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

譯者: Lilian Chiu 審譯者: Chloe Choo

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

抗生素：在其背後， 它們讓許多現代醫學變成可能。

We use them to cure infectious diseases,

我們用抗生素來治癒感染性疾病，

but also to safely facilitate everything from surgery to chemotherapy

也能安全地協助從手術、化療 到器官移植等各種治療。

to organ transplants.

Without antibiotics,

沒有抗生素，

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

就連慣常的醫療程序都有可能 導致有生命危險的感染。

And we’re at risk of losing them.

而我們正面臨著失去抗生素的危機。

Antibiotics are chemicals that prevent the growth of bacteria.

抗生素是化學物質， 可以預防細菌生長。

Unfortunately, some bacteria have become resistant

不幸的是，有些細菌已經

to all currently available antibiotics.

對目前可得的抗生素產生抗藥性。

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

同時，我們也不再研發新的抗生素。

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

在這個問題上， 我們仍然有希望可以超越。

But first, how did we get into this situation?

但，首先，我們是 怎麼落到這個地步的？

The first widely used antibiotic was penicillin,

最早廣為使用的抗生素是盤尼西林，

discovered in 1928 by Alexander Fleming.

由亞歷山大．弗萊明 於 1928 年發現。

In his 1945 Nobel Prize acceptance speech,

1945 年，他在諾貝爾 得獎演說中提出警告，

Fleming warned that bacterial resistance had the potential to ruin

認為細菌抗藥性 有可能會摧毀抗生素的奇蹟。

the miracle of antibiotics.

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

他說的沒錯：在 1940 和 1950 年代，

resistant bacteria already began to appear.

有抗藥性的細菌已經開始出現。

From then until the 1980s,

從那時到 1980 年代，

pharmaceutical companies countered the problem of resistance

藥廠對付抗藥性問題的方式

by discovering many new antibiotics.

就是發現更多新的抗生素。

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

一開始，這是個很成功 且利潤很高的「事業」。

Over time, a couple things changed.

隨著時間過去， 一些事情也發生了變化。

Newly discovered antibiotics were often only effective

新研發的抗生素通常

只對一小部分的感染有效，

for a narrow spectrum of infections,

whereas the first ones had been broadly applicable.

最早的抗生素 應用範圍就相對很廣。

This isn’t a problem in itself,

這本身並不是個問題，

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

但那就表示這些藥物 能銷售出去的劑量比較少——

making them less profitable.

利潤就會跟著減少。

In the early days, antibiotics were heavily overprescribed,

早期，抗生素的處方被過度濫開，

including for viral infections they had no effect on.

連用抗生素無效的病毒感染 也開抗生素處方。

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

對處方的監督增加了雖是好事，

但也讓業績下降。

At the same time, companies began to develop more drugs

同時，製藥公司開始開發更多

病人一生都可以服用的藥物，

that are taken over a patient’s lifetime,

like blood pressure and cholesterol medications,

比如血壓和膽固醇相關的用藥，

and later anti-depressants and anti-anxiety medications.

後來還有抗憂鬱 和抗焦慮相關的用藥。

Because they are taken indefinitely, these drugs more profitable.

因為這些藥物要無限期地服用， 帶來的利潤就會比較高。

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

到了 1980 年代中期，

沒有任何新種化學分類的 抗生素被發現。

But bacteria continued to acquire resistance and pass it along

但細菌持續產生抗藥性 並將它傳遞下去，

by sharing genetic information between individual bacteria

個別細菌之間可以互相分享 抗藥性基因的資訊，

and even across species.

甚至還能跨物種傳遞。

Now bacteria that are resistant to many antibiotics are common,

現在，對許多抗生素 有抗藥性的細菌很常見，

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

漸漸地，有些菌種便能抵抗 我們目前所有的藥物。

So, what can we do about this?

所以，我們能怎麼辦？

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

我們需要控制既有抗生素的使用， 並創造新的抗生素、

combat resistance to new and existing drugs,

對付對新藥物和既有藥物的抗藥性，

and find new ways to fight bacterial infections.

並找出新方法來對抗細菌性感染。

The largest consumer of antibiotics is agriculture,

最大的抗生素消費者是農業，

which uses antibiotics not only to treat infections

農業不僅用抗生素來治療感染，

but to promote the growth of food animals.

也用來促進肉用經濟動物的生長。

Using large volumes of antibiotics

使用大量的抗生素

increases the bacteria’s exposure to the antibiotics

便會增加細菌暴露 在抗生素下的機會，

and therefore their opportunity to develop resistance.

讓它們更有機會發展出抗藥性。

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

許多在動物中常見的細菌，

如沙門氏菌，也會感染人類，

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

而具有抗藥性的版本就有可能 透過食物鏈傳給我們，

and spread through international trade and travel networks.

再透過國際貿易 和旅遊網路散播開來。

In terms of finding new antibiotics,

至於發現新抗生素，

大自然提供了最理想的新化合物。

nature offers the most promising new compounds.

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

數百萬年來，其他微生物 及菌類等有機體已經演化成

to live in competitive environments—

能在很競爭的環境中生存——

meaning they often contain antibiotic compounds

意即，它們通常含有抗生素化合物，

to give them a survival advantage over certain bacteria.

讓它們能在面對某些 細菌時仍有生存優勢。

We can also package antibiotics with molecules that inhibit resistance.

我們也能把抗生素和抑制 抗藥性的分子結合在一起。

One way bacteria develop resistance is through proteins of their own

細菌發展出抗藥性的方式之一

是透過它們自身能將 藥物降解的蛋白質。

that degrade the drug.

By packaging the antibiotic with molecules that block the degraders,

將抗生素和阻擋降解劑的分子結合，

the antibiotic can do its job.

抗生素就能做好它的工作。

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

噬菌是會攻擊細菌 但不會影響人類的病毒，

are one promising new avenue to combat bacterial infections.

是對抗細菌感染的理想新方法。

Developing vaccines for common infections, meanwhile,

同時，針對常見感染來開發疫苗

can help prevent disease in the first place.

也對一開始就先預防疾病有所幫助。

The biggest challenge to all these approaches is funding,

上述這些方法最大的挑戰就是資金，

which is woefully inadequate across the globe.

而這方面的資金 在全世界都嚴重不足。

Antibiotics are so unprofitable that many large pharmaceutical companies

抗生素的利潤這麼低，

因此許多大型製藥公司 都已經不再嘗試開發了。

have stopped trying to develop them.

Meanwhile, smaller companies that successfully bring new antibiotics

同時，比較小的公司就算 成功把新的抗生素帶進市場，

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

通常還是會破產，比如 美國的新創公司 Achaogen。

New therapeutic techniques like phages and vaccines

噬菌及疫苗等新式治療技術

也和傳統抗生素 面臨相同的根本問題：

face the same fundamental problem as traditional antibiotics:

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

如果它們的效果很好， 就只需要使用一次，

which makes it difficult to make money.

那就表示很難用它們來賺錢。

And to successfully counteract resistance in the long term,

長遠來看，若要成功對付抗藥性，

we’ll need to use new antibiotics sparingly—

我們就需要節制使用新的抗生素——

lowering the profits for their creators even further.

這會進一步降低其創造者的利潤。

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

有個可能的解決方案，

就是不要讓利潤 來自抗生素的銷售量。

For example, the United Kingdom is testing a model

比如，英國在測試一種模式，

where healthcare providers purchase antibiotic subscriptions.

讓醫療機構去認購抗生素。

While governments are looking for ways to incentivize antibiotic development,

雖然許多政府在想辦法 獎勵抗生素的開發，

these programs are still in the early stages.

但這些方案都仍在初始階段。

Countries around the world will need to do much more—

世界各國必須要做得更多——

but with enough investment in antibiotic development

若對抗生素的開發能有足夠的投資，

and controlled use of our current drugs,

並能好好控制我們目前的藥物使用，

we can still get ahead of resistance.

我們仍然可以超越抗藥性。