Waging war on superbugs
By Eva Van Den Berg
Hosam Zowawi, a 36-year-old Saudi clinical microbiologist, is a leading expert in a subject that is currently one of the medical world’s greatest causes for concern, and which has given rise to numerous WHO alerts in recent years. This is a serious threat, since the problem currently causes 700,000 deaths per year, and the UN agency warns that if the present trend continues, the number of deaths could be as high as 10 million by 2050. This would be more than all the deaths caused by cancer and traffic accidents combined.
Zowawi, an international pioneer in his field, received the Rolex Award for Enterprise in 2014, the same year in which Time magazine hailed him as a Next Generation Leader, thanks to his fight against one of the greatest threats facing mankind today. “Bacteria are very good at developing mechanisms to fight against antibiotics, and our misuse of these antibiotics is the driving force behind their success in doing so,” warns the Laureate recognised by Rolex, whose Awards for Enterprise have provided support over the last 40 years to individuals with innovative projects who expand the field of human knowledge.
This represents one of the greatest threats facing humanity, and we are not even aware of the fact that the resistance of certain bacteria to antibiotics could quite simply lead to the collapse of modern medicine.
According to him, multi-drug resistant bacteria (or “superbugs”) are multiplying all over the world due to various factors, such as the over-prescription of antibiotics, the casual availability of antibiotics in pharmacies (which often leads to their inappropriate use), failings in hand-washing hygiene in hospitals (which causes more infections), a growing tourism industry (which encourages the spread of these superbugs all over the planet) and a low level of understanding from the general public, who underestimate the risks involved in using antibiotics. “Every time we take an antibiotic, we open the door for bacteria to develop a resistance to it.” These micro-organisms are now already complicating the care of numerous infectious diseases, including tuberculosis, pneumonia, gonorrhoea and urinary tract infections. The problem is that their ability to resist the methods we use to fight them is extraordinary.
For proof of this, we need look no further than an experiment undertaken in 2016 by the Harvard Medical School in Boston and the Technion-Israel Institute of Technology. In their creative experiment published in the journal Science, the researchers covered a surface area of 1.2 x 0.60 metres with 14 litres of agar, a substance used to feed bacteria, and divided the area of this rectangle into nine equal strips. While the end strips only contained agar, with each new strip approaching the centre of the rectangle an increasing amount of antibiotic was added to the polysaccharide. The minimum initial dose added to kill the bacteria was multiplied by 10, and then by 100, until a dose of 1,000 times more was added in the centre strip.
After releasing Escherichia coli bacteria on both the end strips, the bacteria started to advance, feeding and multiplying at high speed until they reached the adjoining strip, where they came to an abrupt halt. However, just a few hours later, one of the bacteria mutated, became resistant to the antibiotic and then penetrated the following strip. Not only did it do this, but it also succeeded in transmitting the newly acquired resistance to its descendants and other bacteria present, with which it exchanged genetic material. At that point, the second segment was colonised, and when it reached the third segment, where the antibiotic dose was 10 times higher, the pattern was repeated with the same result. This continued up to the central strip, where despite the fact there was up to 1,000 times more antibiotic present, the E. coli bacteria, which had now converted into “superbugs”, were able to prosper. In less than 11 days, they succeeded in dominating the entire rectangle.
From his laboratory in Brisbane, Australia, Zowawi is specifically studying two types of hospital pathogens. One is the subject of this highly visual experiment: a strain of E. coli bacteria, which is normally harmless and present in our digestive tract. The second is a bacillus that has also mutated into strains that are difficult to combat: Klebsiella pneumoniae. Both bacteria can cause the death of patients with even common conditions such as urinary infections (up to 30% of women develop an infection of this kind at some point in their lives). Although they are normally curable, if the strain hosted by the patient has developed this type of immunity, it can be fatal. “I’ve seen a lot of people battle against this type of illness, including my mother. They suffer from them repeatedly, the illness comes and goes frequently and it can eventually lead to serious kidney infections and even death,” says Zowawi.
But the development of superbugs isn't something we didn't see coming. One of the pioneers of the antibiotic revolution, Alexander Fleming, already alerted the world to the dangers they could entail 76 years ago. “There is a danger that an ignorant man may be able to give himself an insufficient dose of antibiotic, and, by exposing the microbes to a non-fatal quantity of the medicine concerned, make them resistant,” he declared in 1945 when he received the Nobel Prize for discovering penicillin.
Zowawi is particularly concerned about certain bacteria’s phenomenal ability to adapt, as he fears the terrifying scenario when modern medicines stop working could indeed become a reality. For several years, he has been developing and marketing rapid tests to detect within a few hours whether a particular form of bacteria carries genes for an enzyme known as beta-lactamase, which is produced by certain bacteria in order to resist the effects of antibiotics. These tests are very useful, since they give doctors more leeway to find the right medicine to treat a particular infection.
The microbiologist states that it's important to emphasise that human beings only consume 30% of the antibiotics used in the world. The remaining 70% is used for livestock production. “This is due to the increase in the human population and our consequent need for food. The days when people kept a few animals for their own consumption have long gone. Today we confine large numbers of animals in tiny spaces, so they grow as quickly as possible, before slaughtering them and selling them. In such conditions, they can easily develop infections, and for this reason they are given antibiotics as a preventive measure. It was also discovered that animals treated with antibiotics grow more quickly, so antibiotics were considered to have a double advantage. This is a typical example of the type of abusive consumption we need to fight against. The problem of resistance to antibiotics is similar to that of climate change: each person’s actions have an impact on the entire planet. To deal with this huge threat, we also need global action,” declares Zowawi, who favours introducing a holistic approach to health that would include human, animal and environmental health within the same focus. He warns that if we don't take action to deal with this problem, modern medicine could quite simply collapse. After all, it's not “just” the fact that diseases are becoming incurable because of this. Many surgical operations, such as transplants, also require antibiotics to prevent post-operative infections.
So, couldn’t the problem be solved by creating new antibiotics? “An awful lot of time and money is required to develop a new antibiotic and to conduct the relevant clinical tests,” explains Zowawi. We are talking about up to a decade and as much as a billion dollars. And despite the alarming increase in the effects of superbugs, the percentage concerned is small when compared with the large number of infectious diseases in existence. Conducting research into this area wouldn't be profitable for pharmaceutical companies. And the current economic model doesn't favour this type of initiative. We need to find public funds to subsidise part of the cost of such research and regulatory processes for new antibiotics.”
In Zowawi’s opinion, it's absolutely essential to work more on the prevention of infections, and to raise public awareness of the dangers involved in the irresponsible use of antibiotics. That's why for many years he has been conducting a communication and awareness-raising campaign in the Persian Gulf states within his home country of Saudi Arabia, which is an area that has been particularly affected by this problem. He is also researching into how bacteria succeed in becoming so resilient. Hoping to conduct further research into this subject, in 2016 he collaborated with a fellow Rolex Young Laureate, the geologist and speleologist Francesco Sauro, with whom he explored underground caves beneath the tepui mountains of South America that were like windows on the past, where no human being had ever set foot before. “These places are full of primitive micro-organisms and I believe that studying them will enable us to establish how superbacteria has evolved over time. A knowledge of the diverse microbial ecology present in these caves will shed light on how they produce the chemical components that enable them to resist attacks from other microbes. Some components could be used to produce new antibiotics in the future,” explains Zowawi.
The work of the Saudi microbiologist and many other scientists is key to facing this challenge. However, each of us must also take responsibility for our own actions. To cite just one statistic, up to 40% of Europeans still believe that antibiotics should be taken against flu, and too many antibiotics can be obtained without a doctor’s prescription. It is only by working together that we can reverse this emerging danger.
Hosam Zowawi received a Rolex Award for Enterprise in 2014. This article has been prepared with the support of Rolex, which collaborates with National Geographic to cast light, through science, exploration and dissemination, on the challenges facing the systems most crucial to sustaining life on Earth.
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