Similarity between global antibiotics resistance and peak oil

A new type of antibiotic resistance (called NDM-1) has recently been discovered which could become the next global health crisis. Sarah Bosely in her global health blog in the Guardian, recently drew a parallel with peak oil. The following is my explanation / exploration of these ideas.

In a recent editorial in British Medical Journal, Angela Raffle, a public health consultant at Bristol and also a member of Transition Town Bristol, clearly described the impact of peak oil on health and healthcare. I’ll try to use this as a basis for finding parallels with antibiotic resistance.

 

Discovery

• Looking at the frequency of discovery of new oil wells, the global peak was mid-20th century. The frequency of productive wells follows discovery with approx 40yr lag time (due to economics etc). Oil which is easiest to extract is the most economical (and has the highest net energy). Once they become uneconomical the wells close. Many countries’ oil production is now in decline (USA, UK). This doesn’t mean the wells are empty (although we know the resource has to be finite) it’s just uneconomical (and may become negative net energy to extract).
• Once Alexander Flemming had discovered the effectiveness of penicillium as an antibiotic (1928), this enabled researchers to find variations on a theme, and also to investigate antibiotics which could work through novel mechanisms. Now it would be ideal to show a graph of antibiotic discovery here... but presumably it increased rapidly through the latter half of the 20th century. Unfortunately microbes become resistant to certain antibiotics, through a process assumed to be natural selection. Many antibiotics don’t actually kill bacteria (germs) they just slow them down to give our natural immune system a chance to clear the infection. This means that there’s a chance that some bacteria, through genetic mutation, will find ways of surviving in the presence of the antibiotic and become resistant. Once that happens the progeny of that bacteria (strain) cannot be successfully treated with that antibiotic – i.e. the infection will fester. What’s worse is that this resistance can spread between different strains and even types of bacteria by genetic transfer (eg. Plasmids). This means that antibiotics can gradually become ineffective due to increasing frequency of resistance. Like the oil wells, antibiotics may have a finite lifespan, due to the spread of resistance. However if an antibiotic’s use was curtailed bacteria could, in time, lose resistance thereby increasing effectiveness of the antibiotic again. Unlike oil, antibiotics are not a finite resource. Development of new ones however takes an uncertain amount of time and investment. This could be called a technology gap and is similar to the gap between using fossil fuels and developing renewable power.

Demand

• Oil (energy) demand seems to increase constantly, with economic growth, and especially with rapid industrialisation of ‘developing’ countries. The increasing demand, combined with limits to production is expected to start to produce oscillations in the market – price rises until it’s no longer affordable, followed by economic ‘crunch’ and decrease in price, followed by gradual recovery and price increase again. These cycles of price rises and falls could be more damaging to the economy than anything else.
• Whenever there are scares of antibiotic resistance there are concerns about unnecessary use or lack of compliance. The theory is that the more bacteria are exposed to low levels of antibiotics, or incomplete treatments, the faster they will adapt and become resistant. It could be said that ‘western’ societies use of antibiotics has matched it’s profligate use of oil. Examples would include including antibiotics in household soaps, or giving healthy farm animals antibiotics. Both of these are prophylactic uses of antibiotics, which is a new approach to using antibiotics, normally used as a treatment, with specific instructions to follow the full course of medication. The problems arising from patients who don’t complete the course as well as the increased use in our home and farm environment is that these low dose or constant exposures produce the environment which is likely to give rise to antibiotic resistance. I’m not suggesting that either of these practices has caused the new antibiotic resistance (NDM-1), but that profligate use of antibiotics will increase likelihood of future resistance problems.

Economics

• Sarah Boseley refers to the economics of antibiotic research and development. While production of antibiotics is very economical, research and development has become less favourable. Pharmaceutical companies have to justify investment in research by the impact of the potential therapeutic. This raises many difficult questions. As the price of antibiotics fall, due to increasing production efficiency and patents running out, the potential financial return on a new product also decreases. Also, from a population perspective, there is little demand, because existing antibiotics are, for the most part, doing the job. This may be the strongest link with peak oil: whilst there is little financial impact currently, the economics does not support investment in new technologies (renewable in the case of peak oil).

Affected population

• Peak oil will affect the poorest most harshly. I don't think it is possible to define an at risk population any further, apart from maybe; those are most dependent on consumables now will be most affected
• For antibiotics, the other question about the health economics is who will be affected. If a small population are likely to be affected, pharmaceutical companies will lack incentive to develop new drugs. If the likely population are poor or live in a developing country, then again there is low incentive. From initial reports (lancet) NDM-1 resistance has been found in India and Pakistan, with only sporadic incidences in UK, mostly thought to have been contracted whilst in Asia. From a pharmaceutical company’s perspective investing in research and development does not look like a sound financial choice.

Risk perception
The difficulty in tackling these issues will be in risk perception. Both peak oil and peak antibiotics appear to the mainstream as low risk, distant future issues. The people who discuss the issues are labelled doomsayers. It seems the issue is likely not to be taken seriously until it affects people in the ‘western’ world and creates an impact on the ‘market’. However, due to the lag time in developing new technologies, it will certainly be too late.