Change at every level needed to crack drug resistance

想象一个没有抗生素的世界。曾经很容易用简单的药物治疗的疾病和感染突然是不可逆转的，并且威胁生命。

This might seem like a far-fetched dystopian vision. But for many people who contract drug-resistant strains of TB, pneumonia, gonorrhoea or hospital superbugs like MRSA and C. difficile, this is already happening. And the hardest-hit are those living in low- and middle-income countries.

当细菌因用来杀死它们的药物而变化时，就会发生抗生素耐药性，直到这些药物最终失败。

The potential for drug resistance has long been acknowledged. The discovery of penicillin in 1928 was expected to herald the end of infectious diseases. But even its discoverer, Alexander Fleming, warned as early as 1945 in his Nobel Prize acceptance speech that bacteria could become resistant to it with overuse.

That prediction has been borne out in the decades that followed, not just with penicillin, but with every class of antibiotics subsequently discovered. After the initial ‘golden era’ of antibiotic discovery that followed penicillin, drug development has failed to keep pace with the rise in resistance.

耐药性已成为全球公共卫生危机。2016年，有490,000人开发了多药耐药结核病，现在在用来与艾滋病毒和疟疾作斗争的药物中看到了抗药性。如果我们使用的药物变得无效，它不仅会影响我们与杀手疾病作斗争的能力，而且对手术程序和癌症治疗也会产生可怕的后果。

2001年，《世卫组织》启动了全球抗菌抗性战略。它警告世界一个需要紧急行动的全球问题。

The strategy aimed to spur national and regional interventions which would help prevent infection, slow the emergence of resistance and reduce the spread of resistant microorganisms. It said we need to target poor sanitation and hygiene in hospitals, overprescribing of antibiotics, inappropriate use of antimicrobials in farming. And we need to develop new vaccines and treatments.

Dial forward to 2050 and drug-resistant diseases could cause 10 million deaths each year, warned a 2019 report by the抗菌耐药性的联合临时机构间协调组– and cause damage to the economy as catastrophic as the 2008-2009 global financial crisis.

By 2030, antimicrobial resistance could force up to 24 million people into extreme poverty if nothing is done to stem this crisis, the report warned.

在这两份报告之间的近二十年中，我们对驱动抗菌素耐药性的知识以及我们可以解决的方法的了解无疑已被完善。但是将知识转化为行动的进展似乎很慢。

Part of the problem is that this is complex. It’s not just a health issue, but an agricultural one, and an environmental one. Earlier this year, a global study found dangerously high levels of antibiotics at hundreds of sites in rivers around the world. Antibiotics are literally being flushed into waterways from hospitals and drug manufacturing plants, adding to the rise in resistance, which has so many contributory factors.

And just as there are many things driving resistance, there is no one simple fix in the form of new antibiotics or technology to replace them. Nanosilver, probiotics, and bacteriophages are promising alternatives but there is no silver bullet.

即使鉴于不断的抗性周期，也必须解决开发新抗生素的障碍。

新药的管道正在干燥，没有足够的激励措施开发新的抗菌剂 - 对于制药公司来说，这是昂贵的，由于需要最大程度地减少其使用并使其负担得起。像美国生物技术公司Achaogen这样的公司filed for bankruptcy4月，因将毒品推向市场而受到损害。

但是，尽管有这些障碍，但必须说服大型制药公司投资于抗生素开发。不这样做意味着其业务的其他业务，例如癌症药物，也将失败。

In the meantime, change is needed at every level of society to tackle this problem – from cracking down on over-the-counter sales of antibiotics, to improving hygiene standards in hospitals and banning growth promoting antibiotics on farms.

Doctors prescribing medicines have tools like the WHO’s new AWaRe classification system at their disposal to do so responsibly. Now it is up to every country to make sure this is implemented.

“Antimicrobial resistance is one of the most urgent health risks of our time and threatens to undo a century of medical progress,” said WHO director-general Tedros Adhanom Ghebreyesus, as the organisation launched the AWaRe campaign in June to encourage appropriate antibiotic use. Countries must strike a balance, he said, between ensuring access to life-saving antibiotics, and reserving the use of some antibiotics for the hardest-to-treat infections.