The Bugs We Fear

Back in May, I wrote a post detailing some of what I perceive to be threats facing humanity. This is the second of what will be seven posts providing more details on each of these threats. This one concerns infectious diseases.

Starting in the 1940’s, modern medicine discovered the magic bullet of antibiotics. Antibiotics have prolonged the lives of hundreds of millions of people by enabling bacterial diseases to be stopped before they created sepsis inside of humans, and caused massive organ failure. The practice of medicine soon became the story of the prescription of antibiotics, and the eventual over-prescription of the same. Once the knowledge of the power of antibiotics became known, the customer (i.e., the patients) were insistent on being prescribed antibiotics even when they suffered from a viral infection, like a cold. All of society believed that antibiotics were able to put the suffering of the past from bacterial infection out of the memory of humanity.

Except. Except that human greed and the needs of commerce got in the way. Except that human behavior caused the effectiveness of antibiotics to be compromised. Now, barely 77 years after the first widespread use of an antibiotic to treat diseases, the news is full of stories about bacteria that are resistant to all but the most powerful antibiotics, and even some strains of bacteria have developed resistance to all forms of antibiotics. How did we get here? It started when agricultural researchers discovered that by applying low-dosages of antibiotics to animal feed, weight gain for the animals was increased and disease incidence was reduced. Since agriculture in the US relies upon high animal density in farms and feed lots, and since anything helping the profit margins of farmers was viewed as a God-send, commercial animal feeds began to incorporate antibiotics as a key additive. Unfortunately, this served as an ideal breeding ground for bacteria to show the powers of evolution. Ever wonder why all antibacterial commercial products claim that their product kills 99.99% of bacteria? It’s because there are always a few bacteria that have a mutation that enables them to survive the onslaught of the chemicals aimed at killing them. It may not be a concern for a kitchen countertop to have some bacteria that survive bleach or other similar kitchen cleaner. But it is totally different when a strain of bacteria survives a dosage of antibiotics inside of a farm animal. That strain now faces less competition since many other bacteria were inhibited by the antibiotics in the feed. Soon, the resistant strain is circulating among farm animals, and slowly the antibiotic in the feeds lose their effectiveness as the population of resistant bacteria increases in the environment. Since they began to incorporate antibiotics, animal feeds have used most of the types of antibiotics, which means that effectiveness of many antibiotics have been lowered over time. Market demand is now pushing agricultural firms to proclaim that their animals are antibiotic-free, but only time will tell if that movement will grow fast enough to keep antibiotics at least partially useful.

Human behavior also plays a role. As noted earlier, patients often demand a prescription for an antibiotic even when their infection is viral. This dosage of unneeded antibiotics increases the chance of developing a resistant strain directly inside of a human. Add to this the tendency for some folks to stop taking a medicine once they feel better, and you end up with the worst case for developing antibiotic resistance. By not taking the full course of antibiotics, it is more likely that some of the bacteria will survive, and then their traits will be passed on to subsequent generations of bacteria. One way or another, the bacteria will outwit us as we currently use antibiotics.

But bacterial infections are only a part of the disease story. Viruses cause many more diseases, and there are several factors in our modern world that enhance the possibility of a viral infection causing huge problems in our society. First, viruses are mobile. They can hitch a ride upon any animal infected with the virus. Whether that is a chicken carrying the latest variant of bird flu, or whether it is an international traveler that had unknowingly been exposed to the latest version of Ebola or Marburg disease from Africa, viruses can travel amazingly fast in our modern, interconnected world. Then there is this little issue about climate change. Regardless of the source of a warmer climate, one result is that mosquitoes that are intolerant of cold, are now expanding their ranges into temperate climates. Thus malaria is expanding its range. Other viral diseases that once were known only in Africa are now showing up in Sardinia, a handy stopping place on the way to infect southern Europe.

Yet another factor is affecting viral disease transmission. Through extensive research, humanity has managed to control the immune system to enable it to react to viral invaders that can cause diseases. Thus, humanity has wiped out the dread disease smallpox as a scourge. Only remote pockets of polio remain, which means this crippler of people is nearly extinct. Who remembers iron lungs where the sufferers of polio were kept, enabling them to breath until they regained at least a semblance of muscle strength? The use of vaccines has greatly limited tetanus, and diphtheria, and whooping cough. The old childhood diseases of measles, mumps, and chickenpox are no longer rites of passage for children. All have been vanquished through the use of vaccines.

Except. Except that a growing percentage of the population no longer believes that the benefits of vaccination exceed the perceived costs. Especially with the growth of the internet, there are groups convinced that vaccines are causing the growth of conditions such as autism. And therefore they are opting out of mandatory vaccination protocols. Either opting out, or spacing vaccinations out over a longer period than recommended, all in a belief that they are protecting their children from a fate worse than the disease that the vaccine is intended to prevent. What this is doing is increasing the percentage of the population who does not have immunity to the disease, and as a result, diseases that had been nearly eliminated are making a comeback. In 2017 there was an outbreak of measles, mainly within the Somali immigrant population around Minneapolis. According to the CDC, the rate of measles vaccination of Somali children was only 54% in this area. This enabled measles imported from a visit from Africa to spread throughout the community, until 65 cases were recorded. Of those, 20 required hospitalization. I remember my own case of measles, back in 1961. I contracted it right after my tonsillectomy, another rite of passage that is no longer nearly universally prescribed. It was not fun, but I did not suffer any of the permanent effects that could have resulted.

How should we deal with infectious diseases in the future? Certainly there is a need for more pharmaceutical research in antibiotics. If we can stay ahead of the resistance curve, we may still be able to keep the tragedy of blood poisoning from killing thousands and thousands each year. Unfortunately, pharmaceutical companies are not investing heavily into antibiotic research. The perceived market is deemed too small to justify the vast expenditures required for drug development. This is an area where government-directed research is required since the lack of private company research does not appear to be amenable to a market-based solution. The current trend towards reducing antibiotic supplementation in animal feed needs to become universal. This may be a problem though, in other countries where a simple and cheap way to control animal disease and increase animal yield is not viewed as an existential threat.

Finally, for viral diseases, there may not be good ways to deal with them. The warming of the climate will result in the spread of many diseases beyond their current tropical ranges. Unless we can put the climate warming genie back into the bottle, we may have to deal with the effects. Vaccine development is required, and investment in additional vaccine capacity for diseases such as yellow fever. But the hardest problem to deal with may be the human resistance to acknowledge that science has the answer for disease prevention. It may never be possible in this fractured society to convince a large enough percentage of the population of the benefits of a vaccine. There will always be self-sustaining groups who convince themselves that they know more than all of the scientists in the world. After all, the scientists are the elites who have failed us, right?