Following up on last week, this grim appraisal appeared in Science:

In 2019, while attending the annual conference of the American Society for Microbiology, I listened to an interview with Carl Nathan, a renowned tuberculosis researcher. During the conversation, Nathan shared that in 1948 he was among the first group of civilians to receive penicillin treatment for pneumonia. At that time, pneumonia, primarily caused by Streptococcus pneumoniae, was the leading cause of death in the United States. Tuberculosis ranked second. The introduction of penicillin and streptomycin in the 1940s provided the first effective treatment for pneumonia and tuberculosis, respectively.

 

The benefits that antibiotics brought to society were monumental. Before they were introduced, infectious diseases were the leading cause of death, driving epidemics with unimaginable mortality rates. For example, a plague epidemic is believed to have triggered the Neolithic decline in Europe. The resulting population drop-off facilitated the spread of Indo-European languages during the Bronze Age. A few centuries later, the plague of Justinian caused devastating mortality in the Byzantine Empire, killing between a quarter and half of the population and contributing to the empire’s downfall. And between 1492 and 1600, an estimated 80 to 90% of the Native American population died from infectious diseases introduced by Europeans and Africans, a factor that contributed to European colonization of the Americas.

 

Living through the COVID-19 pandemic, which killed approximately 0.4% of the US population, provided only a glimpse into the fear and societal impact associated with catastrophic population declines caused by infectious diseases….

 

As I listened to the interview with Nathan, I recalled a recent prediction that by 2050, the mortality burden from drug-resistant infections could surpass that of cancer and cardiovascular disease. If this comes to pass, Nathan’s first dose of penicillin will have marked the beginning of a century-long period during which infectious diseases were no longer the leading cause of death. But this extraordinary period in human history seems to be nearing its end. I can’t help but think of the era of antibiotics as a bubble that is about to burst.

 

I have been fortunate to live my entire life within this bubble. Most of us were born into it. Living in the bubble has made us comfortable and isolated from the historical threats of infectious diseases. We don’t fear contracting a deadly infection during surgery, which carried a 40% mortality rate in the pre-antibiotic era. It has deprived us of understanding the true threat that infectious diseases pose to humanity and has made us complacent….

 

[T]he rise of drug-resistant infections is steady and entirely predictable. Typically, within a decade of introducing a new antibiotic, resistance becomes a clinical issue. Over time, this problem grows as the prevalence of antibiotic resistance continues to increase steadily.  Unfortunately, this pattern has occurred with nearly all antibiotics developed so far. Compounding this issue, the development of new antibiotics has stalled, hampered by economic and regulatory challenges. The result is an antibiotic resistance crisis that threatens to burst the bubble of safety in which we currently live. Addressing this crisis will require decision-makers to acknowledge the scope of the problem and to allocate resources that match the severity of the threat.