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Digital Subscriptions > Prospect Magazine > February 2016 > Losing the war on bugs

Losing the war on bugs

Fake, or substandard medicine—some peddled by criminal gangs— is a big but hidden cause of antibiotic resistance

In the infectious disease wards of Ho Chi Minh City’s main hospital for tropical illnesses, patients are arranged behind plate-glass windows like mannequins in a department store. Those that are conscious stare blankly through the glass that separates them and their frightening pathogens—cryptococcal meningitis, perhaps, or septicaemia—from the efficient hum of nurses and orderlies on the ward. A runner comes in and hands a doctor a sheaf of papers, the latest batch of results from the microbiology lab.

For the glassed-in patients—the hospital’s most serious cases— these reports are rarely encouraging. The pathogens that have colonised their blood, lungs, or tissues have evolved their way around every drug that could have been used to combat them. And researchers working on the frontline of resistance blame the mutant bugs, in part, on fake and second-rate medicines.

This may be happening far away, but it is the west’s problem too. In these days of global tourism, travel and migration, drugresistant bacteria are highly mobile. “Humans think a lot of themselves,” said Paul Newton, professor of tropical medicine at Oxford University, who works out of a microbiology lab in Vientiane, the capital of Laos. “But in fact we’re really just exoskeletons for bacteria. They take cheap flights as often as we do.”

No-longer curable variants of bugs bred in Ho Chi Minh City may be coming to a hospital near you. In 2008, an especially nasty genetic mutation that made several bacteria resistant to multiple classes of antibiotic was identified in a Swedish patient returning from India (hence its name, New Delhi metallo-beta-lactamase 1, or NDM-1). It was found in Britain that same year, and by 2013, in over 70 other countries. And it is not the only such infection to come to Europe. Multi-drug resistant staphylococcus, thirdgeneration cephalosporin-resistant E.coli and K.pneumoniae have also travelled the world. At the last count, these infections and other resistant ones were already killing 25,000 Europeans a year—without measuring newer imports, such as NDM-1.

In recent years, there has been much wailing and gnashing of teeth about the advent of superbugs that have outwitted the drugs made to treat them. The UK added the threat of antimicrobial resistance to the National Risk Register for the first time in March 2015, worrying that “without effective antibiotics, even minor surgery and routine operations could become high-risk procedures.” If bacteria with mutations such as NDM-1 were rife, doctors would hesitate to recommend hip replacements or even chemotherapy: the risk of becoming infected with untreatable bacteria would be too high. In December 2014, a governmentcommissioned review on antimicrobial resistance warned that drugresistant pathogens could slice 3.5 per cent offthe world’s output by 2050, as well as putting 10m people into early graves every year.

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About Prospect Magazine

In Prospect’s February issue: Lawrence Summers questions Robert J Gordon’s thesis on the impact of the digital revolution, John Sawers, the former Chief of MI6, highlights how technology is making the work of spies harder and Frank Furedi examines the student movements demanding protection from the offensive and uncomfortable. Also in this issue: Gershom Gorenberg on Israel, Ben Judah on the complexity of London and Elizabeth Pisani on the impact of fake drugs. Plus Sam Tanenhaus on Obama’s gun control plans.
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