Last week, amid lots of media fanfare, the Longitude Prize 2014 was launched. This involves six scientific challenges, one £10 million pound prize and one public vote to choose the area in which the prize should be awarded.
This launch marks the 300-year anniversary of the original Longitude Prize whereby the UK Government offered £20,000 for a means by which longitude could be determined to within half a degree; a key challenge of the time. This incentive proved to be a key catalyst and a solution was developed. It is hoped that a similar scenario will repeat itself 300 years later…
The 6 issues are: food security, dementia, paralysis, carbon-free air travel, access to clean water and antibiotic resistance. The challenges identified are certainly worthy of this legacy of discovery but whether they will be as readily solvable will remain to be seen… there is also the issue of whether such a public prize is an appropriate forum to address some of the most potentially catastrophic problems facing humankind. Surely we should be incentivising research in all of these areas as a matter of priority anyway? Pushing that to the side for the moment, I’d like to make my own plea for one of the challenges: antibiotic resistance.
During the launch of the prize last week I attended a two day meeting at the Royal Society which focused on addressing the threat to global health from antimicrobial resistance (AMR). While I was a passionate advocate of this cause before, I left this conference even more assured that this is an issue which must be urgently addressed. The Biochemical Society is also involved in this area; the society is a firm supporter of Antibiotic Action and is working on a number of projects and initiatives to address AMR.
The statistics are frightening; one child dies every 5 minutes in South East Asia from infections caused by resistant bacteria. However, what is really scary is that the threat of AMR is insidiously building; unless we act now it will creep up on the world and influence practically every area of modern medicine. Many of the medical advances made in the past century will be rendered useless unless we can find an appropriate way to address AMR.
A multi-faceted approach will be required; appropriate stewardship, infection prevention, investigation into new antimicrobials and alternative therapies/technologies and global co-ordination will all be vital. The particular area the Longitude Prize challenge focuses on is the development of rapid diagnostics for bacterial infections.
A key problem with the prescribing of antibiotics is that the nature of the infection is not always clear. Antibiotics will obviously be ineffective against a virus but there is often no rapid means of discerning what type of infection a patient is suffering from so antibiotics are often mistakenly prescribed. Moreover, even if it is known that an infection is bacterial in origin, it is difficult to determine the type of bacteria involved which means that doctors are unable to prescribe targeted bacteria-specific therapies. A rapid (ideally around 20 minutes) diagnostic would enable appropriate antibiotic prescribing in a far greater number of cases.
The development of diagnostics would also serve as a critical enabler for antibiotic development as well as prescribing. At the moment, one of the key problems with antibiotic R&D – as well as the fundamental scientific challenges and perceived financial disincentive within the pharmaceutical industry – is the challenge presented by running effective clinical trials. Without a diagnostic it is difficult to identify patients with the key resistant pathogen to be targeted. Therefore the size of the trial required is increased and so the cost and the regulatory complexity are also increased. Using a diagnostic to identify so-called ‘enriched’ patient populations would make the running of clinical trials more facile.
To me, antibiotic resistance is the obvious choice for the Longitude Prize; indeed, without antibiotics many of the discoveries in the other challenge areas could be rendered useless. Treatments for dementia and paralysis may be irrelevant if vast numbers of the world’s population die from bacterial infections before they reach the age where they are struck down by dementia or as a result of infections gained as side-effects or complications from being in a paralysed state. This may sound far-fetched but it could be a very real possibility.
So, I urge you: vote antibiotics!