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On May 1st, the World Health Organization released a report stating that we have reached the “post-antibiotic” era, a time in which many of our common infections are no longer treatable by drugs. According to the report, “The problem is so serious that it threatens the achievements of modern medicine…Far from being an apocalyptic fantasy, [it] is instead a very real possibility for the 21st century.” Alexander Fleming, the man who gave us the antibiotic when he developed penicillin, stated, “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” If he had been alive to see the horrors of dosing livestock with antibiotics for years and years, he would have no doubt added a quote about that as well. Infectious diseases are equal opportunity pathogens, the rich and poor alike are vulnerable to them. However, for over a century, epidemiologists have known that health and socioeconomic status are highly correlated. The poorer you are, the higher your risk of being sick…from all diseases, illnesses, and injuries.

Around the world, these microbes have been festering in poor communities, growing stronger, preparing themselves for outbreaks that affect even those who are not poor. It happens as people travel, as people immigrate, as they have the poor wait on them, and as they become ill enough to need hospital care. In all cases, this brings the problems of the poor to the footsteps of everyone else. In his book, When Germs Travel, Howard Merkel, quotes the journalist Abraham Cahan who said,

“The American public’s concern about unsanitary living conditions and related social problems of the downtrodden seem to get attention only when such epidemics threaten the palaces of the rich.”

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What everyone else, particularly the elite in the form of rich pharmaceutical companies, has been doing about this problem will only lead the world to more misery.

If you’re a fan of PBS, you might catch the Frontline series from time to time. In the past year, they have twice covered a growing threat to humanity about which the media periodically sounds the alarm: superbugs. In the episode entitled, “Hunting the Nightmare Bacteria,” Frontline introduces the viewer to gram-negative bacteria, a new class of germ both deadly and resistant to antibiotics. These bacteria are described as having built a coat of armor around themselves that make them impenetrable to the body’s own immune fighting cells and antibiotics. Some examples of the many bacteria that have gone commando are 1) E. coli, infamous for food-borne outbreaks; 2) Neisseria gonorrhoeae, a sexually transmitted disease; and 3) Mycobacterium tuberculosis, of course, the bacteria that causes tuberculosis. Other bacteria have names like MRSA, CRE, and VRE. Of these, the one associated with the most concentrated outbreaks is tuberculosis. So much so that Frontline also decided to do a documentary on the global crisis being caused by this disease, “TB Silent Killer.”

Tuberculosis is perhaps the scariest superbug, because it is both an airborne and foodborne antigen. Although the United States has had limited contact with Multi-Drug Resistant-TB (MDR-TB) and Extensively Drug Resistant-TB (XDR-TB), these forms of the disease have been rising in other parts of the world at alarming rates, especially in poor countries. The disease likely took a strong foothold in these countries because of the lack of access to treatment they had. According to the Economist, “As a report last year by the Centre for Global Development, an American think-tank, pointed out, resistance often increases the drug bill, because patients are forced to turn from cheap, widely used drugs (whose very ubiquity encourages the evolution of resistant strains) to dearer alternatives” (emphasis added).

This point is important. Patients have been forced to turn to cheap, alternatives to better drugs, leading to the evolution of resistant strains. There are other ways that ignoring the healthcare needs of the poor will come back to bite the rest of us. When the poor are very sick with high fevers due to infection, they will go to the hospital to get treatment. However, when they receive a prescription to continue the antibiotics they receive, they are frequently going to be unable to fill or refill that prescription due to lack of health insurance. This, too, will increase the strength of bacteria.

Healthcare policies made by the elite betray us all. We have two places to turn for help in this crisis: the pharmaceutical industry and government. In the case of the latter, the austerity imposed by our politicians has left governments without funding to conduct necessary research in this area. These politicians are all too often behaving at the behest of special interests: namely the wealthy and corporations. Government can also be faulted for not prioritizing research in this area, as discussed in the “Hunting the Nightmare Bacteria” documentary, but drug development is not a traditional government role, so it is also understandable. Therefore, it is the pharmaceutical industry that society has expected to research and create antibiotics to treat these superbugs. Except, they aren’t doing it.

Drug companies have numerous excuses for not investing ongoing efforts in research to fight drug-resistant forms of bacteria. Despite scientists, who worked for Pfizer, saying they were on the verge of a breakthrough with gram-negative bacteria, the company shut down its antibiotic research division. The company claims that it was a “portfolio management decision” and not a “ruthless” one. They say it was because they wanted to find vaccines instead of antibiotics. They say the research was too hard, even as their scientists say otherwise. Pfizer’s decision to bow out was particularly important, because as a company they were most associated over the long-term with producing antibiotics, including being the company to bring us the first one, penicillin. Other companies are not blameless. They similarly shut down their research divisions for this type of drug. Why? All of these companies have the same reason. It is not profitable to work on antibiotics, because unlike your drugs for chronic conditions like impotence or high blood pressure, people only need them for a short period of time. David Shlaes, author of Antibiotics: the Perfect Storm, writes on his blog this week of new developments at Astra Zeneca,

“We have a company with a promising pipeline for the treatment of resistant Gram negative infections, an impending public health calamity – especially in certain regions of the world (including various areas of the US) caused by resistant infections, and the company will either be taken over by one hostile to antibiotics or the company itself may abandon some or all of its pipeline.”

So, here we are as a society facing a massive public health crisis about which the WHO is not shy to use the word, “apocalyptic.” It truly is a revenge of the poor for neglect of their most pressing health problems. It is worsened by the betrayal of the elite, our corporations and our wealthy, who both refuse to invest in treatments either through private research or public research that requires tax dollars. In the end, though, everyone is vulnerable to these superbugs, and they will have the last word.