The use of antibiotics, essential to modern medicine, is being likened to fossil fuels, highlighting the critical issue of overuse and the growing concern of antibiotic resistance. While antibiotics helped create the modern world, their overuse threatens their effectiveness. As early as 1954, shortly after the widespread introduction of antibiotics, doctors were aware of the resistance problem, as natural selection meant that using these new medicines gave an advantage to microbes that could survive the assault. Currently, the UN classifies antibiotic resistance as “one of the most urgent global health threats,” with resistance already killing over a million people annually, a figure forecast to grow. Furthermore, new antibiotics are not being discovered fast enough, with many essential today having been discovered more than 60 years ago.

Unlike other drugs that target human biology, antibiotics target bacteria. As bacteria spread between people, the challenge of resistance is social, making antibiotic resistance more than just a technological problem. Yet, most antibiotics are derived from substances originally produced by bacteria and fungi, evolved millions of years ago. This similarity to fossil fuels, created from dead plants, illustrates that both resources offered an illusory promise of “miraculous” and never-ending power over nature – a promise that is now coming to an end. Considering antibiotics as the “fossil fuels” of modern medicine could change how we use them, helping to make the fight against infections more sustainable.

The antibiotic era is less than a century old. Alexander Fleming first noticed the activity of a strange mould against bacteria in 1928, but the active ingredient – penicillin – was not isolated until the late 1930s. Initially, penicillin was extremely scarce, but after production was scaled up during World War II, it became cheaper. Antibiotics enabled the construction of modern medicine, making procedures like heart surgery and organ transplantation possible, which were extremely risky due to infections before antibiotics were available. They have also enabled industrial farming, contributing to the rise in meat consumption. Despite the resistance crisis, antibiotics remain relatively cheap, partly because the negative consequences of their use (externalities) are not priced in. It is estimated that 31% of the 40 most used antibiotics globally enter rivers, increasing resistance levels in environmental bacteria. Factories, particularly in India, contribute to pollution, with wastewater containing very high levels of antibiotics.

Like the climate crisis, antibiotic resistance has exposed global inequalities. Some high-income countries have taken steps to reduce antibiotic use, but only after benefiting from their past abundance. This makes it difficult for them to take a moral stand against their use elsewhere, a dilemma that mirrors the situation of industrial nations urging developing nations to forgo the economic benefits of cheap energy.

Unlike fossil fuels, which we look forward to phasing out completely, antibiotics will always be part of medicine’s “energy mix.” However, the vast majority of deaths from bacterial disease worldwide are due to lack of access to antibiotics, not resistance. Therefore, we need to become more sustainable in our approach to development and use. Many pharmaceutical companies have abandoned the search for new antibiotics. Alternative models are needed, such as government funding of an international institute for the development of publicly owned antibiotics, or incentives for development through large prizes. To address overuse, health authorities could run “subscription” models that remove the incentive to sell large quantities of antibiotics. Finally, we should support “renewable” approaches like vaccines, which prevent diseases and reduce the need for potential antibiotic courses. Also, the best public health improvements, such as sanitation, have been more effective than antibiotics in curbing infectious diseases.

Regional Perspective

The analogy of antibiotics to fossil fuels highlights a shared challenge of sustainable resource management. Globally, the overuse of antibiotics, mirroring the historical exploitation of fossil fuels, has led to critical issues like antimicrobial resistance (AMR). This global health threat, estimated to cause over a million deaths annually, necessitates a paradigm shift in how we develop, distribute, and utilize these vital medicines. The article's perspective is particularly relevant in regions where access to antibiotics is limited but where their overuse in agriculture and healthcare settings contributes to the global AMR crisis. For instance, in many developing nations, the lack of robust regulatory frameworks can exacerbate the problem of antibiotic misuse. The call for alternative models, such as publicly funded research and development of new antibiotics, and subscription-based payment models, offers a potential pathway toward more equitable and sustainable access and use, addressing both the immediate health needs and the long-term challenge of resistance.

Analysis

The comparison of antibiotics to fossil fuels is a potent framing device that underscores the unsustainable trajectory of their current use. Just as fossil fuels powered industrial revolutions but led to climate change, antibiotics have revolutionized healthcare but are now succumbing to resistance. The article correctly identifies that the market failure in antibiotic development—where R&D is costly and returns are diminished by the very need for stewardship—mirrors issues seen in other critical resource sectors. The call for public funding, prize incentives, and alternative payment models (like NHS subscriptions) addresses this market failure head-on. These strategies aim to decouple antibiotic development from traditional sales volumes, encouraging innovation while promoting responsible use. Furthermore, the emphasis on non-antibiotic interventions like vaccines and improved sanitation points to a broader public health strategy that recognizes antibiotics as a crucial but finite resource within a larger ecosystem of health interventions. The long-term implication is a necessary shift from a consumption-driven model to a stewardship-driven one, ensuring that these life-saving drugs remain effective for future generations. The global nature of antibiotic resistance means that collaborative international efforts, similar to climate accords, will be essential for effective mitigation.