Cast Back into the Dark Ages of Medicine? The Challenge of Antimicrobial Resistance

Antimicrobial resistance is unlikely to signal a return to the “dark ages of medicine”, argues new research by Professor Cormac O’Grada

The challenge of antimicrobial resistance (AMR) is unlikely to signal a return to the “dark ages of medicine” as public health measures and new drugs will lessen the impact of resistance, according to a recent briefing by Professor Cormac Ó Gráda.

Professor Ó Gráda, economics professor at the University of College Dublin and research associate at CAGE, recently presented a policy briefing paper at the Social Market Foundation to an audience of interested policymakers and journalists. The paper, Cast Back into the Dark Ages of Medicine? Lessons from the Past for the Present and Future, analyses the challenges to global public health in controlling infectious diseases as the effectiveness of long-used antibiotics wanes.

Prof. Ó Gráda said that the challenge of antimicrobial resistance needs to be set in historical context: though real, it is unlikely to mean a return to “the dark ages of medicine”.

Highlights from the briefing:

· With the virtual eradication of most infectious diseases, life expectancy in the UK and other high-income countries has doubled in the last century. The gains in poor countries have been smaller, but are still significant. Most of the increase in life expectancy preceded the antibiotics revolution.

· Public health measures have been essential to controlling infectious diseases. Even if AMR increases, the effect of existing and new public health measures will limit the negative consequences.

· The challenge of tackling antimicrobial resistance requires a focus on both the supply of antimicrobials (the ‘pipeline’) and the demand for them (consumption).

· There is considerable scope for reducing consumption and thereby the spread of resistance. Public health initiatives and health education can usefully reinforce measures to restrain consumption.

· The ‘pipeline’ of new drugs is not as dry as is usually claimed in the media, showing that, as of December 2014, 37 new antibiotics were listed as being ‘under development’ in the United States alone.

While the briefing states that the challenge posed by AMR is very real and there is no room for complacency about what new antibiotics will emerge from current efforts, how effective they will be, and how long it will be before they too encounter resistance, it concludes that many of the warnings of ‘AMR apocalypse now’ are overdrawn.

Professor Cormac Ó Gráda, commented: 

“History suggests that antimicrobial resistance poses a major challenge to both policy-makers and to scientists and that the human cost of many worst-case scenarios, such as those regularly broadcast in the media, would be very high indeed and should not be treated lightly.

However, history also shows that some of the more apocalyptic scenarios being aired are unlikely, partly because, as in the past, preventive medicine and public health measures can play a major role, partly because the threat should result in the reduced use of antimicrobials, and partly because the commercial opportunities that threats such as AMR offer to inventors and manufacturers.”

This paper is the second in the Global Perspectives series, the collaboration between the Social Market Foundation and CAGE. A pdf of Professor Ó Gráda’s paper can be found here.

Professor Ó Gráda’s research was, in part, originated from an ESRC funded study into AMR which also involved CAGE researchers Dr Romola Davenport and Dr Kerry Hickson. This study looked at AMR in the context of Social and Economic History, examining the issues with regards to demographic history of the UK and for other countries on past incidence of important infectious diseases which could not be treated at the time.

The outputs of the AMR study are as follows:

CAGE AMR Report (Short Report)

Health, Wellbeing and Antimicrobial Resistance: Insights from the past for the present

The development of resistance by organisms to antimicrobials is a natural phenomenon. There is evidence of resistance to most antimicrobials within years of their discovery. The problem in the twenty-first century is that this resistance is coinciding with the reduction in new therapies to replace ineffective ones. Antimicrobials are used widely across the healthcare service: from treating specific infections, to prophylactic applications in surgery, radiotherapy, and cancer chemotherapy. As a result some maintain that many modern advances in medicine could be lost. Our research highlights a more optimistic scenario. Although antimicrobial resistance is likely to pose some serious problems, history highlights that there are numerous strategies that governments can employ to maintain the health of the population. For example, preventative measures such as vaccination, hand washing, appropriate family practice prescribing, effective infectious disease control procedures in hospitals, and surveillance will go a long way to curtailing the extent and consequences of microbial resistance. This is reflected in the history of numerous diseases, from the plague to tuberculosis to methicillin-resistant Staphylococcus aureus (MRSA). These experiences all highlight that with good governance that delivers sound public health policies it will be possible to substantially reduce the impact of antimicrobial resistance. A key next area of research is therefore to consider the most efficient public health policies to stem the spread of antimicrobial resistance.

CAGE AMR Report (Long Report)

Health, Wellbeing and Antimicrobial Resistance: Insights from the past for the present

A longer background paper which provides more detail on the AMR study

We also have 3 working papers that relate to the study:

233/2015 Cormac Ó Gráda: Cast back into the dark ages of medicine? The challenge of antimicrobial resistance

241/2015 Kerry Hickson: The Welfare Cost Of Antimicrobial Resistance - Tuberculosis As An Illustrative Example

242/2015 Romola J. Davenport: The first stages of the mortality transition in England: a perspective from evolutionary biology