Infectious Futures – Stories of the post-antibiotic apocalypse

By Roger Highfield, Longitude Prize Committee Member

“It is not difficult to make microbes resistant to penicillin.”

No, this is not a warning from one of the army of doctors fighting superbugs today but, remarkably, from a speech given by Alexander Fleming in 1945, when he accepted his Nobel Prize for the discovery of penicillin.

Doctors of his generation knew all about the nightmare of the post-antibiotic era because they had witnessed first-hand the horror of the pre-antibiotic era, when a tiny cut could leave you fighting for your life; infant mortality – deaths of children before their first birthday – was around one in 20; and opportunistic infections snuffed out the lives of the elderly and vulnerable.

Today we are more dependent on antibiotics than ever before in much of modern medicine, from organ donations to hip transplants, but our antibiotic arsenal is becoming increasingly ineffective with the rise of resistant microbes.

Over the years the alarm about superbugs has been sounded many times by a wide range of influential bodies, such as World Health Organisation and US Centres for Disease Control. Professor Dame Sally Davies, Chief Medical Officer and Longitude Committee member, now talks of a “catastrophic threat”; one that, as the Prime Minister put it, threatens to send us back ‘into the dark ages of medicine”.

In a world where we are inundated with impersonal facts and headlines routinely warn of impending doom, narrative offers a visceral way to explore an issue.

The very fact that we have been recounting Homer’s Iliad and Beowulf for centuries shows the special power of storytelling. The ease with which a dramatic story can seduce the human mind was underlined by a classic 1944 study by psychologists Fritz Heider and Mary-Ann Simmel in which people were shown an animation of a pair of triangles and a circle moving around a square. When describing this, the participants told elaborate stories about the circle and the little triangle being in love, the big-bad grey triangle trying to lure away the circle, the blue triangle fighting back, yelling to his love to escape, and how they embraced and lived happily ever after.

There’s meat machinery in our heads to find narratives, in the form of patterns linked with survival and our ability to pass on our genes. One can speculate that, as our ancestors evolved to live in groups, they told stories to make sense of increasingly complex social relationship and to help us make sense of threats. And today one of the biggest threats of all is that of antibiotic resistance.

With this in mind, Nesta, an innovation charity, has invited established and emerging sci-fi writers to explore the future of antibiotic resistance to help underline the urgency of the £10 million Longitude Prize, which aims to spur the creation of a cheap, accurate, rapid, and easy-to-use test for bacterial infections that will allow doctors and nurses to better target their treatments.

This anthology, visualises a dystopian future where initiatives like the Longitude Prize have come to nothing. These stories are a meditation on the dark side of evolution. Resistance is inevitable, perhaps the most depressing implication of the revolutionary ideas of Charles Darwin. When treatment with an antibiotic begins, non-resistant bacteria are wiped out, leaving resistant cells to thrive.

As Fleming suggested, resistance dates back to the start of the antibiotic era. For example, the first resistant pneumococcus arose during the 1960s in the Trobriand Islands off New Guinea, which were visited by the Polish anthropologist Bronisław Malinowski during the First World War because they were so remote.  Today the misuse of antibiotics in agriculture – to promote livestock growth – and in hospitals and by doctors drives the proliferation of drug-resistant bacteria.

Yet competition does not tell the whole story of biology. I doubt many realise that, paradoxically, one way to win the struggle for existence is to pursue the ‘snuggle for existence’: to cooperate. Building on the work of many others, the co-author of my last book, Martin Nowak of Harvard University, has identified at least five basic mechanisms of cooperation which gives human beings their extraordinary capacity to work together.

If we are to win this struggle for existence, and avoid the post antibiotic apocalypse, there’s no choice but to harness this extraordinary creative force.  The winner of the Longitude Prize, which we hope will be announced by 2020, could be a lone inventor but will most likely be a team, where clever people assemble various technologies in unexpected ways, a collaboration of highly specialist skills splintered among many minds. By harnessing this creative force of evolution, we can stop science fiction from becoming science fact.

Roger Highfield is a member of the Longitude Committee and Director of External Affairs of the Science Museum, which has a sample of Fleming’s original Penicillium mould. With Martin Nowak, Highfield wrote the book SuperCooperators: Evolution, Altruism and Human Behaviour or, Why We Need Each Other to Succeed.