public health

Fighting the health crisis of tomorrow

Today, climate change is universally recognized as the extinction-level threat of our future. But another monster lurks, one you probably haven’t thought about.

In the next few years, our world will face a public health crisis: bacteria that are resistant to antibiotics. In 1928, when the first antibiotic was discovered, it was perceived by society as a miracle, an end-all solution to their illnesses. Yet, as the decades have passed, more and more bacteria are evolving to adapt against their killers, antibiotics. In the U.S. alone, the CDC estimates that 23,000 deaths and 2,000,000 infections are caused each year by bacteria resistant to single antibiotics. Extremely rare strains of bacteria, such as Mycobacterium abscessus, aren’t affected by any available medications. This is alarming – if a single strain of these bacteria infected a populous area, it could very well escalate into an epidemic.

This disquieting reality can be explained by Charles Darwin’s laws of natural selection. When someone pops out antibiotics and takes them one after another, 98% of the harmful bacteria in their body will die, but the 2% that are immune to the antibiotics, due to random genetic mutations, will survive. History is told by the victors. Because only the bacteria that survive antibiotics live long enough to divide into new cells, over many bacterial generations (which may be just a few years), the gene pool will shift towards those with favorable traits. Soon enough, the 2% of drug-resistant bacteria will become 4%, the 4% will become 8%, and so on. We’ve been lucky that this process has taken several decades to occur around the world. But now, almost 70% of common bacteria have developed immunity to antibiotics. We face a major crisis if we can’t keep up with them.

So, how do we do that?

Meet the bacteriophage.

A bacteriophage has an icosahedral “head” that encapsulates RNA, as well as a tall body and spider-like legs.

Sounding like something out of a sci-fi movie, bacteriophage literally translates to bacteria eater. Bacteriophages are viruses that attack bacteria. Just like how common viruses inject DNA into human cells to infect our bodies, bacteriophages can be thought of as “good viruses” that infect bacterial cells. After injecting viral DNA into bacterial cells, bacteriophages will create hundreds of copies of themselves to burst the bacterial cell, killing it, and enabling the new clones to do the same to other cells. This can pose a serious threat to infections in your body.

Whereas antibiotics kill a wide range of bacteria – including those that are beneficial –bacteriophages are specialized to attack only specific bacterial species. This preserves your body’s intestinal bacteria, essential to digestion. Antibiotics are inherently unable to reach this level of specificity. Furthermore, bacteriophages are especially useful because of their ability to adapt and evolve just as bacteria do. They, too, are made of the same nucleic acids and rely on the same nucleic acid replication processes that allow genetic mutations to occur. Consequently, they’re able to evolve over time. This allows humans to keep pace with the ever-evolving strains of bacteria without investing in the massive amounts of research necessary to churn out new antibiotics whenever old ones become defective.

And perhaps most importantly, bacteriophages have empirically proven to excel where the best of antibiotics have failed. For example, in Nevada, a patient’s lungs were infested with a strain of Mycobacterium abcessus resistant to all known drugs. Alternative medicine like bacteriophages were her last source of hope. Doctors gave her a mixture of bacteriophages via an IV, and remarkably, her symptoms vanished in the coming months.

That sounds great, so why aren’t bacteriophages commonly used?

Perhaps the primary reason why the use of bacteriophages is uncommon is because there has been insufficient investment in the research and development of large-scale bacteriophage production. Big pharma, or pharmaceutical industrial powerhouses, haven’t had the need to invest in bacteriophage research – until now, traditional antibiotics have worked just as well. In addition, it’s difficult to patent a biological organism like a virus, so companies aren’t assured that they’ll be given the rights to their biological “inventions.”

Yet, a problem perhaps even more fundamental remains. In a world where 1% of the world’s population controls 45% of the world’s wealth, even when biomedical researchers innovate new treatments, their efforts can be invisible to billions around the world. Some argue with more R&D, big pharma will be able to reduce the costs of production and make medicine affordable to more people. While that may be true, this perspective ignores the crux of the issue: The disparity in healthcare between first-world areas and underserved communities is the product of a multitude of interwoven factors – it can’t be remedied by a single-pronged approach. Instead, we must support the comprehensive efforts of NGOs in increasing public health awareness and providing low-cost healthcare, all the while investing money and resources in these areas. Perhaps a comprehensive solution, in addition to R&D, can help address the multifaceted nature of the public health crisis.

The path ahead lies riddled with difficulties for families around the globe. Will we humans be able to use our ingenuity to outwit a species that has been around for 2 billion years before us? Or, will we become another extinct species, lost to the specter of time?

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