB among the non-UK-born population was 20 times the rate among those born in the UK.
According to Davies, AMR ‘does not really have a “face” because the families of most people who die of drug-resistant infections think they died of an uncontrolled infection’. But it does have a face and that is the face of Big Pharma. Pharmaceutical corporations developed 13 classes of antibiotics between 1935 and 1968, but only two since. Of the 18 largest pharmaceutical companies, 15 have abandoned the antibiotic field. Mergers and acquisitions between pharmaceutical companies have substantially reduced the number and diversity of research teams. Antibiotic research conducted in academia has been scaled back as a result of funding cuts blamed on the economic, ie capitalist, crisis. The rapid advance of AMR and the consequent need to use these drugs sparingly has convinced pharmaceutical companies that antibiotics are not an ‘economically wise’ investment. As antibiotics are used for relatively short periods and are often curative, they are not as profitable as drugs that treat chronic conditions, such as diabetes, psychiatric disorders, or asthma.
The net present value of a new antibiotic is only about $50m, compared to approximately $1bn for neuromuscular disease drugs. Chronic conditions are more profitable, and so pharmaceutical companies prefer to invest there. In addition, antibiotics are generally priced at $1,000 to $3,000 per course, while cancer chemotherapy costs tens of thousands of dollars. The low cost of sale of antibiotics and restraint regarding new antibiotic use, as they are held in reserve for only the worst cases due to fear of promoting drug resistance, leads to the reduced use and diminished returns on Big Pharma’s ‘investment’.
Pharmaceutical companies have also taken a more active interest in developing antibiotics for MRSA, rather than Gram-negative pathogens. Gram-negative bacteria are more dangerous, more resistant to antibodies and antibiotics than Gram-positive bacteria because their outer membrane is often camouflaged and therefore not recognised as foreign bodies. As explained above, MRSA is a major problem worldwide, whereas the market for treating Gram-negative organisms is smaller and potential profits lower. With Gram-negative bacteria becoming resistant to nearly all the antibiotic drug options available, this is a very myopic and insular approach. The 5,000 deaths from infectious disease in the UK each year are caused by Gram-negative sepsis. Governments must put more pressure on Big Pharma to invest in ‘less profitable’ antibiotic research and, if necessary – and it is necessary – this research and the companies themselves must be taken into public ownership. The excuses of regulatory hurdles or the high cost of R&D must be dismissed. Socialist Cuba has already proven that it does not cost $1bn to develop a single drug. The actual costs of innovation may be less than a fifth of the claimed $1bn (Khadija Sharife, ‘The great billion dollar drug scam’, 29 June 2011, Aljazeera.com). As Fidel Castro said in 1992: ‘Tomorrow will be too late to do what we should have done a long time ago.’
Fight Racism! Fight Imperialism! 261 December 2017/January 2018
