As published in The Sunday Times:
Reckless use of antibiotics will kill more than any war: Overuse by China and India is threatening our ability to fight disease, warns David Davis
The First World War killed 16m people in four years. The Spanish flu pandemic that followed killed more than 50m people in one year. Mother Nature is a far more grimly capable killer than man. The elegant simplicity of the flu virus was matched only by its lethality. The medical profession, with no cure, was powerless to halt the spread of the disease.
Since then we have made astonishing medical advances. Powerful and effective antibiotics and anti-viral drugs now help us to fight off diseases that would otherwise be lethal. But we are losing these defences and we have only our own reckless profligacy to blame.
We are fast approaching the point where diseases that we cannot treat could cause the same damage as the 1918 pandemic. We are in danger of a world where a trip to the hospital could be considered a life-threatening event. A world where routine surgery, such as an appendectomy or a hip replacement, or even childbirth, would carry terrifyingly high mortality rates; where many of us will sit helplessly by the hospital beds of our loved ones as their lives are claimed by the common diseases we thought we had defeated 40 years ago. This is not a post-apocalyptic fantasy. The shocking truth is that 25,000 people now die in Europe every year from antibiotic-resistant infection.
The problem is simple: we overuse and abuse antibiotics. Darwin best explains the consequences: pathogens constantly exposed to a hostile environment created by antibiotics inevitably react — they evolve. Resistant strains are starting to evolve faster than we can create new drugs to combat them. We are already seeing untreatable E coli infections, and incidents of resistant strains of tuberculosis and malaria are increasingly common. MRSA has turned our hospitals into a deadly lottery.
Many of us are guilty of demanding medicine from our GPs the second we have a sore throat or a runny nose. But our personal antibiotic consumption is only a small part of the problem. Most of our antibiotics are used in food production with almost 50% of antibiotics in the UK and about 80% in the United States used on livestock. The scientific consensus is that most antibiotic resistance in human infections is of farm-animal origin.
The danger cannot be overstated. The failure of antibiotics to work would mean a global death toll that dwarfs any war. Our greatest modern achievements in medicine, such as major surgeries and immunosuppressant cancer treatments, would become too dangerous. Without antibiotics the infection rates for hip replacements, for example, would rise from about 2% to about 50% and it is predicted that 30% of infected patients would die.
This is a global problem and will require a global solution. The key to successful negotiations will be America, China and India; where they lead, others will follow. The United States is only just coming round to the position, adopted by Europe in 2006, that growth-promoting antibiotics should be banned from use on livestock. Its lack of oversight and regulation is putting us all in danger.
If America is dragging its heels, however, in China and India they are running pell-mell towards disaster. China produces and consumes more antibiotics than any other country, manufacturing 210,000 tons annually — and 46% of this is used in agriculture.
The Chinese have reduced the use of antibiotics in their hospitals but their use in livestock is widespread. There is little prospect of this changing without international pressure. Even if a ban were imposed, enforcement in a country with millions of farmers and limited infrastructure would be almost impossible. The problem in India is similar with antibiotics perceived as a universal panacea. Until recently the most potent were available over the counter without a prescription.These drugs were often produced illegally and then diluted, with the poor unable to pay for a full course, all of which creates the perfect breeding ground for resistant diseases.
If we are to persuade other countries to sign up to strict global standards we are going to have to be robust. We cannot repeat the sort of diplomacy we have used in other areas, such as human rights in China, where we complain in private but continue to greedily swap trade privileges.
There will undoubtedly be significant resistance to any action. The vested interests of the drugs industry and the belligerence of some governments will be a substantial obstacle. But the dangers of inaction are too great.
It needs to be made plain to all countries that this carelessness and such a reckless disregard for all our lives will cost them dear. If we are to safeguard our only defence against disease we need to make it absolutely plain that the civilised world will not tolerate this and we must make that known. We are running out of time to act.