Bacterial Antimicrobial Resistance

If you get an infection, it normally is not a big deal. Unfortunately, this has lulled us into a false sense of security.

This article originally appeared in mid 2022.

Bacteria and viruses are often confused. A virus can’t survive without a host, is smaller and consists of a protein coat around either DNA or RNA genetic material. COVID-19 is a virus. Coronavirus is typical in that its RNA randomly mutates, periodically making changes that create a new dominant variant. A virus survives longest when it mildly impacts its host but doesn’t kill it, allowing it to spread to other creatures.

Bacteria, on the other hand, are larger than viruses and are independent living organisms that use DNA to reproduce. They are very hardy and often specific to an environment like hydrothermal vents deep in the ocean or in your intestine (gut). Bacteria can help or harm, depending on the circumstances.

Mutations occur during replication or exposure to a mutagen (e.g., chemicals, radiation). Mutations occur randomly, with successful ones building resistance to drugs that previously defeated them. Harmful microorganisms are called pathogens, and antibiotics were developed following the discovery of penicillin by Alexander Fleming in 1928. These wonder drugs were very successful, but bacteria are catching up by evolving to evade existing drugs.

Developing new antibiotics is very challenging, time consuming and expensive, often without success. In this game of adjustments, we are standing still and the bacteria continue to evolve. While medicine has had great success, bacteria are battling back and we are starting to lose. It is time to resist this trend with a plan.

The implications to our daily lives are material. In the not so distant past a cut or scrape that became infected could be fatal. Rates of survival to adulthood are important metrics even now in some locations without ready access to antibiotics– increasing antimicrobial resistance make these trends globally important.

Much of the strongest resistance is currently found in hospitals. This leads to a growing dilemma. Who wants to have a voluntary procedure that could be deadly? Everything from knee replacements to Botox injections becomes risky. And what mother would allow their child to play football or rugby with such a risk on every field or pitch, knowing that a simple abrasion could be deadly?

The Lancet published a thought-provoking paper on bacterial AMR (The Lancet Feb 12, 2022). The paper notes the regional differences in this global problem. In an area like sub-Saharan Africa their suggestion is to expand availability of antibiotics, while in south Asia (think a little broader than India to Malaysia) they recommend restricting antibiotics as they are overused. While forms of pneumonia and staph infections were the leading problem bacteria, a recent pathogen commonly found on the battlegrounds of Iraq and Afghanistan, A baumannii, is causing problems. Permafrost is a likely future topic for this newsletter, but one concern is that ancient bacteria unknown today could melt out of the frozen tundra and be released back into the environment.

Insurers care about AMR for several reasons. It impacts health insurers as claims increase. It impacts life insurers as mortality increases at all ages and longevity decreases. It impacts all institutional investors as a population with shortened lifespan looks at investments in housing and other purchases in new ways.

Bacterial antimicrobial resistance is a topic that insurers should monitor and encourage research into building new tools to fight these pathogens.