"With few replacement products in the pipeline, the world is heading toward a post-antibiotic era in which common infections will once again kill."
The declaration urges countries to cut back on the use of existing antibiotics in order to preserve their effectiveness, to make better use of vaccines instead, and to spend more money on developing new antibiotics. It doesn't put any actual money on the table, however, and it doesn't even make make it illegal to pump "sub-therapeutic" doses of antibiotics into farm animals. (It can't. National governments have to do that.)
I was not really recommending the death penalty for feeding antibiotics to livestock. That was just for dramatic effect. But the reckless misuse of antibiotics is rapidly destroying their effectiveness.
The problem of bacterial resistance has been understood for a long time. If the antibiotic kills all the harmful bacteria it targets in the person or animal it is given to, then no resistance develops. But if it only kills off the weaker ones because it was a very low dosage, or because the course of drugs was not finished, then the surviving bacteria will be the most resistant ones. They will pass their resistance on to all their descendants, who will undergo similar episodes of winnowing out the less-resistant ones many more times, and gradually the resistance grows.
The only way to keep antibiotics effective, therefore, is to use them as rarely as possible, and to make sure they kill off all the target bacteria when they are used.
We are not doing this. Doctors overprescribe antibiotics, often giving them to people who do not have bacterial infections just to get them out of their offices (and sometimes getting a kickback from drug companies for each prescription they write). And nobody makes sure patients complete the course of treatment even though they already feel better.
Much worse is the widespread practice of giving regular low doses of antibiotics to cattle, pigs and chickens, partly as a means of controlling the spread of disease in their cramped and insanitary living conditions, but mostly because it makes them put weight on more quickly. Getting them to the slaughterhouse a week or two faster is money in the hand.
This insanely greedy and reckless practice is now banned in the European Union, but it is still commonplace in China and the United States. In fact, 80 per cent of American antibiotic production goes to farm animals who are not ill. As intensive farming methods spread to developing countries, so does antibiotic use in agriculture.
This has to stop. So does overprescribing by doctors in developed countries, and the over-the-counter sale of antibiotics without prescriptions that is so normal in many developing countries.
"We are now staring at overwhelming evidence of rampant antibiotic resistance, across all ages, all over the country," said Dr Vinod Paul, head of paediatrics at the All-India Institute of Medical Sciences in Delhi.
We also need a whole new generation of antibiotics to replace those that are hopelessly compromised, which requires persuading large pharmaceutical companies to change their research priorities. (They make more money by developing new drugs that address the chronic health problems of the affluent, so we'll have to subsidise them.)
It all has to be done, and it has to start now.
"On current trends," said Dr Chan at the UN, "a common disease like gonorrhea may become untreatable. Doctors facing patients will have to say, 'I'm sorry, there's nothing I can do for you'."
�Gwynne Dyer is an independent journalist whose articles are published in 45 countries.
