The next pandemic

Faculty

Steven Hoffman, Osgoode Hall Law School & Susan Rogers Van Katwyk, Global Strategy Lab

---

Funding

Wellcome Trust

While the COVID pandemic has gripped global society, another pandemic has had the same devastating effect, without grabbing the headlines. And it’s been happening for years. 

This one kills over a million people a year – and by 2050, the death toll could be as high as 10 million annually. 

Ironically, this pandemic is caused by something good – antimicrobial medicines, like penicillin. 

But don’t blame the drugs. The problem – the growing number of infections becoming resistant to the drugs we use to treat them – comes from our overuse of the very medicine that is there to heal us.

“For decades we have overused antimicrobial drugs in humans and animals which has sped the natural process of resistance development in microbes,” says Dr. Susan Rogers Van Katwyk, managing director of the World Health Organization (WHO) Collaborating Centre on Global Governance of Antimicrobial Resistance at York University. 

"By overusing antimicrobials, we've stepped on the gas and we're pushing the whole system forward at a much faster rate than would occur naturally."

Antibiotics are a product of nature, notes Rogers Van Katwyk, an epidemiologist. Long before humans learned to create drugs that can kill bacterial infections like pneumonia and tuberculosis, plants learned to emit chemicals that would destroy the pathogens trying to harm them. 

Later, ancient civilizations in Egypt, China, Serbia and Greece healed wounds by applying moldy bread.

But the antibiotic revolution really got going only fairly recently. In 1908, German scientist Paul Erlich collaborated with others to create an antibiotic to treat syphilis. Then, in 1928, came the famous accidental discovery by Scottish physician Alexander Fleming. He returned to his lab after a holiday and saw that petri dishes containing staphylococcus bacteria had been halted by mold containing a substance called penicillin notatum. 

Since then, antimicrobials have revolutionized health care and led to significantly longer lifespans.“ In the past 30 years, globally, maternal and child health have improved significantly. Deaths have gone way down. And that’s just one example,” says Steven Hoffman, Dahdaleh Distinguished Chair in Global Governance and Legal Epidemiology and a professor of global health, law and political science at York. 

Drug resistance occurs because bacteria and viruses evolve quickly, as we’ve seen with the COVID pandemic and all of its many variants.  With a bacterial infection such as pneumonia, an antibiotic will kill most of the bacteria and your immune system will take care of the rest. 

“But when you use antibiotics as widely as we do and over a long period of time, bacteria develop mechanisms to survive,” says Rogers Van Katwyk.  “Different species of bacteria can share genetic codes for resistance. These genes are like the cheat code for how the bacteria can avoid an antibiotic.” 

At one time, antibiotics such as penicillin took care of pneumonia easily, but Hoffman says that overuse has created new strains of resistant pneumonia that are often fatal. Then there are the ultra-dangerous infections like MRSA and C-DIFF and a form of tuberculosis that are extremely resistant to antibiotics. 

And this overuse is happening in many sectors. Hoffman points to U.S. statistics that show that only 10 per cent of patients who seek treatment for a sore throat will need an antibiotic. But at least 50 per cent of them will leave the doctor’s office with a prescription for an antibiotic. Rogers Van Katwyk says the same is happening in the food industry, where “antibiotics are widely used in meat-producing animals to make them grow faster” and antimicrobial agents are overused on crops further contributing to drug resistance. 

“We’re not saying we should all stop using antimicrobials,” says Hoffman. “We’re saying we must use them when they are necessary, keeping in mind their impacts on human health, animal health, and the environment.”

They believe progress can be made through evidence-based research and capacity building to support the development of better policies. To that end, the Wellcome Trust has awarded Hoffman and Rogers van Katwyk $8.7M to launch what they call a Policy Accelerator. 

“Many countries are rewriting their national plans on drug resistance, and this is one area where our evidence-based policy research can support effective policymaking. We’re going to work with governments to help solve the challenges they’re facing,” says Rogers Van Katwyk. 

"We’re forming a team that will apply the science and expertise we have as a research group at York and a WHO Collaborating Centre and we’ll tailor our work to each country, because what works in Canada will be different from what works in Nigeria.”

Hoffman likens their upcoming work to a consulting role where “we will have a razor-sharp focus on impact for people around the world. Our goal is not to do what we normally do as academics and publish papers. Our success will be measured in policy changes and lives saved. This is an amazing opportunity.”