Antibiotics Are Failing Us: Here's What Comes Next

This one’s probably a bit of a bleaker episode, but it’s about something absolutely fascinating that we should know more about: Antimicrobial resistance. By 2050, it could kill more people than cancer.

Now, in this episode I use the terms antimicrobial and antibiotic interchangeably. Technically they’re not the same thing — but for the sake of this episode, they are.

This is a huge issue we’re all facing, and most of us are completely unaware of it.

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Transcript

Kia ora, kaitiaki, and welcome to Now That’s What I Call Green. I'm your host, Brianne West, an environmentalist and entrepreneur trying to get you as excited about our planet as I am. I’m all about creating a scientific approach to making the world a better place—without the judgement—and making it fun. And of course, we’ll be chatting about some of the most amazing creatures we share our planet with.

So, if you’re looking to navigate through everything green—or not so green—you’ve come to the right place.

Kia ora, kaitiaki, and welcome back.

Today is a fun science episode… if you’re anything like me. Anyway, I’m back at university, studying part-time, doing some postgrad study—and I freaking love it. Right now we’re working on antimicrobial resistance and, obviously, I couldn’t resist telling you all about it. It’s kind of relevant, actually, because by the time you listen to this, I will have had hand surgery—that’s happening tomorrow—and I’ll be on a course of antibiotics, despite the fact that I actually really hate taking them. You’ll understand why at the end of this episode.

So, it’s timely.

A lot of you have probably already heard about antibiotic resistance. But let’s set the scene, shall we? Because you’re probably not scared enough—and you know I’m nothing if not fear-mongering.

By 2050, antimicrobial resistance could kill more people than cancer. And yet, cancer is infinitely scarier sounding, right? More than 1.3 million people every year already die because antibiotics no longer work for them.

Now, I use the words antimicrobial and antibiotic interchangeably in this podcast. For those people out there who have perhaps a bit more training—or perhaps are just a little bit pedantic—technically, they’re not the same thing. But for the sake of this episode, they are.

That number—1.3 million—is only rising. And there’s an awful lot more people who are dying with antimicrobial resistant issues as well. So it’s a growing global concern that we definitely do not have a handle on.

But imagine things like surgery. My surgery tomorrow couldn’t go ahead if we didn’t have antibiotics. Childbirth—so many people used to die during childbirth because they couldn’t control infection. Things like scraped knees—if you’re unlucky enough to get an infection in a cut? Gone burger. That’s the world we’re heading for.

And that sounds kind of negative, but it’s actually really quite a scary and incredibly realistic scenario. And yet, despite all this—despite the fact that we’ve known this for a very long time (in fact, resistance developed just five years after antibiotics were first introduced)—we’re still handing out antibiotics like they’re harmless. People still go to the doctor and demand them for things like the flu or a cold.

Of course, they don’t work on viruses, which I think is widely known, but just to reinforce this: antibiotics do not work on viruses.

We still pour them into factory farms—about 70 to 80 percent of all antibiotics on Earth are used in agricultural settings. And the worst bit, of course, is that pharmaceutical companies like Pfizer and Merck have all but abandoned antibiotic research. Why? Because there’s just not a lot of money in it, and a lot of cost in terms of R&D.

But here’s the part that should kind of make you a little bit furious—although it’s maybe not as cut and dried.

We did have an alternative.

We still have the alternative, but we’re years away from it being a commercial reality. Kind of because of geopolitics. And a little bit of xenophobia. And also egos, and all sorts of nonsense.

There’s a solution that’s centuries old, extremely precise, adapts alongside bacteria, and doesn’t destroy our gut microbiome the way antibiotics can. But we shelved it—for a few reasons. And you’ll find out why. You’ve probably never even heard of them.

But more on that soon.

What is antimicrobial or antibiotic resistance?

It’s when microbes develop ways to survive drugs that are meant to kill them. This can happen in many different ways. The biggest issue, of course, is bacteria. They evolve very, very fast—because they divide very quickly.

To give you an example: E. coli, in the perfect living scenario, can reproduce every 20 minutes. That becomes exponential very quickly.

But not only do they evolve and spread quickly, they also share survival strategies with one another.

Resistance happens in three ways, primarily:

1. Innate resistance – Some bacteria are just naturally tough. They’ve got structural defences that mean certain antibiotics can’t get inside their cells, or if they do get inside, the bacteria pump them back out. It’s kind of like wearing a suit of armour.
2. Evolved resistance – This is what you’ve probably heard about the most. Bacteria mutate over time. The ones that survive a round of antibiotics—this is why you’re told to finish your full course—those ones that survive are the ones that reproduce and develop resistance.
3. Acquired resistance – Arguably the scariest. This is when bacteria swap resistance genes with each other. They can absorb DNA from dead bacteria floating around. They can use viruses to pass genes between one another (and viruses are many, many, many times smaller than bacteria). Then there’s something called conjugation, where two bacterial cells physically connect—like plugging in a USB—and swap genetic code or plasmids. All of a sudden, instead of having one resistant bacteria, you’ve got two.

Hopefully that makes sense—it can get very technical, very quickly.

This isn’t some kind of distant, hypothetical problem.

As I already said, 1.3 million people die from antibiotic resistance every single year.

But it’s also things like gonorrhoea, which is becoming untreatable.

Drug-resistant tuberculosis kills over a million people a year. And tuberculosis is already bloody terrifying—because year after year, for hundreds of years, it’s been the number one infectious killer of humans. COVID pipped it for a while, but it’s back this year.

Even simple infections that you don’t really think about—like urinary tract infections (UTIs)—are no longer responding to bog-standard antibiotics. So doctors are forced to use stronger, more toxic alternatives. And unfortunately, it’s not just the bacteria that they’re toxic to—some antibiotics become really horrible for us as well.

The ESKAPE pathogens

There is a group of pathogens that are particularly bad. They’re called the ESKAPE pathogens—spelled E-S-K-A-P-E. That name’s pretty fitting because they quite literally escape our most powerful antibiotics.

You’ve probably heard of some of these before:

• Staphylococcus aureus, or methicillin-resistant Staphylococcus aureus, known as MRSA. This is the stuff you often hear about causing hospital infections—skin infections, pneumonia, bloodstream infections. It kills about 100,000 people every year, and there’s not a lot we can do about it.
• Pneumonia is another massive cause of death. A group of bacteria called Klebsiella causes a lot of it, and some strains are resistant to our strongest antibiotics—with a mortality rate of about 50%.
• One of my favourite words: Pseudomonas. These are everywhere in the environment around you. Resistant strains infect the lungs of people who are immunocompromised or have cystic fibrosis, for example. They also cause UTIs and a lot of hospital-based infections—known as nosocomial infections—and they have a hugely high fatality rate.

Some strains of bacteria out there are now pan drug-resistant—which means we don’t have anything that works against them. If you get one of those, it is not a good time.

Doctors are now being forced to bring back old, toxic antibiotics like colistin, which were largely abandoned because, yeah, they might save you from an infection—but you might need a new kidney afterwards. And they still don’t always work.

The ESKAPE bacteria are responsible for some of the most difficult-to-treat infections worldwide.

But of course, they’re not the only ones developing resistance—they’re just the ones we focus on because they thrive in hospitals, they target people who are already vulnerable, and we’re pretty much running out of treatment options.

That is a very scary thought.

And we created this crisis.

We’ve overused antibiotics in medicine, farming, and everyday bloody cleaning products. We’ve given bacteria the perfect environment to evolve and become that little bit more problematic—and we’re still acting like this isn’t a big deal.

I cannot tell you how many times I’ve gone to the doctor and been offered antibiotics when I really don’t think I needed them. I had bronchitis once—which can be viral or bacterial—and the doctor prescribed me both antibiotics and steroids.

Now, I just took the steroids for three days. I said to myself, right, we don’t know if this is bacterial or viral, and I don’t want to take antibiotics just in case it’s viral. So, for a day or two, I only took the steroids to see what would happen. Didn’t need the antibiotics—so they sit in a drawer.

Please do not do that. If your doctor gives you antibiotics—take them. I’m just using that as an example of how a doctor prescribed antibiotics without actually knowing if they were necessary. And yes, it takes time to test and figure out what’s causing an infection. And I appreciate that people want medicine quickly—but we might be facing a time when that’s no longer the solution.

A brief history of antibiotics

Now, I always find the history of science fascinating—so let’s chat.

Before the 1920s, if you got a cut, an infection, a toothache—you probably died. Tooth infection? Death. Scratch? Death. Strep throat? Death. It sounds a little negative, but yeah... different times. People died all the time from pneumonia, tuberculosis, infected wounds. Surgery was horrifically risky. And if you survived? You may not have wanted to—because, let’s be honest, there was no anaesthetic. And you probably got an infection anyway.

They did start to develop some early treatments—coal tar dyes, for instance—which had mild antibacterial properties. But they weren’t great. They contained heavy metals like arsenic and mercury, which are just as toxic to us as they are to bacteria.

Then in the 1930s, the first real antibacterial drugs came out: a group called sulfonamides (or “sulfur”). Again, they came from coal tar dyes. The story of their discovery is fascinating—and is the subject of a book called The Demon Under the Microscope by Thomas Hager. I’ve recommended some of his books before—he just does it so well.

These drugs were an absolute miracle. For decades—forever, basically—you got something, and nine times out of ten, you died. Your immune system did what it could, but if you got a horrific infection? Game over.

All of a sudden, sulfur comes along—and it saves you. Incredible.

These drugs saved thousands of lives, including Franklin D. Roosevelt Jr., whose name you might recognise.

But resistance developed quickly.

Enter: penicillin

In 1928, Alexander Fleming discovered penicillin—by accident. He wasn’t particularly tidy, and he noticed that mould in a petri dish was killing bacteria.

He couldn’t find any other scientists who were interested in pursuing it, so it was left for about 10 years. It wasn’t really revisited for a few technical reasons until World War II. And it was the early 1940s when it finally became widely available.

This was the golden age of antibiotic discovery.

Scientists started searching everything—from soil to fungus to bacteria—looking for new drugs. And they had all sorts of breakthroughs: streptomycin, the first drug to treat tuberculosis; tetracyclines; cephalosporins; erythromycin. These drugs revolutionised medicine.

And again—it’s hard for us, in this age, to understand what it would’ve been like to go from untreatable illness and near-certain death… to cures, in just a few years.

But as I mentioned—resistance happened fast.

They noticed resistance developing in a few species right away. First was, unfortunately, our old friend Staph—Staphylococcus aureus. Then it appeared in tuberculosis, gonorrhoea, and lots of other common infections.

By the 1980s, antibiotic resistance was already a major public health threat. Yeah—we’ve known about it for that long.

In fact, the first report of resistance to penicillin came before it was even widely available. It developed resistance during the experimentation phase—before it even hit the public.

That’s how quickly this happens.

Unfortunately, all of this came hand in hand with drug companies beginning to lose interest in antibiotic development.

As I mentioned earlier, antibiotic development is expensive—and because antibiotics lose their effectiveness pretty quickly, it wasn’t a very profitable thing to do.

There have only been a few new antibiotic classes discovered since the 1980s. Overall, discovery rates are massively down.

You could call the era from the 2000s to now the antibiotic collapse. Some people do. It might sound dramatic—it might be terrifying—depends on your point of view.

But essentially, most major pharmaceutical companies have abandoned antibiotic research.

New discoveries are very rare, even though prospecting—which is when scientists look for new drugs in things like soil or fungi—is starting to pick up again. But bacteria are evolving way faster than we are finding new solutions.

So we’re left with ageing antibiotics, and bacteria that are massively outpacing our ability to treat them.

And we’re still accelerating the problem

I mentioned before that a lot of prescriptions are unnecessary. It’s estimated that 50% of antibiotic prescriptions are unnecessary.

Every single time we take an antibiotic we don’t need, we’re giving bacteria another chance to develop resistance. Every time you take antibiotics but don’t finish the course, you’re helping those bacteria get stronger.

Please, please, please—if you’re taking antibiotics, take the full course.

Now, let’s talk about farming

This one really gets me.

70 to 80 percent of all antibiotics on Earth are given to farm animals.

But they’re not given to sick animals. They’re used prophylactically—to prevent disease. Especially in overcrowded, intensive farming systems. In some countries, they’re even used to make animals grow faster—because antibiotics can have that side effect.

Obviously, that’s not great for animal welfare or for the environment.

There’s some debate about whether antibiotic use in agriculture directly contributes to human resistance. But studies do suggest that it can spread via:

• Meat
• Farm workers
• Water runoff
• Even the air

So it’s definitely not negligible.

And of course, there are massively different standards around the world for how antibiotics are used and distributed.

In some countries, you can just go and buy them over the counter. That’s terrible.

In others, patients can’t afford the full course, so they stop taking it early. That’s not only catastrophic for the patient, who might go on to develop a resistant version of their own infection—but it also helps spread resistance even further.

Every single mistake we make gives bacteria an opportunity to evolve.

And we’ve been making mistakes for decades.

And I really want to hammer this point home—because I don’t think people take it seriously enough.

And it’s just not talked about enough.

Imagine if you wanted a hip replacement, or you needed a C-section, or even just a tooth removed—and antibiotics no longer worked.

Post-surgical infections can happen in up to one in four people. And without prophylactic antibiotics, that number would be much higher. And that could be deadly.

Cancer treatment weakens the immune system, making patients massively vulnerable to infection. Again—much more likely to be deadly without antibiotics.

Childbirth—used to kill a huge number of women. And it could do so again.

The big one for me: tuberculosis

TB kills millions of people.

It’s a disease that has changed the face of the world in more ways than you can imagine. And if you’re interested in that, there’s a brilliant book called The End of Tuberculosis by John Green—it’s only about a week and a half old, and it’s fascinating. It even has something to do with the start of World War I, believe it or not.

Tuberculosis is the number one infectious killer almost every year.

And drug-resistant TB already kills over 200,000 people a year.

Imagine if all strains of TB became resistant to antibiotics.

That’s a very scary thought.

Now, if we put all the death and destruction aside for a second, this isn’t just a health crisis—it’s also shaping up to be an economic disaster.

The World Bank has estimated that by 2050, if we don’t act, drug-resistant infections could cause a global economic loss of up to $100 trillion. It would push millions more people into extreme poverty.

And of course, while this technically affects everyone, the burden won’t be shared equally.

Low-income countries will suffer the most:

• Limited access to new treatments
• Overcrowded hospitals
• Poor sanitation

But wealthy countries aren’t immune either—because drug resistance doesn’t care about borders.

Now I say we’re working on this slowly—but that’s not to say people aren’t doing anything.

Scientists, doctors, and researchers aren’t just sitting back and watching it happen. There are ongoing efforts to slow the spread of resistance and to develop new solutions.

Antibiotic stewardship

This is probably the easiest option, right?

Stop giving unnecessary antibiotic prescriptions. Promote responsible use. Give people better education. Put strict guidelines in place.

That should’ve happened years ago—but here we are.

We need more drugs

And that is happening in some places. Some smaller biotech firms are working on novel drugs or combining existing ones to create different treatment mechanisms.

But funding is a major challenge.

Vaccines

Vaccines are a huge way to reduce the need for antibiotics—because if you’re vaccinated against things like tuberculosis, meningitis, or pneumonia, you’re much less likely to get them in the first place.

But of course, the anti-vax movement isn’t helping.

There’s been a massive wave of misinformation, and it’s lowered immunisation rates. Now, I get it—I actually used to be an anti-vaxxer in high school, which might surprise some of you.

I was a typical teenage girl, a bit of a contrarian. I didn’t trust authority. I thought, “What do they know? I know better.”

That’s where a lot of anti-vax stuff comes from—distrust of authority.

Now, I still have a healthy disregard for some authority, but I do trust science. I’ve rethought my position, and I’m very pro-vaccine.

That’s not to say some vaccines don’t have side effects—of course they do. No one has ever said vaccines are perfectly safe for everyone. But you know what? It’s a damn sight safer than getting the disease.

And that’s the bit I think anti-vaxxers miss.

I saw an article recently about a poor girl in the US who died of measles. Her parents came out and said that, even if they had their time again, they still wouldn’t vaccinate her—because they don’t trust vaccines or health authorities.

I don’t even know how to combat that level of ignorance.

But this vaccine hesitance is causing a resurgence of preventable diseases. There’s a measles outbreak in the US right now. There was one in Samoa not long ago—it killed people.

And of course, RFK Jr.—the United States Secretary of Health and Human Services and a well-known vaccine opponent—had a great deal to do with that Samoan outbreak.

USAID has also withdrawn funding—about $880 million in support of the global vaccine alliance—which has led to suspended immunisation in many parts of the world.

I know they think they’re doing the right thing for America, but interestingly enough, bacteria don’t care about passports.

Enter: CRISPR and gene editing

There’s some really interesting work being done with CRISPR—you might’ve heard of it.

Scientists can use gene-editing tech to create precision antibiotics that only target harmful bacteria—leaving the good stuff intact.

That’s a big deal, because traditional antibiotics have a lot of side effects:

• Yeast infections
• Disruption of your gut microbiome
• Killing good bacteria along with the bad

So this type of targeted therapy is really promising.

My favourite solution: bacteriophages

The solution I got very excited about in the introduction is something called bacteriophages—or phages for short.

Now, what the hell is a bacteriophage, you ask?

It’s a virus.

Yep. Remember how I said viruses are much smaller than bacteria? Well, phages are viruses that infect and kill bacteria.

Unlike antibiotics—which work broadly and kill many different types of bacteria—phages are very specific. They usually only target one bacterial species, or even a strain within that species.

And get this: there are more phages on Earth than there are stars in the universe.

They’re everywhere—in soil, water, the human body—anywhere you can imagine bacteria, there are phages.

Why haven’t I heard of them?

We’ve known about them since the early 20th century, but their discovery was... controversial. Of course it was.

Scientists have egos. And while we like to think scientific research is above all that human drama... it’s not.

Back then, researchers couldn’t agree on what phages actually were. Were they viruses? Were they enzymes?

It wasn’t until a French-Canadian microbiologist named Félix d’Hérelle (excuse my French pronunciation) provided strong evidence in 1917 that phages were viruses that infected and killed bacteria.

Everyone laughed at him.

That’s not an overstatement. The scientific community stayed divided for years.

It wasn’t until 1940, when the first image of a phage was taken via electron microscopy, that people finally said, “Oh, sh*t. They’re real.”

Why we didn’t go all in

Here’s where history gets in the way.

At almost the exact same time phages were discovered, antibiotics entered the conversation.

And while phage therapy was difficult—scientists didn’t understand them properly, the treatments weren’t consistent, and early formulations were unstable—antibiotics worked every time.

So the Western world chose antibiotics.

But in the Soviet Union, phage therapy thrived. They kept developing it.

Then came the Cold War, and the West began actively discouraging phage research. Articles came out calling it guesswork. “Only stranger places are still looking at this,” they said.

Western pharmaceutical companies also saw no commercial value in phages—because they couldn’t be patented the same way antibiotics could.

So funding dried up. Interest disappeared.

But Soviet scientists kept going. Phages were even used on the battlefield during World War II to treat infected wounds—successfully, if they got the strain right.

And thank goodness they did.

Because now that antibiotics are failing us, we have decades of research from places like Georgia (the country, not the US state) to draw from.

Why phages are exciting

Phages evolve alongside bacteria.

So when bacteria develop resistance to something, phages can mutate too, making them a constantly adapting treatment. That’s huge.

They also cause no collateral damage. Antibiotics can mess with your gut, kill off good bacteria, and cause things like yeast infections.

Phages? Not a problem.

They’re hyper-specific—they only kill the bacteria they’re designed to kill. That’s it.

And they’ve been shown to work where antibiotics fail. There are loads of case studies of people with drug-resistant infections—especially in chronic wounds, cystic fibrosis lung infections, or antibiotic-resistant UTIs—being saved by phage therapy.

They work.

But.

Why they’re not widely used (yet)

They’re not easy to deploy.

There are regulatory barriers. Western medicine hasn’t accepted phages very broadly—partly because of the Cold War history, and partly because regulations haven’t kept up.

Getting approval to treat a patient with phages is complex and time-consuming.

Big Pharma still isn’t that interested. But there are some smaller companies doing amazing work.

The biggest issue, though, is that phages are too specific.

Doctors can’t just guess and hand you a pill. They need to figure out exactly what’s making you sick and then match you with the right phage.

That takes time.

And phages break down easily outside of lab conditions. They’re harder to mass-produce, harder to store, and just not as convenient as antibiotics.

But let’s be honest—antibiotic resistance isn’t convenient either.

Despite all that, interest in phage therapy is growing.

Clinical trials are underway. Researchers are working on broader-spectrum phages and faster treatment methods. It’s still early days, but phages could become one of our best hopes in the fight against antibiotic resistance.

And honestly, I’d love to start a biotech company working on phages.

But I need a benevolent billionaire. So if you know one, send them my way.

So, what can we do?

In the meantime, how about we just… stop using so many antibiotics in farming?

How about we stop giving antibiotics to everyone who asks for them?

I know people who get a tiny puncture wound—and before anything even happens, they go to the doctor and demand prophylactic antibiotics.

That’s madness.

There are so many things we can do—things I’ve talked about in this episode—to prevent the further spread of resistance. And yet… we’re just not doing them.

We also need to know more.

It was only a couple of years ago that a global review on antibiotic resistance came out. We don’t actually know as much as we need to. And that makes it hard to solve.

But let’s be honest—she’s scary.

The solutions are coming. But it’s time we start taking it a little more seriously.

And by “we,” I don’t mean scientists. They’ve been sounding the alarm for years.

I mean us, the general public.

So, there you go.

Sorry if that was a little bit of a depressing episode—but I find it absolutely fascinating.

And if you do too, there’s another book I’d recommend: The Good Virus. I’ll pop the details in the show notes. It’s a fascinating read.

If you’ve learned something new—or now have a deep fear of scraping your knee—I'm really sorry. But antibiotic resistance is scary, and it should be something we all know about. Because it’s something we can do something about.

And the longer we wait, the fewer options we’ll have.

A little bit like all the other crises, really—climate change and so on.

Thanks for listening! I hope you enjoyed the episode.

Share it with everyone you know who still thinks antibiotics cure colds. And if there’s a topic you want me to tackle next, let me know.

Kia ora, see you next time.

And there you have it.

I hope you learned something—and realised that being green isn’t about everything in your pantry matching with silly glass jars or living in a commune. If that’s your jam, fabulous.

But sustainability, at its heart, is just about using what you need.

If you enjoyed this episode, please don’t keep it to yourself. Feel free to leave me a rating and hit that subscribe button.

Kia ora, and I’ll see you next week.