Genetics -- fiddling while Rome burns

Stories about the growing threat of antibiotic resistance generally include alarming predictions about the coming post-antibiotic era, about how even simple medical procedures that are now safe will become dangerous once we lose the ability to fight infections, and indeed simple infections will once again become life-threatening, as they might have been for most of human history.  We in the rich world can still imagine that this future might be avoidable, as we've still got useful drugs for many of our microbial illnesses -- plus, we're pretty good at being delusional (see climate change).

But that ominous future is already here for much of the world.  A reader sent us a link to a heart-wrenching story in the Dec 3 New York Times; "'Superbugs'" Kill India's Babies and Pose an Overseas Threat", Gardiner Harris.  Lack of widespread public health measures including sanitation are largely responsible for high infant mortality rates in poor nations.  Infectious diseases that would be avoidable or easily treated in rich countries are lethal in countries where the health care infrastructure is weak.  Antibiotic resistance is more widespread in these same countries, exacerbating the health care challenge.

The infant mortality rate (IMR) in India was 41/1000 live births in 2013, or 4%! -- by contrast, the lowest rates in the world in 2013, in Israel and Ireland and several other nations, were 3/1000, or 0.3%.  The IMR hasn't been as high in the United States as it is now in India since the beginning of the antibiotic age.  But India may never see the kind of decrease in infant mortality that the US experienced beginning in the 1940's, and it looks as though growing antibiotic resistance will be a major reason.

Infant, post-neonatal and neonatal morality rates, United States, 1940-2006; deaths per 1000 live births; CDC

In India, Harris reports, many infants are already dying of infections that are resistant to multiple antibiotics.  And, "a significant share of the bacteria present in India— in its water, sewage, animals, soil and even its mothers — are immune to nearly all antibiotics."  And those bacteria are quickly traveling around the world.

For many reasons, bacterial infections spread quickly in India; people defecate outdoors, sewage is untreated, drinking water can be contaminated, hospitals can be a source, even as they are in the West, and so on.  The most frequent bacterial infections in infants are from bacteria found in human waste.  And to compound the problem, antibiotics are available over-the-counter, in recent years women have been encouraged to give birth in hospitals, often in unsanitary conditions, and, Harris reports, infants have often been given antibiotic injections preventatively, all of which adds to growing resistance.

“Reducing newborn deaths in India is one of the most important public health priorities in the world, and this will require treating an increasing number of neonates who have sepsis and pneumonia,” said Dr. Vinod Paul, chief of pediatrics at the All India Institute of Medical Sciences and the leader of the study. “But if resistant infections keep growing, that progress could slow, stop or even reverse itself. And that would be a disaster for not only India but the entire world.”

In addition, antibiotic resistance is linked to widespread use in animal husbandry; the increased industrialization of meat production in India, with accompanying antibiotic use, may be adding to the problem there.

None of this is a surprise.  Just as the increase in 'super weeds' as a result of the widespread use of plants genetically modified to resist herbicides, which are then liberally sprayed on fields, was completely predictable.  Like the herbicide Round-Up, antibiotics are a strong selective force that encourage resistance.

But this is much more than a science problem.  It's a social, and an economic and a moral problem. Antibiotic resistance is developing much more quickly in poor countries, because of lack of public health infrastructure, and more infectious disease in general.  Preventing it takes resources, and it hasn't been a very glamorous claim on resources for high-flying research investigators who are driven by our society's worship of high technology.  But as we've written before, spending billions of dollars on things like genetics -- or, say, flights to Mars -- may well turn out to be fiddling while Rome burns.