We have an antibiotic problem. It kills more Australians than road accidents

Heard of any of these terms? Antibiotic resistance. Superbugs. Drug-resistant infections. Antimicrobial resistance. AMR. They all describe the same thing – the ever-increasing presence of bacteria that can no longer be effectively killed by our current arsenal of antibiotics.

And no, your body doesn’t become resistant; the bacteria do. One of the most powerful classes of drugs ever discovered – and one of the few that generally cure the disease they are used to treat – antibiotics underpin the modern medical system. Without them, surgery, cancer therapy, dialysis, and even simple cuts and scrapes become deadly gambles.

Resistant infections in Australia are already causing an estimated 1600 deaths a year, more than the road toll of 1300 fatalities, yet we’re barely talking about it, let alone acting.

The problem is two-pronged: bacteria are becoming more resistant, and we’re not developing new antibiotics fast enough to keep pace. The emergence of “superbugs” – bacteria resistant to multiple antibiotics – is driven by their ability to rapidly evolve and share genetic information. This allows them to adapt after exposure to sublethal antibiotic doses and pass survival strategies to other bacteria. Combatting antibiotic resistance starts with reducing unnecessary and excessive antibiotic use, slowing the creation and spread of resistance.

Globally, about two-thirds of antibiotics are used in animals, not humans, and sometimes even on fruit crops. This use is often to promote faster growth rather than treat animal illness, and needs tighter control. Australia is pretty good at this, with low agricultural antibiotic use compared with the rest of the world. However, we’re among the worst for excessive use in humans, with one of the highest prescription rates in the world. Globally, about two-thirds of the antibiotics prescribed to people are not needed.

Part of the problem is the lack of rapid diagnostics to identify bacterial from viral infections, so antibiotics are prescribed “just in case”. This is unusual for a drug class. Doctors don’t prescribe – and patients don’t ask for! – cancer drugs without a diagnosis because there are well-known toxic side effects. So, why do we do this with antibiotics?

Antibiotics are widely seen as being safe, but that reputation is misleading. They can potentially damage hearing, muscles and kidneys, and disrupt beneficial bacteria in the body. Research into faster, more accurate diagnostics is under way and could dramatically reduce unnecessary antibiotic use if implemented.

The other side of the problem is the dwindling supply of effective antibiotics. We’re no longer discovering new ones at the rate we used to, largely for economic reasons. Almost all major pharmaceutical companies have abandoned early-stage antibiotic discovery because they can’t make enough money if they get a new antibiotic approved. Any powerful new antibiotic must be reserved for special cases, not widely used – the opposite of a profitable blockbuster drug. The market fundamentally undervalues antibiotics. A life-saving antibiotic might earn $15,000 per course, while cancer therapies can charge $500,000 for a therapy that may or may not work.

As a result, venture capital has fled the sector, particularly after antibiotic-focused biotech companies such as Achaogen, Tetraphase and Melinta Therapeutics went bankrupt despite securing drug approvals. This has led to a sparse development pipeline, with only 50 to 60 antibiotics in human trials compared with thousands of cancer drugs at the same stage.

Access is also a problem. Lower-income countries with high resistance rates often cannot afford new antibiotics. Smaller high-income countries such as Australia face a different barrier: the cost of registering a new antibiotic often exceeds potential sales. Of the 23 antibiotics approved globally since 2013, only two are approved for use in Australia. We’re missing out on life-saving medications. Doctors must instead apply for special access with more than 30,000 applications lodged between 2018 and 2023.

So what do we do? Australia needs to invest in research and infrastructure. Responsibility for antibiotics and antimicrobial resistance is spread across multiple federal and state government departments, with no co-ordination. The Australian Antimicrobial Resistance Network (AAMRNet) has been established to bring together interested industry, academic and not-for-profit agencies to advocate for change, but its funding remains fragile. Australia should participate in global endeavours to kick-start antibiotic discovery, such as CARB-X (Combatting Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) and GARDP (Global Antibiotic Research and Development Partnership). Research groups in Australia are the recipients of funding from these organisations, yet Australia does not contribute.

One solution is for antibiotic reimbursement to adopt the “Netflix” subscription model, with Australia paying a fixed fee for access to a new antibiotic regardless of use. We don’t fund firefighters only when they show up to a fire. Public advocacy also matters. Australia produces world-class research, but grant success rates are now below 8 per cent. National Health and Medical Research Council funding has stagnated, with awarded grants falling from 1090 in 2014 to 740 in 2024, while the Medical Research Future Fund sits on nearly $400 million per year of unspent funds that could be supporting life-saving research.

Look to the person on your left, then to the person on your right. One of you has taken an antibiotic in the past year. If it didn’t work, would that person still be alive? Do you really want to take that gamble? Support the researchers working to ensure you never have to.

Mark Blaskovich is a professor at the Institute for Molecular Bioscience, University of Queensland.

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