The antibiotics crisis isn't the fault of science – it's market failure

The WHO has warned of rising drug-resistant infections, and Singapore has just updated its action plan on this. But it cannot fight this alone.

- Hsu Li Yang

Dying from a bacterial infection after injuries sustained during an air raid in the Second World War, UK policeman Albert Alexander was the first person to be treated with penicillin.

Desperate doctors, who had already had to remove an eye, treated him with the antibiotic on Feb 12, 1941, and he rapidly recovered. However, the limited supply ran out, and he died — a reminder that antibiotics save lives only when we have them, and when they still work.

It's timely to reflect on that, as — ironically — superbugs that resist antibiotics such as penicillin are in the news.

The Government has reviewed and updated its National Strategic Action Plan (NSAP) on antimicrobial resistance rate (AMR) on Nov 12. AMR refers to the phenomenon wherein microbes evolve to survive the drugs and chemicals used to kill them leading to the rise in drug-resistant infections. The first NSAP was launched in 2017 to reduce the AMR here.

The move comes even though Singapore's drug-resistant bacterial infection rate is lower than globally, according to data submitted to the World Health Organisation (WHO). But a few days before the Government's announcement, the WHO had issued a warning that, globally, the number of drug-resistant infections is soaring. One in six bacterial infections worldwide — out of over 4.5 million such infections reported by 104 countries in 2023 — was caused by drug-resistant bacteria, a WHO study found.

Low and middle-income countries (LMICs), including most Asean and South Asian states, had higher rates of drug-resistant infections compared with wealthier countries such as Australia, Germany and the United States.

This mirrors a study in the Lancet journal that there were 4.71 million deaths associated with drug-resistant infections in 2021, again concentrated in LMICs.

While the numbers are worrying, there is a deeper challenge: antibiotic resistance is as much about access and economics as it is about biology.