BY DR IAN SMITH

As we approach 2017, despite being at the apex of medical science, Mankind is in imminent danger from two major public health threats – deadly pandemic flu / viral pathogens and massive antibiotic failure.  Together these two looming threats could wipe out centuries of medical and technological advances and return the world to the Dark Ages.

It can happen right here in Britain. This is no exaggeration.

The Black Death was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people and peaking in Europe in the years 1346–53. Analysis of DNA from victims in northern and southern Europe published in 2010 and 2011 indicates that the pathogen responsible was the Yersinia pestis bacterium, probably causing several forms of plague.  The Black Death is thought to have originated in the arid plains of Central Asia, where it then travelled along the Silk Road, reaching the Crimea by 1343. Spreading throughout the Mediterranean and Europe, the Black Death is estimated to have killed 30–60% of Europe’s total population. In total, the plague reduced the world population from an estimated 450 million down to 350–375 million in the 14th century. The world population as a whole did not recover to pre-plague levels until the 17th century. The plague created a series of religious, social, and economic upheavals, which had profound effects on the course of European history.

A year back, scientists reported that antibiotic resistant superbugs now have the capability to break through our last line of defence:

“Researchers have found a gene that makes bacteria resistant to the last line of antibacterial defense, and it is now being passed down through bacteria — potentially leading to a huge and unstoppable epidemic”

(Source the Independent November 19, 2015)

The Global Antibiotic Crisis has reached the point where common injuries such as minor cuts and abrasions or even a sore throat can kill you due to massive and widespread antibiotic failure. Margaret Chan, Director General of the W.H.O, has announced that the era of safe medicine is ending.  The end of the Antibiotic Age has seen MDRB (multi drug resistant bacteria) proliferate out of control.

The fact is we have been living within a protective bubble since penicillin became widely available after WWII and streptomycin in the 1950s.  That bubble will soon burst. Diseases such as Tuberculosis, that seemed vanquished fifty years ago, have resurfaced and now multi drug resistant TB strains have spread from the developing world into major European and US cities. Entire classes of antibiotics have been compromised, such as CRE (carbapenem-resistant enterobacteriaceae), and are now failing at an alarming rate.

Antibiotic resistance has been accelerated by horizontal gene transfer (HGT, where a genetic modification made by one bacterium can be shared with other bacteria, even those of different strains).  This transfer happens thanks to plasmids, small bundles of DNA, which may impart adaptations to improve the organism’s survival, such as antibiotic resistance. These plasmids are often shared when bacteria come into contact with each other.

The world could soon be “cast back into the dark ages of medicine” unless action is taken to tackle the growing threat of resistance to antibiotics, the last UK Prime Minister, David Cameron, said.

“Sexually-transmitted Gonorrhea has basically been developing resistance against every medication we’ve thrown at it,” said Dr Manjula Lusti-Narasimhan, a scientist in W.H.O’s department of STDs.  New topical antimicrobials will need to supplement antibiotics.

“It is not if we will have a deadly global pandemic, but when”

Dr Margaret Chan the Director-General of W.H.O

This antibiotic crisis is reaching the point where routine operations and all major surgery could become impossible within a few years, because patients will not survive post surgical infections. Every kind of surgery from Caesarean sections, hip replacement, all transplants, heart surgery and cancer operations will  be untenable.

In the post antibiotic age, deaths from trauma: car accidents, stabbings, industrial mishaps and even minor wounds; will run out of control.  Children will die of strep throat, women will die in childbirth from simple infections and even stomach ulcers could become deadly.

The consequences of global antibiotic failure will be massive economic meltdown, breakdown of society, civil disorder and chaos.  The effects of antibiotic failure will be global; there will be massive depopulation, famine, breakdown of essential services and upheaval.

There are few new antibiotics in the development pipeline and there won’t be any major new antibiotics available in the near future.  When new antibiotics do become available many will be quarantined and held off the market lest bacteria develop resistance. They will only be used in times of severe emergency.

In order to protect the remaining antibiotic umbrella there is an urgent need for new drug compounds that can replace antibiotics for applications such as stomach ulcers, diabetic leg ulcers, urinary tract infections, cystitis and a range of topical antimicrobial treatments for Gonorrhoea, cuts, abrasions, minor wounds etc.  Replacing antibiotics for as many applications as possible will preserve patients’ remaining viable antibiotics for emergencies.

Ian is a retired Canadian medic living in London and a Country Squire Magazine Guest Writer.