VitaMins Health: Antimicrobials – don’t take them for granted!

What are antimicrobials?

An antimicrobial is a substance that either kills microorganisms or halts their growth. Examples include antibiotics, antivirals, antifungals and antiparasitics. They are used in the prevention and treatment of infection.

The modern era of antibiotics started with the amazing, but accidental discovery of penicillin by Sir Alexander Fleming in 1928. Since then, the development of antimicrobials has transformed modern medicine and saved millions of lives. Therefore, any resistance to standard antimicrobial usage is a significant problem. Pathogens (bacteria, viruses, fungi, and parasites) change over time and can develop the ability to survive treatment by existing antimicrobials. This is known as antimicrobial resistance (AMR) and results in increased transmission of diseases and infections which are difficult to treat.

Antimicrobials are central to modern medicine and have contributed to significant increases in life expectancy in the 20^th century, but according to the National institute for Health and Care Excellence, antimicrobial-resistant infections now result in at least 700,000 deaths worldwide each year.

Unfortunately, the situation is worsening, and AMR is increasing. According to the World Health Organization (WHO), this is due to overuse and misuse of antibiotics in both humans and animals, alongside poor infection prevention and control. Although at a basic level, AMR is unavoidable due to natural selection, the misuse and overuse of antibiotics is accelerating the problem. Various countries have attempted to tackle the issue. For example, in the UK, the Department of Health and Social Care published a five-year Antimicrobial Resistance strategy beginning in 2013 to help slow the development and spread of AMR. The strategy resulted in a decrease of 4.5% in antibiotic prescriptions in England between 2013 and 2017. In addition, the World Health Organization (WHO) have declared a World Antimicrobial Awareness Week (this year taking place 18^th – 24^th of November) to raise awareness and develop strategies to tackle this serious emerging problem.

Unfortunately, despite these efforts, AMR is still one of the most significant worldwide challenges for healthcare providers. In the developed world, we have come to rely on and expect common infections to be treatable. However, this common reliance is under threat due to ever emerging pathogens that are resistant to currently available drugs.

Resistance to nearly all antibiotics that have been developed has been seen. Therefore, the production of new antibiotics is vital. However, forthcoming developments are not very promising, with only a handful of new antibiotics in the pipeline classed as “innovative”. Antibiotic shortages caused by AMR are an issue that is not concentrated within certain areas, but is instead impacting all developing and developed countries.

The resistance that we are seeing today is a relatively new problem; during the 60s, 70s and 80s, a steady stream of new antimicrobials meant that when an infection became resistant to one drug, an alternative was on hand to be used instead. Antibiotics have saved lives and have played a vital role in achieving advances in medicine and surgery. As well as treating common infections, they play a key role in managing more severe diseases. For example, they have treated or prevented infections in chemotherapy patients, as well as those with chronic diseases or those recovering from surgery.

What if antibiotics stopped working?

Since antibiotics have become so commonplace in developed societies it is now hard to imagine a world without them. But there is the real possibility that we will reach a point when there are few or no working antibiotics available. If we consider the implications of this, the picture looks bleak.

According to the Chief Medical Officer for England, antimicrobials add an average of 20 years to life expectancy across the world. So, would we see a sharp decline in life expectancy as both common and complex diseases we are familiar with can’t be treated as effectively? In 1920 the US life expectancy at birth was around 53 years. Now, it is nearer to 80 years. This is largely due to the discovery and development of antibiotics.

The UK review on Antimicrobial Resistance estimates that if all antimicrobials are lost, this alone would cause ten million more deaths annually by 2050. To give this some perspective, this is higher than the annual number of deaths from all cancers.

And the cost of AMR extends beyond individual health implications into national economies and their health systems through prolonged hospital stays and the need for more expensive and intensive care.

What does this mean for pension plans and insurers?

There are a range of possible outcomes going forward. There is clear global recognition of the severity of the problem, and this could be the catalyst for a significant change and improvement both in the use of antibiotics and the development of alternative treatments. However, if the effort doesn’t pay off, there is the potential for significant reductions in life expectancy and many excess deaths.

We would love to hear your thoughts on this subject.