In 1941, Albert Alexander, an English constable in the police, became the first human to be injected with penicillin. Only months earlier, he had been scratched in the face by a rose thorn while gardening. The scratch festered after getting infected. His face ballooned, puss oozed out of abscesses that covered his head and one of his eyes had to be removed. The doctors, seeing that Alexander was a terminal case, authorised the administration of penicillin—discovered by Stephen Fleming in 1928—on him. The results were astonishing. With just one dosage, Alexander’s fever had come down, bringing back his appetite. His swelling had receded and the infection had begun to heal. But because the science of antibiotics was still evolving at the time, there was not enough of it around. Alexander would eventually die, as the infections retook the modest gains made by the penicillin. His treatment, however, would change the human race forever. 

In the 70 odd years since the successful administration and commercialisation of antibiotics, human life expectancy has increased by 10 years. It has not only made us capable of curing a host of diseases which otherwise would have been fatal, but has also altered the human way of life. How carefully would you live if you knew a scratch from a rose thorn could kill you?

Very carefully, implies Ramanan Laxminarayan, a scientist with the Center for Disease Dynamics, Economics and Policy and lecturer at Princeton, as I sit down with him for a chat in Kathmandu. Laxminaryan is a tall, soft-spoken man and he explains his concepts patiently. The concepts themselves, however, are nothing short of alarming.

According to him, with the rampant and unchecked use of antibiotics, we are at the tail-end of a golden era of medicine ushered in by penicillin. He describes the overuse of antibiotics as a variation of the ‘tragedy of the commons’, an economic theory popularised by ecologist Garret Hardin.

The tragedy of the commons is an economic theory of a situation where individual users acting independently according to their own self-interest behave contrary to the common good of all users by depleting a resource through their collective action. That, according to Laxminaryan, is exactly what has happened with antibiotics.

“The pharmacy sells it because it has an incentive to push more drugs for perks from companies. The doctors prescribe antibiotics because its miraculous healing capacity provides an incentive for patients to return back to the same doctor.” If the doctors don’t prescribe antibiotics, the patients just go to another one who will. The problem is even more acute in developing countries like Nepal, where the dangerous mix of lax regulations and the lack of health facilities mean that pharmacies often prescribe antibiotics over the counter themselves, without prescriptions.

“Doctors, or others, prescribe antibiotics easily but often they might not even be necessary. While reaping personal benefits this way they are hurting others,” Laxminaryan asserts. So how does the rampant prescription of antibiotics harm the patient and the larger society? “Look at it this way,” suggests Laxminaryan, “we live in a world full of bacteria. You in fact have more bacteria in your body than you actually have human cells.” Usually these bacteria live amicably within the body, until we come in contact with ‘bad’ bacteria like the seasonal flu. The antibiotics we take, then, target these obstructive bacteria and restore the balance.

Bacteria, however, are incredibly resistant organisms that can survive without food, water, light and even air and can be found from the deepest ocean to the highest mountain. But more importantly they are incredibly good at adapting to new situations and transmitting shared knowledge among themselves. Thus, with the rampant use of antibiotics all over the world, the bacteria are also evolving to become super-microbes that can resist the effects of these once ‘miracle’ drugs.

It is a problem that is affecting patients all over the world. The drugs that were once miraculous and life-saving are no longer as effective, while pharmaceutical companies are growing increasingly reluctant to fund research that finds cure for these newly evolving super-microbes. To put thing into perspective, consider this: It takes up to 10 years for a pharmaceutical to research and make a new drug viable for commercial production. A whole generation of bacteria—stronger, more resistant than before—can spawn every 20 minutes. 

Fueling the problem further is how popular antibiotics have become in the cattle industry. Because these drugs spurn growth and quick maturation in animals like cows, hogs and chickens, it has become standard practice to introduce dosages of antibiotics to most animals consumed by humans, either through the feed or through periodic injections. 

“India has a policy where we are mixing antibiotics with animal feed. When India is making the policy it is not taking into account that the feed is also coming into Nepal and that is creating problems in Nepal as well. And you see this in every part of the antibiotics usage,” says Laxminaryan. “Their actions are almost always hurting someone else’s lives.”

A recent paper notes that the sales of veterinary antibiotics have risen over 50 percent from 2008 to 2012. Today, almost 80 percent of the antibiotics in the world are administered on animals meant for human consumption.

A comprehensive report published the World Health Organization, titled Antimicrobial Resistance: Global Report on Surveillance 2014, warns that recent trends in antibiotic resistance may be leading us to a post-antibiotic era in which common infections and minor injuries are no longer easily curable and can turn fatal.

Yet, despite the growing alarm, there is little that modern science can do to curb antibiotic resistance.

Laxminaryan suggests tweaking day-to-day behaviors including constant hand washing and preventing infections in hospitals should help. As antibiotics get weaker and weaker, Laxminaryan hopes that infection control will get more attention. He also hopes that introducing incentives for companies that research and introduce alternatives to antibiotics—much like governments have been subsidising the development and commercialisation of electric cars—will help as well.

“What we have to do is that first-line antibiotics should be available to people easily but the second and third-line antibiotics should need prescriptions,” says Laxminaryan. “We need to get antibiotics out of our food and need to curb the willy-nilly prescriptions handed out by doctors, or worse pharmacies themselves.”

Or else, as it becomes abundantly clear by the end of our conversation, we could be looking at a world were a tiny scratch by a rose thorn could yet again lead to death. A horribly painful one at that.