We Knew About the Antibiotics Problem. But These 5 Things We Learned Were Staggering

Antimicrobial resistance (AMR) is a mouthful of a phrase, and that’s appropriate. It’s a big problem, and bound to become much bigger. Some 700,000 people lose their lives due to AMR each year, and the figure is set to swell to 10 million by 2050 — more than the number of lives cancer currently claims.

With Project Marvelous, we set out to chip away at that reality in partnership with the Wellcome Trust, looking at how human-centred design might reduce the amount of unnecessary antibiotics prescribed and taken. We started by deepening our understanding of how antibiotics are doled out and used and what AMR looks like. And we realized that, even as conscious consumers, some of our assumptions were shockingly wrong. Here are 5 big eye-openers we’ve come across so far:

1. Pharmaceutical companies are fleeing the antibiotics space: With the looming threat of AMR, we assumed pharma giants would be racing to find the next class of antibiotics. Quite the opposite. July saw Novartis’ announcement that it was killing its antimicrobial research programs and moving its resources elsewhere. It wasn’t a novel move: AstraZeneca, Sanofi, and Allergan have proceeded it with similar decisions. The space isn’t a total wasteland: Small biotech firms are still on the quest, as are giants like GlaxoSmithKline and Johnson & Johnson.
2. Antibiotics aren’t actually lucrative. Relatively speaking. The problem is the bottom line: Getting a drug to market can cost £1 billion, and the ROI just isn’t there. A Duke University study cited by Bloomberg found that of 16-brand name antimicrobials approved this century, just five brought in more than $100 million (£77 million) in annual sales. Sure, there are some antibiotics that cost an eye-popping $1,000 (£775) per day, but patients finish antibiotics in just days or weeks, not months or years as they do with cancer drugs, which can bring in billions.
3. Even age-old diseases are affected. Like leprosy. A multi-drug strategy became the routine way to treat it in the early ’80s, but now that trio of drugs isn’t as foolproof as it once was. Beginning in 2009, nearly 2,000 leprosy cases across 19 countries were studied for resistance to antibiotics like rifampicin, dapsone, and ofloxacin by analyzing certain gene regions and looking for mutations. 8% of cases had these mutations. The first two drugs are part of that routine and inexpensive drug regimen. There’s a two-part alternative, but it needs to be taken daily for two years and is very pricey — and ofloxacin is half of it. The problem is not yet serious, experts say, but there is a call for vigilance from the likes of the WHO and others.
4. Healthy animals are dosed with antibiotics: One animal is sick, and healthy animal after healthy animal is given antibiotics? Pretty much. That’s because dosing animals with antibiotics as a preventative measure is legal — and hugely problematic. The WHO wants antibiotics that are crucial for human use to be restricted to human use, with only the antibiotics “least important” to human health given to animals in a restricted fashion. The overuse of antibiotics among the animal kingdom can foster AMR among humans, and according to WHO stats, in some countries only 20% of medically important antibiotics go to humans. The rest? Yep, animals.
5. It’s a global problem — but India is ground zero. We assumed antibiotic overconsumption was on the rise everywhere. Not so. This recent study looked at antibiotic consumption among 76 countries between 2000 and 2015 — and found global consumption surged 65%. But while consumption in high-income countries like the United States and France was basically flat, consumption exploded in low- and middle-income countries: It was up 65% in Pakistan, 79% in China, and 103% in India — with India emerging as the world’s biggest consumer of antibiotics (and a hotspot for unregulated ones).

Have you been jolted by another AMR fact? Shock us, too: We’d love to hear it. Follow us as our design journey and ideas evolve at Project Marvelous, a project from IDEO, a global consultancy that creates impact through design, and the Wellcome Trust, an independent global charitable foundation that takes on big problems, fuels imaginations, and sparks debate.