The Borg are bad. Antimicrobial resistance is worse.

4 September 2017, 1954 EDT

Microbes are turning into the Borg; our resistance is becoming futile. As any Star Trek: The Next Generation nerd knows (and this is an IR-related blog, so I’m guessing the Venn diagram of DoM readers and ST:TNG fans shows quite a bit of overlap), this is incredibly worrisome for humanity and threatens to give all of us the life expectancies of a red shirt. The international community may yet have a chance to fight back, but it will require both forward thinking and a willingness to cooperate.

The basic problem is the growth of antimicrobial resistance (AMR). An antimicrobial is something like an antibiotic—it kills or inhibits a microorganism like a virus or bacteria, but doesn’t harm the host. When you take penicillin to treat an infection, the penicillin goes after the bacteria causing the infection, but it generally doesn’t cause side effects or do damage to the rest of you. This is what makes antimicrobials so powerful and useful. They gave humanity a fighting chance against infections that had once been a death sentence. With Alexander Fleming’s accidental discovery of penicillin in 1928, health professionals had a powerful tool on their arsenal. Between 1944 and 1972, life expectancy increased by eight years—an increase largely attributed to antibiotics and other antimicrobials.

Sounds good, right? Antimicrobials are miracle drugs that keep us healthy, fight off nasty bugs, and give everyone a free puppy, so what’s the problem? In short, we’ve gone overboard with the antimicrobials, and the microbes have figured out how to fight back. The indiscriminate use of antimicrobials gives microbes more and more opportunities to develop resistance. Farmers regularly add antibiotics to animal feed in order to promote animal growth; half of the antibiotics imported into Australia go into animal feed, and animals in the US receive more than four times the amount of antibiotics as humans. Doctors prescribe (and parents often demand) antibiotics for common colds and ear infections in children, even though antibiotics have no effect on viruses. In many places, people can buy antimicrobials over the counter without having to consult a health care professional. All of these situations allow for the emergence of antimicrobial resistance.

The idea of antimicrobial resistance itself isn’t new. When Fleming won the Nobel Prize in Physiology or Medicine in 1945, he used his acceptance speech to warn his audience about the ease with which microbes could develop resistance to penicillin. What has changed in recent year is the scale of the problem. Late last month, Lancet reported about a new strain of pneumonia that has appeared in China—and none of the pneumonia drugs in China can treat it. A woman in Nevada died of a bacterial infection that was resistant to all 26 antibiotics available in the United States. The World Health Organization is reporting that an increasing number of countries are reporting strains of drug-resistant gonorrhea. The CDC has identified three urgent drug-resistant threats, including Clostridium difficile or C. diff. That’s the same illness that nearly killed comedian Tig Notaro a few years ago. At the same time, no new class of antibiotics has come on the market for more than a quarter-century. Teixobactin is the first new antibiotic to be discovered in nearly 30 years, but it won’t be available commercially for another five years. As a result, we have an increasing number of drug-resistant microbes and a decreasing number of tools to fight back.

The failure to address antimicrobial resistance would be huge. Research by the RAND Corporation finds that AMR could cause the world’s population in 2050 to be decreased by between 11 and 444 million. The cumulative cost to the world’s economy could range between $2.1 and $124.5 trillion—and yes, that’s trillion with a T. We’re essentially in a place where the rise of AMR threatens to wipe out many of the health advances we have made globally since Fleming got his Nobel Prize.

That’s where international politics enter the picture. Stopping AMR requires collective action; all of the countries need to work together on this. What’s more, addressing AMR means addressing both human and animal health and working with food producers. It can be hard enough to get countries to work together in a single area; bringing states together to deal with interlocking issue areas could be even more challenging.

All hope is not lost, though. One year ago, the United Nations held its first High-Level Meeting on Antimicrobial Resistance. At the conclusion of the meeting, the assembled leaders pledged their cooperation to tackle the issue by strengthening regulations, encouraging research on new antimicrobials, and promoting public education about AMR. Holding this meeting put the issue of AMR on the international agenda and brought unprecedented attention to it. The World Health Organization also passed a resolution requiring the Director-General to provide updates every two years on his efforts to combat AMR, and the UN Secretary-General has been tasked with providing a similar report to the General Assembly for consideration during its 2018-2019 session. Resolutions by themselves don’t fix the problem, but they do signal the international community’s recognition of the importance of addressing AMR before the problem gets any worse.

The Borg are super scary (they even assimilated Picard!), but Starfleet has proven itself wily enough to keep the Borg at bay. That’s the sort of political will that we will need in order to address antimicrobial resistance. It won’t be easy politically or scientifically, but it’s absolutely necessary.