“Without effective antibiotics, we’ll lose the advances made by modern medicine.”

UNI NOVA: How did we let it get to the stage where our healthcare system has such a gap in provision?

DEHIO: In 1928, Alexander Fleming discovered the antibiotic penicillin. After the end of the Second World War, this medication was considered a panacea for decades. Further antibiotics were discovered in quick succession, for example, streptomycin, with which tuberculosis could be combated effectively for the first time. That was the golden era of antibiotics research. Medicine cabinets were stuffed full of effective antibiotics. We had the feeling we had the problem of bacterial infection under control, but then resistance kicked in.

UNI NOVA: A drug suddenly stopped working?

DEHIO: Exactly. So we took another one out of the cabinet, but in time multidrug resistance arose. All of a sudden, certain germs were resistant to all available antibiotics. No therapy will work at all in this case.

UNI NOVA: How did resistance come about?

DEHIO: Through the widespread use of antibiotics, human beings have accelerated a natural evolutionary process to the point that it has become a major problem for medicine. Bacteria in the soil produce antibiotics to prevent other bacteria from growing. So that they themselves can grow, these antibiotic producers also express resistances. Those were always there, just not in the germs that are dangerous for us humans. However, bacteria exchange their genetic information. That is how resistant genes ended up in germs that cause disease in humans. So treatment with antibiotics actually breeds resistant pathogens. The more widely the active substance is used, the bigger the problem caused by the spread of these resistant pathogens.

UNI NOVA: If you now develop new antibiotics as part of your research, won’t you aggravate the problem and accelerate this vicious circle?

DEHIO: No, on the contrary. We urgently need new antibiotics based on new principles that can kill the existing multidrug-resistant germs. But that’s only ever a short-lived victory because resistance to any new active substance will arise sooner or later. We need new active substances from time to time to get one step ahead of the resistant germs in the race against bacterial evolution.

UNI NOVA: Why has the pharmaceutical industry not produced any new antibiotics recently?

DEHIO: First of all, the market has stopped working. There is no money in antibiotics any more. The main reason is that the known antibiotics are ridiculously cheap because the patent rights have expired. Compared with other medical therapies, treatment with antibiotics, which saves human lives rather than just prolonging them, is almost free. Secondly, the industry has made serious attempts to develop new antibiotics in recent decades but has not succeeded. This may in large part be due to the artificial laboratory conditions they work in. The cultivated bacteria do not resemble the physiological condition of the germs in our bodies. In the laboratory, bacteria grow at maximum speed, but in the body only slowly or not at all. Initially, work was successful under these conditions, but the method has reached its limits. Innovation has ground to a halt and we only ever find out what we already knew.

UNI NOVA: So research used to be very successful even though it worked under non-natural conditions?

DEHIO: Exactly. Most known antibiotics were discovered using these artificial conditions.

UNI NOVA: The market is not working, you said. So what has to change?

DEHIO: One way is for health systems to spend more money on antibiotic treatments. This is already the case in the UK, and other countries, such as the US, are considering it. As soon as there is money to be made again, more companies and investors will get back into antibiotics development. Or you create new incentive systems: The company that develops a new antibiotic earns a market entry reward if it is successfully introduced to the market. This instrument takes account of the fact that a new antibiotic is first supplied only to a cabinet of reserved medications so that initial sales are low.

UNI NOVA: Why?

DEHIO: Because a new antibiotic that is deployed too widely will immediately give rise to resistance and would soon become ineffective. It has to be reserved for seriously sick patients who urgently need effective medication.

UNI NOVA: You’re a biologist. Do you wish you were also an economist?

DEHIO: No, the market mechanisms and regulatory measures are the preserve of business and politics. Our NCCR is concerned with scientific innovations at the early stage of antibiotics discovery and development.

UNI NOVA: What if the NCCR and the new antibiotics it is helping to develop did not exist? What would happen?

DEHIO: With the NCCR, we want to bring about a paradigm shift in antibiotics research, but luckily there are more research activities in this field, in both the academic and the industrial sector, that could contribute to innovation. If collectively we do not succeed in developing new antibiotics, humanity will increasingly suffer from the impacts of resistance. A study commissioned by the British government forecast that by 2050 more people would die from antibiotic resistance than from cancer in this scenario. You can imagine what that would mean for society and what costs would be incurred. The risk of dying from a routine medical intervention or a simple infection would suddenly be as great as in the 19th century. We have to prevent that.