Immunity Under Siege

Thanks to the miracle of modern drugs, especially various forms of antibiotics, we think we live in an era of immunity from the effects of many, but not all, diseases and infections. That era may be ending with the rise of drug and microbial resistance. Its passing will affect many aspects of our lives, our economies, mental and emotional health. With luck, the challenge could result in greater cooperation, and radically new tools and techniques. If not, we could face even harsher times.

What is changing?

Drug resistance is rising. Tuberculosis is one of the world’s biggest killer diseases, causing over 1,000,000 deaths a year. There were recently reports of TB cases in India that were completely resistant to all drugs; likewise in Italy and Iran. While they proved to be wrong this time, according to the World Health Organisation, it may only be a question of time before it is true. Cases of TB that is resistant to many types of drugs are increasing – up from an estimated 30,025 in 2007 to 54,967 in 2010, and rising; and that Multi Drug Resistant form may be becoming an Extreme Drug Resistant form.

Malaria is also a major killer- accounting for more than 600,000 deaths each year. Since 2008, concern has been rising about malaria’s growing resistance to drugs. Recent reports about the identification of a very resistant strain of the disease in the Thailand/ Burma border area are raising major concerns.

But it is not just these ‘big killers’ that are increasingly resistant. Death rates as well as infection rates from  MRSA (Methicillin-resistant Staphylococcus aureus)  and E.Coli are rising in many western nations as antimicrobial resistance increases. Another infection, Klebsiella pneumonia, which normally infects and/ or causes death in people who are already sick or weak, is beginning to infect young, healthy people. There is concern that it too could also become very, if not totally, resistant to drugs.

Drug resistance is also spreading in other ways. Humans, it is assumed, are bringing drug resistance to remote areas such as Antarctica and the Galapagos Isles. Water ways, such as Lake Geneva, are contain drug resistant bacteria probably via run off or waste water. Meat from ‘drug free farms’ has been found to contain MRSA, as a result of contamination somewhere along the processing route.

Why is this important?

Drug resistance is important in and of itself, raising the spectre of the mortality rates and levels of fear that illness, or even minor injuries, produced in pre-antibiotic times. Routine operations may become too risky, condemning older people to living with crumbling and very painful hips or knees. Parents may become highly protective of children, restricting freedom and active play even more than currently, if relatively minor injuries could result in major, or fatal, infections. Individuals may become increasingly fearful and suspicious of anyone with health problems, or from areas where such infections and diseases are more prevalent, increasing the dangers of xenophobia. To name but a few.

Then there is the economic cost. Drug resistant infections are estimated to cost Europe some €1.5 billion, and about $45 billion in the USA –$25 billion in societal costs plus $20 billion in health care costs. Research indicates that poor health in childhood affects not only physical but cognitive development and that persistent health problems within nations correlate with poor economic performance. African economies are beginning to outperform many others worldwide, but are also home to the vast majority of malaria deaths. A new wave of TB and malaria could radically set back Africa’s progress, but also that of other emerging nations such as China and India.

But the nature of the threat, the geographic spread, and the recognition of overuse of antibiotics in animal and human health as a prime cause may combine to create more cooperation and a new wave of responses. A malaria vaccine may be available by 2015; disease monitoring remotely using tools such as satellites or in-situ miniature cameras – even ‘tooth tattoos’- is becoming more feasible; a plasma flashlight is capable of killing resistant bacteria; genetic profiling is helping us develop new drugs but also understand mutations. We will also need to cooperate more effectively within and between nations and recognise the inter-connectedness of animal and human health.

If the new responses fail, we could face not only the end of immunity, but an era of far greater fear and suspicion, exacerbated by and in turn exacerbating the effects of climate change on health and disease migration.

By Sheila Moorcroft

About the author

Sheila has over 20 years experience helping clients capitalise on change – identifying changes in their business environment, assessing the implications and responding effectively to them. As Research Director at Shaping Tomorrow she has completed many futures projects on topics as diverse as health care, telecommunications, innovation management, and premium products for clients in the public and private sectors. Sheila also writes a weekly Trend Alert to highlight changes that might affect a wide range of organisations.