The next pandemic may be just around the corner, but this time it is not a new virus waiting patiently to leap into the world from a remote Asian or African province. In fact, many experts believe that in this future health crisis, viruses will not be our enemies, but our allies. Scientists have been warning for years about the danger posed by ‘superbugs’, pathogens that, in addition to the misuse – read overuse – of medicines that we humans have displayed over the last few decades, have become resistant to virtually all the antibiotics with which we have traditionally fought them since Alexander Fleming’s discovery of penicillin almost a century ago.
Dying from an infected wound may seem absurd today, but before the widespread use of antibiotics in the 1940s it was relatively commonplace – and it could become so again. A recent study published in the prestigious scientific journal The Lancet estimates that antibiotic-resistant bacteria were responsible for more than 1.2 million deaths in 2019, more than diseases such as AIDS or malaria. This is a worrying finding, as until now it was estimated that these ‘superbugs’ would cause around 10 million deaths by 2050, but the new evidence suggests that “we are much closer to that figure than we thought”, as explained by the study’s co-author, Professor Chris Murray, from the Institute for Health Metrics and Evaluation at the University of Washington.
The study, entitled ‘Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis’, estimates that there were a total of 4.95 million deaths associated with antibiotic resistance in 2019, of which a total of 1.27 million are directly attributable to it. Again, underdeveloped countries and regions of the globe were hardest hit, with West sub-Saharan Africa leading the mortality rate with an average of 23.7 deaths per 100,000 population, while in the Australasian region this incidence dropped to 6.5 deaths per 100,000 population. The study covers 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019.
The scale of the threat is such that scientists, who are engaged in a kind of arms race against the clock against these micro-organisms, believe they have finally hit on their match. On 22 March 2016, young Karen Northshield was seriously injured in the terrorist attack at Brussels’ Zaventen airport, which killed at least 14 people. She was taken to hospital in cardiac arrest, where doctors resuscitated her and, due to the severity of her injuries, had to amputate part of her hip and perform emergency surgery to save her leg. The real ordeal began later, however, when doctors realised that Northshield’s wounds were infected with a bacterial strain that would not respond to any of the usual antibiotics. After months of unsuccessful treatments, salvation came in the form of something we have all learned to fear over the past two years: a virus.
Bacteriophages or phages are viruses that exclusively infect bacteria. They are everywhere, in the soil, in our intestinal tract or in a sewer, like the one that finally, in a combined therapy with drugs, freed the young woman from the Klebsiella pneumoniae infection that had kept her bedridden for several months, as reported by El País on 18 January. The scientific consensus is that phages are one of the most promising weapons in the fight against the danger posed by superbugs, but there are still many years of research (and investment) to refine the use of these microscopic allies, which are harmless to humans because they have evolved in symbiosis with them for millions of years.
A bit of history
Far from being novel, phage therapy is even older than antibiotics themselves, having been discovered in 1917. However, the development of penicillin and its derivatives soon put the brakes on research into these viruses, whose use to cure infections only flourished as an alternative to drugs in the former Soviet Union, where they played a prominent role in battles such as Stalingrad. After the fall of the Iron Curtain, phage knowledge was kept alive in former Soviet republics such as Georgia and Poland, where the Hirszfeld Institute in Wroclaw and the Eliava Institute in Tbilisi are at the forefront of developing antibacterial treatments with these viruses and have served as a bridge for researchers and institutions around the world to take up the baton of research and prepare us for a pandemic in which, for the first time, much of the blame will be placed on human irresponsibility.
By Fernando Moldenhauer