Year Ahead

The threat of superbugs will loom too large to ignore

Antibiotic-resistant infections threaten our health system. We need urgent action.

(Illustration by Anna Minzhulina)

Gerry Wright is a professor of biochemistry and biomedical studies at McMaster University

Several years ago, I contracted a foodborne illness while travelling in Europe. It didn’t respond to oral antibiotics, and I grew sicker as the bug spread through my bloodstream. Finally, I had no choice but to check into a hospital to treat it with IV antibiotics. They saved my life.

Most people take antibiotics to fight common infections like strep throat and E. coli. Yet few of us realize just how foundational these drugs are to modern medicine. They allow patients to undergo organ transplants and chemotherapy without infections. They allow premature babies to survive their first days on Earth. Since the discovery of penicillin in 1928, science has been in an arms race with bacteria: they evolve to become stronger, and we make better antibiotics.
Recently we’ve started losing that race. Many of our antibiotics are becoming less effective, and few new ones are emerging. Now we’re hurtling toward a potential crisis. Conditions we can treat today could become untreatable, and life-saving procedures riskier. In part, that’s because we’ve overprescribed antibiotics, giving bacteria more opportunity to develop resistance. So we’re dealing with superbugs that can cause blood, skin and lung infections, and in some cases even spread on surfaces such as floors, walls or clothes. Health Canada now has its eyes on bacteria, including salmonella and C. difficile, that are growing resistant to multiple antibiotics.

Already, several thousand Canadians die annually due to antibiotic-resistant infections. Most of these deaths would have been preventable not long ago. If we don’t make major policy and economic changes beginning this year, the problem will grow, and we’ll come closer than ever to an existential problem for health care: routine procedures will become risky, and more Canadians will die from infections that should have been preventable.

There are ways we can start winning this race again—and there’s no time to lose. First, we need to double down on research. When I started my career at McMaster University in 1993, lots of drug companies had active antibiotics divisions. They barely exist anymore because they aren’t lucrative. There’s more money in drugs people use to control long-term conditions, like high blood pressure or diabetes, not for those used to recover from acute infections. In 2024, our government needs to help make antibiotics profitable again, through what economists call push and pull mechanisms.

The “push” means more funding for labs and biotech companies. This comes from governments, as well as not-for-profits such as CARB-X, a global partnership between governments and philanthropic organizations aimed at developing new antibiotics. In the meantime, small companies such as Fedora Pharmaceuticals in Edmonton and Viotika Life Sciences in Winnipeg have secured investor money and some government funding. The “pull” mechanism is even more important. As with COVID-19 vaccines, the federal government should pre-order all the antibiotics it anticipates it could need and pay companies up front. That would create stability and incentive to grow the field. Governments in Europe, the U.K. and the U.S. have launched pilot projects in this vein. At home, the Canadian Council of Academies provided a report on the issue in September of 2023, but I’ve heard nothing about how it was received by government.

I also want Canada to collaborate better globally in 2024. Since 2010, 18 new antibiotics have come onto the market. Canadians only have access to three, while Americans can get 17. That’s because Canada is a comparatively small market, but also because our bureaucracy is slow to approve new drugs. So we have a smaller arsenal to deploy against infections.

Finally, I want to see Canada’s provincially segmented health system do better at shipping medications where they’re needed. Large hospitals, like Princess Margaret in downtown Toronto, have well-stocked pharmacies—we need a fast, Canada-wide system to get medication to patients in Sudbury or Moose Jaw who catch a superbug. Amazon has taught us that we can ship things almost anywhere quickly; I would love to see a system where powerful antibiotics are delivered to a Canadian headquarters, then shuttled to whichever hospital needs them. For shorter distances, some hospitals have already piloted projects using drones to deliver medical supplies and lab samples.

The average human lifespan has gained 25 years in the last century, thanks in large part to our ability to treat infections. If we lose the fight against superbugs, infectious diseases could again kill more people than cancer. They’ll endanger surgical patients and immunocompromised people. They’ll make others second-guess whether a trip to the hospital is worth it. That can’t happen. The race goes on, and we must win.

This article is part of the Year Ahead 2024, which is Maclean’s annual look at everything that’s coming your way next year. You can buy the print version right here.

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