The UK has achieved an unenviable world first with news that a British man has been diagnosed with a strain of gonorrhoea so far resistant to all antibiotics normally used to treat the disease.
The sexually transmitted bacteria Neisseria gonorrhoeae, identified almost 140 years ago, causes unpleasant symptoms and, often, acute embarrassment – but it is an infection we’ve become accustomed to being easily curable with a simple course of that miracle of modern medicine: antibiotics.
However, when the World Health Organisation (WHO) published a list, last year, of the dozen deadliest superbugs the world is struggling to control, gonorrhoea was among their highest priorities.
In the UK and other high-income nations, we are starting to see occasional cases of hard-to-treat strains, but in many low- and middle-income countries, it is a grave problem and a rapidly rising health burden. If left untreated, the disease can cause serious and long-term health problems.
This man’s so far untreatable case of gonorrhoea may be a first, but it’s an inevitable development in a wider crisis, where common infections have become progressively harder to treat.
Almost two years ago, in May 2016, an independent review led by Jim O’Neill – of which I was a part – published its final report outlining the global scale of drug-resistant infections; superbugs no longer treatable with existing antibiotics.
This report, the Review on Antimicrobial Resistance, funded by Wellcome and the UK government, showed that without effective action the death toll, already at 700,000 a year, could rise to 10 million within a generation.
Talk of an “antibiotic apocalypse” followed, language which perhaps makes this threat seem far off, fantastical even; but as this latest news drives home, it is not far off. This reality is closer than we might like to accept.
Antibiotics have been a vital part of modern medicine for more than 70 years. Treatments we take for granted as routine, such as hip replacements or caesarean sections, complex operations such as organ transplants and chemotherapy, and conditions that we assume are easily treatable – such as gonorrhoea – all depend on the increasingly fragile safety net of antibiotics to ward off potentially deadly infection.
The O’Neill Review also highlighted that decades of scant investment in antibiotic discovery has left the pipeline of drugs in development perilously weak. New treatments are an urgent priority.
In our modern age of great medical and scientific advance, it is perhaps surprising to hear that antibiotic discovery has fallen into such serious decline that we are struggling without replacement drugs – that we are rapidly losing the race to stop superbugs.
But since the short-lived golden age of antibiotic discovery after Alexander Fleming’s famous Penicillium discovery, nearly all antibiotics have been variations on existing drugs. There has been no new class to treat the most dangerous, Gram-negative bacteria, such as gonorrhoea, since 1962.
At the latest global count, there were about 50 antibiotics in the pipeline – with a third targeting the 12 WHO priority pathogens, including three for gonorrhoea. However, the market for new antibiotics is too unpredictable, and insufficiently valuable, for developers to be sure of a reasonable profit.
As the issue has risen up the global agenda in recent years, we have seen an increase in grant funding for small biotech companies, stimulating interest in early antibiotic development.
Wellcome is among those providing support, including about $150m (£107m) for the partnerships Carb-X and GARDP. Gonorrhoea is among the list of bacteria for which companies are racing to find new treatments.
Governments and business still need to do more together to find lasting and sustainable models to fix the broken market and provide better incentives for developers of breakthrough antibiotics.
In parallel, we need new diagnostic tests that improve how antibiotics are prescribed – reducing often wasteful use of this precious medical resource.
Gonorrhoea is one example of where we are already seeing technology put to good use. Some sexual health services in the UK are using state-of-the-art rapid diagnostic tests to give quicker and more accurate diagnosis of common sexually transmitted infections, allowing patients to be given more effective treatment, reducing the use of antibiotics among patients who don’t need them and guiding better treatment for those who do.
The AMR Review emphasised that wider development and use of diagnostic tools could transform how antibiotics are prescribed, and, in doing so, slow the rising tide of resistance. But progress on delivering on this ambition has been slow.
This latest news provides yet more evidence that we risk rolling back a generation of medical progress if we fail to adequately address the dangers of drug resistance. After decades of complacency, now is the time for some urgency.
• Jeremy Knox is policy and advocacy lead for the Wellcome Trust’s drug-resistant infections programme
