Antibiotic resistance: only global co-operation will succeed against this deadliest of threats
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Version 0 of 1. The news last week was awash with threats to global security: al-Qaida-sponsored stealth bombs; British jihadists fighting in Syria; and – least tangible, but perhaps most deadly of them all – antimicrobial resistance. Scientists have been sounding alarm bells about the inevitability of the evolution of disease-causing microbes to become resistant to drugs for decades. Global leaders are now taking heed, with the prime minister launching an independent expert review. The facts are stark. No new classes of antibiotic have been developed for 25 years: the pharmaceutical industry has focused on more lucrative types of drug development. Antimicrobial resistance is already estimated to cause 5,000 deaths a year in Britain and predictions for the future are frightening, with scientists forecasting that resistance could ultimately make any treatment that relies on suppressing our immune systems dangerous. There are echoes here of the climate change challenge. Neither climate change nor antimicrobial resistance can be solved by nations acting alone. On the one hand, their scale is immense: disease and evolution do not respect national boundaries. The rate of depletion of the planet's natural resources affects the whole of humanity but no one country alone has the incentives to make the radical shifts needed. On the other, their scale is intensely human: their solution lies in hundreds of millions of people making small changes to their day-to-day behaviour. And in the case of both, developments in science and technology have a critical role to play. All of this means the typical responses that 20th-century developed nation states are used to taking to protect their populations stand defunct in the face of these super-challenges. There are important lessons to learn from climate change. First, it has illustrated the extent to which we lack the institutions capable of facilitating co-ordinated global action. World leaders are becoming more inward-facing as failed military interventions such as Iraq and Afghanistan have gradually eroded the postwar spirit of co-operation. Closer to home, the European Union is proving an easy scapegoat for many governments across Europe dealing with the popular backlash of an economic crash. Second, the limited progress made so far on climate change illustrates how little we know about how to change human behaviour. Advertisers have deployed sophisticated insights about how to tap into the human psyche to make money, but behavioural science is yet to be applied to protecting the planet. As the public seemingly ignores the calls to action of campaigners and scientists, there is a danger that they become ever shriller: let's tell people the truth of how awful it is to shock them into action. Yet this switches people off rather than motivating them to act. Last, climate change has taught us that science is not intrinsically benevolent. It has delivered innovations that have transformed humanity. But these have not emerged from a private sector putting security and enlightenment before profit, but as a result of a public-private partnership involving significant state investment. Advancements in low-carbon tech have been constrained by industry's perception of limited profits; likewise, drug companies will not invest in antibiotics unless they see benefits for shareholders. The government's investment in pharma has failed to address this; instead, policies such as the Patent Box, introduced in the face of heavy lobbying from industry, have subsidised investment that would have been made anyway. There are some reasons for optimism, though. The science around antimicrobial resistance is less contested than that of climate change, and the laissez-faire assumption that the state has no place intervening in innovation is being challenged, post the banking crisis. Antimicrobial resistance will affect rich and poor countries alike, unlike the effects of climate change, concentrated on some of the poorest parts of the world, which may make co-operation easier. David Cameron is to be commended for taking a lead on this globally. But there is a danger that the review ends up a weighty tome gathering dust on a shelf next to the 2006 Stern review on climate change. The war on disease cannot be fought with an expert report: it will require real action from governments around the world to build international alliances, engage with behavioural science and rethink their relationships with the pharmaceutical industry. |