Technology

The next pandemic has arrived. Covid can teach us how to stop it.

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In the first few decades after the introduction of penicillin, bacterial adaptation and drug discovery crossed each other, keeping the ability of antibiotics to treat infections before the ability of pathogens to escape infection. But by the 1970s, the burst of innovation in the mid-century had faded. Making antibiotics is difficult: drugs must be non-toxic to humans but lethal to bacteria, and they must use mechanisms that have not yet evolved defense capabilities from dangerous bacteria. But it is more difficult to transfer antibiotics produced in nature to synthetic compounds in the laboratory.

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At the same time, resistance leaped forward. Excessive use of antibiotics in medicine, agriculture, and aquaculture spreads antibiotics in the environment and allows microorganisms to adapt. Between 2000 and 2015, the use of antibiotics dedicated to the deadliest infections almost doubled globally. The level of resistance varies by organism, drug, and location, but the most comprehensive report so far, Released in June 2021 The World Health Organization shows how fast the situation is changing. Among the bacterial strains that cause urinary tract infections (one of the most common health problems on the planet), in some countries/regions, certain strains are resistant to common antibiotics as high as 90%; more than 65% cause blood infections Bacteria and more than 30% of the bacteria that cause pneumonia can also resist one or more treatments. Gonorrhea was once an infection that is easy to cure. If left untreated, it can lead to infertility. Now it is rapidly becoming resistant to all drugs used to treat it.

At the same time, resistance factors-genes that control bacteria’s ability to protect themselves-are spreading globally. In 2008, a man of Indian descent was diagnosed in a Swedish hospital with a bacterium carrying a gene cluster that can resist almost all existing antibiotics. In 2015, British and Chinese researchers discovered a genetic element in Chinese pigs, pork on the market, and hospital patients. This gene allows bacteria to break down a drug called colistin, which is called the last Of antibiotics, because it can deal with the most serious superbugs. These two genetic elements, free-riding from one type of bacteria to another, have spread worldwide.

Faced with the economic difficulties of drug research and development, antibiotic research has not kept up. In March, the Pew Charitable Trust evaluated a global pipeline of new antibiotic compounds. Although the team found 43 places in the preclinical or clinical research phase, it was determined that only 13 were in stage 3, and only two-thirds of them were likely to be licensed-and none had a molecular structure against pathogen It is already the most difficult to treat.

Lessons of warp speed

So, what would the distorted speed action of antibiotic resistance look like?

The antibiotic pipeline needs to be promoted in several key areas: basic research, experimental design, and post-approval incentives. Fortunately, the global response to the new coronavirus has set a precedent for these three.

The first step will be long-term support for basic research. Moderna and Pfizer-BioNTech vaccines were ready less than a year from the first detection of human infection. But this preparation came from 10 years of basic research, and did not take into account specific diseases. Once the new coronavirus appeared, Warp Speed ​​brought the Moderna vaccine to the finish line with additional research funds. (Pfizer did not receive research support from Warp Speed, but both companies received funding for manufacturing and production.)

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