How can we solve the antibiotic resistance crisis? - Gerry Wright

翻译人员: Meng Ren 校对人员: Yifei Liu

Antibiotics: behind the scenes, they enable much of modern medicine.

抗生素：现代医学的幕后英雄。

We use them to cure infectious diseases,

我们不仅用它们 治疗感染性疾病，

but also to safely facilitate everything from surgery to chemotherapy

还用它们保障医疗安全—— 从外科手术到化疗，

to organ transplants.

再到器官移植。

Without antibiotics,

若没有抗生素，

even routine medical procedures can lead to life-threatening infections.

常规的医疗程序 也会引起致命的感染。

And we’re at risk of losing them.

而人类正面临着 失去它们的风险。

Antibiotics are chemicals that prevent the growth of bacteria.

抗生素是一些能抑制 细菌生长的化学物质。

Unfortunately, some bacteria have become resistant

不幸的是，一些细菌 已经对当下所有的抗生素

to all currently available antibiotics.

产生了抗药性。

At the same time, we’ve stopped discovering new ones.

与此同时，我们又停止了 对新型抗生素的研发。

Still, there’s hope that we can get ahead of the problem.

尽管如此，人类仍有望克服这一困境。

But first, how did we get into this situation?

但首先，我们是如何陷入这一困境的？

The first widely used antibiotic was penicillin,

青霉素是第一种 被广泛使用的抗生素，

discovered in 1928 by Alexander Fleming.

它于 1928 年 被亚历山大 · 弗莱明发现。

In his 1945 Nobel Prize acceptance speech,

在他 1945 年 诺贝尔奖的获奖感言里，

Fleming warned that bacterial resistance had the potential to ruin

弗莱明警告了世人 细菌的抗药性可能摧毁

the miracle of antibiotics.

抗生素创造的奇迹。

He was right: in the 1940s and 50s,

他说得没错：20 世纪中叶，

resistant bacteria already began to appear.

抗药性细菌已经开始产生。

From then until the 1980s,

到了 20 世纪 80 年代，

pharmaceutical companies countered the problem of resistance

制药企业通过研发新的抗生素

by discovering many new antibiotics.

解决了抗药性问题。

At first this was a highly successful— and highly profitable— enterprise.

一开始，这是一项非常成功 ——也非常赚钱——的生意。

Over time, a couple things changed.

渐渐地，事情发生了变化。

Newly discovered antibiotics were often only effective

新研发出的抗生素

for a narrow spectrum of infections,

通常只对少数几类感染有用。

whereas the first ones had been broadly applicable.

相比之下， 第一代抗生素的适用范围非常广。

This isn’t a problem in itself,

这本身不是问题，

but it does mean that fewer doses of these drugs could be sold—

但它确实意味着 每种药物的销量会下降——

making them less profitable.

利润也随之缩水。

In the early days, antibiotics were heavily overprescribed,

早期，抗生素处方严重过量，

including for viral infections they had no effect on.

甚至被用在毫无疗效的病毒感染上。

Scrutiny around prescriptions increased, which is good, but also lowered sales.

对于处方的审查力度加大是件好事， 但也导致了销量进一步下滑。

At the same time, companies began to develop more drugs

同时，公司开始研发更多

that are taken over a patient’s lifetime,

患者需要长期服用的药物，

like blood pressure and cholesterol medications,

例如血压和胆固醇药物，

and later anti-depressants and anti-anxiety medications.

之后是抗抑郁药物和抗焦虑药物。

Because they are taken indefinitely, these drugs more profitable.

由于患者需要一直服用， 生产这些药的利润更大。

By the mid-1980s, no new chemical classes of antibiotics were discovered.

截止到 1980 年代中期， 已经没有新的抗生素化学类别被发现。

But bacteria continued to acquire resistance and pass it along

但细菌的抗药性与日俱增，

基因信息也开始在细菌个体

by sharing genetic information between individual bacteria

and even across species.

甚至跨种类的细菌之间传播。

Now bacteria that are resistant to many antibiotics are common,

今天，一种细菌对多种抗生素 产生抗药性很常见，

and increasingly some strains are resistant to all our current drugs.

而且越来越多的菌株 对所有药物都产生了抗药性。

So, what can we do about this?

那么，我们能做些什么呢？

We need to control the use of existing antibiotics, create new ones,

我们需要控制现有抗生素的使用， 研发新的抗生素，

combat resistance to new and existing drugs,

抑制对新老抗生素的抗药性，

and find new ways to fight bacterial infections.

并探究治疗细菌感染的新办法。

The largest consumer of antibiotics is agriculture,

抗生素的最大消费领域是农业，

which uses antibiotics not only to treat infections

人们不仅用抗生素治疗感染，

but to promote the growth of food animals.

还用它来促进家畜生长。

Using large volumes of antibiotics

大量使用抗生素

increases the bacteria’s exposure to the antibiotics

增加了细菌和抗生素的接触，

and therefore their opportunity to develop resistance.

从而增加了产生抗药性的可能。

Many bacteria that are common in animals, like salmonella, can also infect humans,

一些在动物体内常见的细菌， 如沙门氏菌，也能感染人类，

and drug-resistant versions can pass to us through the food chain

有抗药性的变种也能 通过食物链传给我们，

and spread through international trade and travel networks.

并通过国际贸易和旅游网络传播。

In terms of finding new antibiotics,

说到研发新抗生素，

nature offers the most promising new compounds.

大自然贡献了 最具前景的新化合物。

Organisms like other microbes and fungi have evolved over millions of years

像细菌、真菌这样的微生物 已经进化了数百万年

to live in competitive environments—

才在残酷的自然界中生存下来——

meaning they often contain antibiotic compounds

意味着其体内通常 含有抗生素化合物，

to give them a survival advantage over certain bacteria.

使其对某种特定细菌 更具生存优势。

We can also package antibiotics with molecules that inhibit resistance.

我们也能用抑制抗药性的分子 包裹抗生素。

One way bacteria develop resistance is through proteins of their own

细菌产生抗药性的方式之一 是用自身蛋白

that degrade the drug.

降解药物。

By packaging the antibiotic with molecules that block the degraders,

将抗生素包裹在 抑制降解物质的分子中，

the antibiotic can do its job.

抗生素就能发挥作用。

Phages, viruses that attack bacteria but don’t affect humans,

噬菌体，一种能攻击细菌 但不感染人体的病毒，

are one promising new avenue to combat bacterial infections.

是一个很有前景的 对抗细菌感染的新途径。

Developing vaccines for common infections, meanwhile,

同时，研发针对常见感染的疫苗，

can help prevent disease in the first place.

能在第一时间防御疾病。

The biggest challenge to all these approaches is funding,

以上所有手段 面临的最大挑战是资金，

which is woefully inadequate across the globe.

全世界都面临着 资金严重短缺的问题。

Antibiotics are so unprofitable that many large pharmaceutical companies

抗生素的利润太低， 以至于很多大型制药公司

have stopped trying to develop them.

都停止了研发。

Meanwhile, smaller companies that successfully bring new antibiotics

其间，成功推出过 新抗生素的小公司

to market often still go bankrupt, like the American start up Achaogen.

往往还是会破产倒闭， 比如美国创业公司 Achaogen。

New therapeutic techniques like phages and vaccines

像噬菌体和疫苗 这样的新治疗技术

face the same fundamental problem as traditional antibiotics:

面临着和传统抗生素一样的困境：

if they’re working well, they’re used just once,

如果它们有效， 那么使用一次就够了，

which makes it difficult to make money.

制药公司因此难以盈利。

And to successfully counteract resistance in the long term,

而且，为了避免 以后产生抗药性，

we’ll need to use new antibiotics sparingly—

人们需要更慎重地 使用新抗生素——

lowering the profits for their creators even further.

这又进一步降低了 生产者的利润。

One possible solution is to shift profits away from the volume of antibiotics sold.

一个可能的对策是 拆解利润和销量之间的关系。

For example, the United Kingdom is testing a model

例如，英国正在测试一种新模式，

where healthcare providers purchase antibiotic subscriptions.

推动医疗机构定期购买抗生素。

While governments are looking for ways to incentivize antibiotic development,

尽管政府正在千方百计地 鼓励研发抗生素，

these programs are still in the early stages.

这些计划仍在初级阶段。

Countries around the world will need to do much more—

世界各国的努力 还远远不够——

but with enough investment in antibiotic development

但是，若能为抗生素 研发投入足够的资金，

and controlled use of our current drugs,

并管控现有药物的使用，

we can still get ahead of resistance.

我们仍然有望战胜细菌的抗药性。