The bugs are winning

Antibiotics are one of the truly remarkable discoveries of the modern era.* By suppressing or eliminating infections, the widespread availability of relative cheap antibacterial drugs has contributed to significant reductions in the mortality rate and consequent increases in life spans. Antibiotics have thus serves as an enabling cause for the unprecedented global population boom of the last century or so.

However, microbes may now have us at checkmate, developing resistances and immunities to our antibiotics faster than we are producing new ones. Despite five decades of warnings from public health authorities, global response has been slow and poorly communicated. Resistant strands are spreading and some are immune to all contemporary drugs.

And it is largely our fault. The overuse and misuse of antibacterial drugs have enabled and encouraged these strains to gain a foothold and spread. Whenever their use is either unnecessary or discontinued prior to a complete course, the surviving bugs (who will be the ones least susceptible to the drug) are left to breed. Just as we have "helped" evolution in our animal husbandry for centuries, selecting the most productive livestock to preserve their genes, so we are helping the evolution of superbugs, selecting those who don't fall down at the first sight of an antimicrobial drug. We are killing off the weaklings and leaving the heroes to breed. And they are fearsome warriors, being perhaps the most effective and feared killers throughout the history of civilisation.

Being the son of a physician, important health lessons like avoiding the abuse of antibiotics were inculcated early. We used them only for bacterial problems that lacked other solutions and always finished our course of drugs. Yet personal responsibility is only effective when widespread. My vigilance seems wasted when others take a few pills as a precaution every time they feel under the weather.

This issue seems to suffer from some remarkable similarities with climate change: a dangerous by-product of a highly desirable human activity with an insidious effect over long periods of time requiring global regulative co-ordination and a personal culture of restraint. It is hard to see in either case how a response adequate to the scale of the problem can be mobilised in the timeframe required amidst the various competing interests and under the ponderous influence of cultural inertia.

Like many of our battles, we go into this one ill-prepared, with failing equipment and not always even sure who the real enemy is. What does it look like to lose well?
*More specifically, I am referring to antibacterial drugs, since there are other microbes than bacteria and other agents that suppress them than antibacterial drugs. However, in common usage, most people mean the latter when using the term antibiotics.