On Friday evening I spoke at a dinner of foreign policy and security experts in Washington DC. Usually issues such as the situation in the Middle East are discussed. I chose to talk about a different kind of threat: antimicrobial resistance, or the growing problem that antibiotics don’t work.
We should understand the potential toll which pandemics can exact. The human cost of World War 1 was appalling, at 14 million lives. Yet in 1918 Spanish flu killed 50 million. Tuberculosis killed 2 billion people in last two centuries alone.
The advent and subsequent mass production of antibiotics in World War II saved millions of lives, and has added 20 years to our life expectancy today. But from the moment that Fleming discovered penicillin he warned that resistance to the drug from misuse would be a problem.
The more that antibiotics are used unnecessarily, the more drug resistance will develop. In the US, 70 per cent of antibiotics are used on animals, including just to fatten them, yet the majority of these drugs are medically important for humans.
Out of 40 million people given antibiotics for respiratory issues in the US every year, 27 million are given them unnecessarily.
Already 1 in 4 healthcare-associated infections in long term acute care are caused by antibiotic-resistant bacteria. Antimicrobial resistance now kills at least 700,000 people a year globally.
But the worst news is to come. A review commissioned by David Cameron when he was Prime Minister predicted that by 2050 the death toll will be 10 million - a quarter from drug resistant TB. This compares with the 8.2 million lives currently lost from cancer each year.
The cumulative GDP loss will be $100 trillion, knocking up to 3.5 per cent off global GDP. It is not too strong to say that this human and economic cost would be catastrophic.
The review made a series of recommendations, including for more information, better hygiene, and reductions in unnecessary antibiotic use.
Some of these things have started to happen. But the crucial recommendations, to step up research and development into new drugs and diagnostics, especially into vaccines, have not been translated into action.
If you think we have nothing to worry about, consider this. In China a pig - ‘apocalypse pig’ - has developed resistance to every known antibiotic in the world.
Just imagine what it will be like to have a serious infection where none of the drugs work. We must take action now.