Despite decades of warnings, many still see antibiotic resistance as a future problem. But currently, in the US alone, four people die every hour from a bacterial infection that no longer responds to any antibiotic drug. Globally, 1.27 million deaths were attributed to resistant microbial pathogens in 2019.
And yet there is another treatment option. Concoctions of viruses that kill bacteria have been available for more than a century in some countries formerly part of the Soviet Union. Until very recently, Western medicine neglected these viral agents.
Lina Zeldovich’s The Living Medicine zooms in on these healing viruses, known as bacteriophages or just phages. But the award-winning journalist’s new book is much more than a history of medical research. Having grown up in a family of dissident Soviet scientists, Zeldovich is well placed to deliver a much fuller story that takes in the horrendous impacts of East-West geopolitics to trace the lives of people who often risked everything to save others. The result is a thriller-like narrative about a forgotten cure, with chapter cliffhangers that make it almost impossible to put the book down and drama-filled storytelling that brings long-gone phage protagonists back to life.
The central characters, of course, are the phages themselves. Although invisible to the naked eye, they may seem familiar from biology textbook images of alien life forms that look like miniature rocket capsules on bent legs.
Unlike Covid, Ebola, influenza or countless other viruses that cause devastating diseases in their own right, phages are generally harmless. They attack only bacterial cells – bursting them open to peruse their insides for their own replication. This includes the pathogenic strains that cause epidemics of some of the world’s most deadly diseases. Think bubonic plague, cholera and typhoid. Zeldovich revisits cholera outbreaks that wiped out entire cities less than a century ago. She recounts stories from the pre-antibiotic era of World War I, when infectious bacterial diseases decimated entire battalions, killing more soldiers than enemy fire.
Drawing on her own childhood experiences in Russia, Zeldovich remembers learning to read and spotting the word phage in stories about food poisonings. That early fascination grew when she realised that phage therapies were originally developed in Georgia at the start of the 20th century, initially with strong support from the former Soviet regime but then, against all odds, during Stalin’s brutal purges.
Zeldovich’s portrayal of two early phage pioneers, Georgian Giorgi Eliava and French-Canadian Félix d’Hérelle, showcases her skill as a writer. Eliava in particular left very little of his own writing – he didn’t keep a diary and his sketchy lab notes were destroyed – but Zeldovich deftly pieces his life’s work together from the biographies of his wife and daughter, by meeting with surviving family members and by spending time at the phage institute he founded in the Georgian capital, Tbilisi.
This immersion allowed her to conjure up Eliava’s effervescent personality and recount specific conversations in such detail that the reader feels like they’re sitting around the dinner table with his family during the 1920s. The reader may also despair as it becomes clear Eliava’s integrity and friendship with d’Hérelle will ultimately seal his fate during Stalin’s reign of terror. Eliava, who declined an opportunity to work at the prestigious Pasteur Institute in Paris in order to help people in his own country, died in a gulag prison in 1937, charged with being an enemy of the state and executed by a firing squad, long before he could realise his vision of developing phage treatments against all bacterial diseases.
Of the two, d’Hérelle was the more methodical researcher. He published volumes of instructions for purifying phage cocktails that continued to be used for decades as other researchers scoured sewers and polluted rivers – or any other places where bacteria, and therefore their viral predators, likely flourished.
Phage therapy was briefly used in the US during the 1930s. But a rush for profit spawned amateur phage peddlers either ignorant or unscrupulous enough to sell their wares as treatments for diseases not caused by bacteria but by fungi. This did nothing to foster trust in phage therapy – and soon, following the 1928 discovery of penicillin, the US and Western medicine went all in on antibiotics.
It would take 15 years to turn penicillin from a laboratory curiosity into a life-saving drug, and the initial focus was on supplying the military with the “wonder drug” during the WWII. Demand grew quickly and the discovery that antibiotics also promoted growth in chickens kicked off their prophylactic use in farmed animals.
But disease-causing bacteria did what they do so well: constantly exposed to these new chemicals in their environment, they mutated to circumvent the drugs developed to kill them. This microbial arms race has continued ever since, to produce today’s bacterial blights that have acquired multiple resistance genes against all available antibiotics.
The result is a thriller-like narrative about a forgotten cure.
Zeldovich argues that the time has come to seriously reconsider phage therapy. She does so by recounting stories of hospital maternity wards where newborns are ravaged by resistant infections, only to be saved by phages. She uses medical case histories of people suffering from chronic infections, being killed slowly but relentlessly by bacteria until phages pull them back from death’s door.
But this is no naive promotion of a miracle cure. Zeldovich pays the same meticulous attention to detail when she chronicles the efforts of contemporary researchers, now part of a fledgling global industry of phage-producing start-up companies, to show just how difficult it is to get from a mix of phages pulled from a sewer to clinical trials and approval as medical treatments.
The main challenge is that phages, on which some groundbreaking work is also being done in this country, are indeed living medicines. Unlike the unchanging chemical compounds we trust to fight off fast-mutating bacteria, phages are a natural part of the microbial ecosystem. Every germ probably has its own highly specific bacteriophage enemy. Perhaps their biggest advantage, Zeldovich writes, is that phages evolve in tandem with their bacterial prey, constantly updating an old weapon against increasingly deadly infections.
THE LIVING MEDICINE: How phages will save us when antibiotics fail, by Lina Zeldovich (Black & White, $39.99 hb), is out now.
