The world may end in fire; it may end in ice. Or it may end in strep throat.
So-called “superbugs” – bacteria that have grown resistant to antibiotics – are not a new phenomenon. However, a newly discovered gene called New Delhi metallo-beta- lactamase-1 (or NDM-1) has accelerated the resistance of all sorts of bacteria, making them able to withstand even the high-powered antibiotics that are currently reserved as last resorts.
India has been hit particularly hard by NDM-1 strains because of the combination of its population size, its infrastructure and sanitation problems, and the abundance of antibiotics available there. However, such resistant bacteria have been found in a variety of other countries as well, including France and Canada.
In a recent editorial, Bloomberg suggested facilitating the release of new antibiotics, since old ones may fail catastrophically against new germs. They theorize that this would help solve the problem of making antibiotics profitable, and would ensure companies continue to develop new drugs to keep up with the new bacteria. (1)
Everybody wants faster and cheaper delivery of better drugs. New drugs will undoubtedly save lives, and encouraging companies to develop them is desirable. But starting with the first batch of penicillin, every new antibiotic has initially been a wonder drug; in turn, every new antibiotic has been susceptible to nature’s vast power to adapt.
The faster a new drug is available, the more rapidly bacteria will gain the exposure necessary to become resistant to it. This is why patients infected in hospitals often face especially virulent strains of disease. It is also why India, with a history of making drugs – including antibiotics – rapidly and cheaply available to its population, is currently the epicenter of the resistance problem.
The ethical, and political, question that arises is this: Should advanced countries develop secret strategic reserves of unreleased antibiotics to be used only in case of dire national or global emergency?
This would mean allowing a certain number of people, mostly people in less developed countries, to die when infected with diseases that freely available antibiotics can no longer treat. But once the strategically protected medicine is released, it will eventually lose its ability to save lives, as other antibiotics have and will.
It’s inevitable that a country, such as India, will release a life-saving antibiotic to its population if it has the means to do so. The only way to prevent India from responding to the needs of its own citizens is to develop such a last-resort antibiotic someplace else and keep it in a vault.
Of course, this plan would still face the hurdle of supply. No drug company wants to develop a drug it can’t sell. Either governments would need to enter the pharmaceutical business themselves, or they would need to fund private companies’ research. In the latter case, governments would subsequently become the sole customer for the resulting drug or drugs.
This scenario would also create a host of political and moral dilemmas. What, precisely, would be enough of an emergency to justify tapping the reserve? In the U.S., would it be American citizens dying? Citizens who hadn’t traveled out of the country, or any citizens? How many citizens? A child? The president’s child? We don’t have enough space in nuclear bunkers for everyone, and similarly, even a large supply of strategic antibiotic reserves would not be enough (or could not be distributed quickly enough) to protect all Americans. Who would decide who has access to the limited supply?
After all, existing strategic reserves of even mundane commodities such as oil are not always tapped for the best of reasons.
There is also good reason to question the government’s ability to buy, store, manage, and refresh a supply of any given drug. Antibiotics expire, and often require storage under very specific conditions.
Additionally, government pressure on private companies to increase supply can only do so much. In the wake of 2001’s anthrax panic, the U.S. government attempted to encourage Bayer, the company that produces the antibiotic Cipro, to increase production to meet demand. While foreign companies were already making ciprofloxacin (the generic form of Cipro), patent laws kept the U.S. tied to Bayer. In order to make developing a strategic reserve antibiotic attractive, the government would have to commit to honoring such a patent. It’s hard to imagine that a private company would not be aware of the lucrative nature of a product with one giant customer who literally could not go elsewhere to refresh expired supplies.
Medical ethicists would, I suspect, be outraged by the thought of keeping a life-saving drug under wraps while risking the death of millions of people abroad. But if countries like India, or more developed nations for that matter, can’t enforce the appropriate and limited use of antibiotics, there may not be another way to prevent global disaster. Mark Toleman, a molecular geneticist at Cardiff University, told Bloomberg that it’s “a matter of time and chance” before NDM-1 reaches pathogens like Yersinia pestis, the cause of bubonic plague. (2)
Keeping a new antibiotic secret is far from ideal, but is it the only way to ensure that a global pandemic does not turn into biological Armageddon?