Superbugs! The End of the Antibiotic Era

So I looked, and behold, a pale horse. And the name of him who sat on it was Death, and Hades followed with him. And power was given to them over a fourth of the earth, to kill with sword, with hunger, with death, and by the beasts of the earth.

–Revelation 6:8

One of the most impressive features of developed societies over the past 75 years has been the remarkable advance in human health brought about by medical science. This is especially true in the arena of microbiology; we have seen the complete eradication of some infectious diseases, like smallpox, and the partial eradication of others, such as diphtheria, cholera and polio. These are diseases that in former times wreaked widespread misery, suffering and death.

The scale of these victories should not be minimized; for example, it is reckoned that some 300 million people died during the 20th century alone from smallpox. Yet by 1979 the world was declared free of the disease after concerted efforts to eradicate it paid off. No new cases have been recorded since that time.

Defeating the Bugs

Advances in science and technology have enabled us to understand the dangerous microbes that cause disease. Their secrets have been unmasked. A formidable arsenal of anti-microbial defenses, such as vaccines, anti-virals and anti-bacterials (antibiotics), has been successfully deployed. This has led to great success in the ongoing war against infectious diseases.

However, despite these advances, the microorganisms—bacteria, viruses, fungi and parasites—have found ways to fight back. Progressively, they have proven adept at eluding our attacks; they have discovered how to outwit our anti-microbial arsenal by building resistance to it; they have developed ever more potent toxins. Indeed, the more bacteria are placed under attack the more active they become, mutating and modifying their genetic structure.

Today we call these microorganisms superbugs! They produce a nightmare of infectious diseases that are progressively overwhelming us, heralding a potential worldwide crisis on our doorstep!

These powerful bugs are our invisible enemies, seemingly spreading everywhere—lurking in hospitals and healthcare facilities, and colonizing our communities; in schools, in sports facilities, in prisons, in our farm animals and even on our pets and in our food. These bugs have become killing machines, because increasingly we have little left with which to fight them. The bugs are winning, and science simply cannot keep up.

So where is all this leading? Should we be worried about superbugs and the threat they pose to our collective well-being? What does the future hold with regard to infectious disease, and does the Bible shed any light on the subject?

The Rise of Superbugs

Initially, the scientific community was euphoric at the prospect that infectious diseases could be banished permanently. Because of the impact of new anti-microbial agents, infection rates were plummeting and spectacular progress seemed to take place. It was tantalizing to imagine that pandemics from the past might never be repeated. For example, the Black Death killed 30–60 percent of Europe's population in the 14th century (maybe 100 million people) and the 1918 Great Influenza pandemic killed upwards of 50 million people around the world at the end of the First World War.

But the new anti-microbial agents did not prove to be all-powerful for very long; in 1928 the first "miracle drug," a fungus called penicillin, was discovered. Adept at killing bacteria such as staphylococcus and streptococcus, and those that caused diphtheria, pneumonia and meningitis, penicillin was widely used from around 1943. Almost immediately, with the increasingly widespread use, resistance to the drug began to develop.

A new family of penicillin-type drugs was rapidly developed, including one called methicillin in 1960. Within one year, a strain of staphylococcus resistant to methicillin appeared and became known as MRSA. Today we have strains of MRSA that are resistant to virtually all antibiotics. They have developed numerous other characteristics that make them true killer bugs, the scourge of hospitals and communities around the world.

In her book, Superbug: The Fatal Menace of MRSA (Free Press, 2010), award-winning science journalist, Maryn McKenna, meticulously lays out in graphic detail the inner workings of MRSA. She notes that this superbug has developed "a huge range of microbiological weapons called virulence factors—more than seventy cell-destroying enzymes and toxins, many more than any other bacterium can produce" (p. 5). She also notes "It became evident that broad use of antibiotics not only caused drug-resistant infections; it also made people who had no symptoms of infection into silent carriers of drug-resistant strains" (p. 42, emphasis ours).

Today, there are resistant strains impacting most diseases, including tuberculosis, which kills 2 million people a year, mainly in developing countries. It is thought that a third of the world's population is infected with TB, and some 20 percent involves drug resistant superbugs. Other examples of resistant bacteria are those producing salmonella and E-Coli infections, tetanus, whooping cough and cholera.

What the Experts Say

So, how serious are these developments? According to a World Health Organization (WHO) fact sheet on Antibiotic Resistance (October 2015), "In the European Union (EU) alone, drug resistant bugs are estimated to cause 25,000 deaths and cost more than US$1.5 billion every year in healthcare expenses and productivity losses."

The same WHO fact sheet summarizes the truly sobering realities now impacting global health, including: "Antibiotic resistance is one of the biggest threats to global health today. It can affect anyone, of any age, in any country. A growing list of infections—such as pneumonia, tuberculosis, blood poisoning and gonorrhea—are becoming harder, and sometimes impossible, to treat as antibiotics become less effective. The world urgently needs to change the way we prescribe and use antibiotics. Even if new medicines are developed, without behavior change, antibiotic resistance will remain a major threat. Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill" (emphasis ours).

Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention (CDC), wrote that "Antibiotic resistance is a worldwide problem. New forms of antibiotic resistance can cross international boundaries and spread between continents with ease. Many forms of resistance spread with remarkable speed. World health leaders have described antibiotic-resistant microorganisms as 'nightmare bacteria' that 'pose a catastrophic threat' to people in every country in the world" (Antibiotic Resistance Threats in the USA, 2013, p. 11).

The CDC conservatively estimates that in the United States, more than 2 million people become ill every year with antibiotic-resistant infections, with at least 23,000 dying as a result (ibid., p. 6). In addition, almost 250,000 people annually require hospital care for Clostridium difficile infections, and at least 14,000 people die as a result. Many of these infections could have been prevented" (ibid., p. 11).

Echoing a number of these thoughts, Professor Dame Sally Davies, Chief Medical Officer for England, wrote, "We are losing the battle against infectious diseases. Bacteria are fighting back and are becoming resistant to modern medicine. In short the drugs don't work!" (The Drugs Don't Work—A Global Threat, Penguin, 2013, p. viii).

Some 1.2 million hospital patients around the world suffer from bacterial infections and 90,000 of them die. It is estimated that 70 percent of bacteria now possess resistance to one or more antibiotic drugs (Superbugs, John DiConsiglio, Raintree, 2012, p. 6).

Did you catch the importance and urgency of these words? Approaching a "post-antibiotic era" … Killed by "common infections and minor injuries"… "The world urgently needs to change" … "Anyone can be affected, anywhere" … "nightmare bacteria" … "catastrophic threat"… "The drugs don't work." All this suggests that we are in deep trouble. A crisis is upon us and we are running out of time and the ability to defend ourselves. As Margaret Chan, Director-General of the World Health Organization, told delegates in her October 11, 2015 speech to the World Health Summit in Berlin, Germany, "Antimicrobial resistance has become a major health and medical crisis. If current trends continue, this will mean the end of modern medicine as we know it."

Disease Epidemics Yet To Come

Will we lose the battle against infectious diseases, or will humanity yet find ways to decisively deal with superbugs? We can certainly hope that medical research will make breakthroughs. Yet it may well be that science will be overtaken by events. Superbugs are relentlessly growing stronger and more ubiquitous. At some point they may break out and afflict our expanding world population with devastating pandemics that we are simply unable to contain. And, in fact, this is what has been prophesied for centuries in the pages of your Bible. A time will come when no amount of medical intervention will be able to stop the onrush of disease and death afflicting mankind.

Jesus described various signs that would herald His return to planet Earth. They would include wars, famines and pestilences (disease or plague, Matthew 24:7). But Matthew adds that these are (only) the "beginning of sorrows" (v. 8). Indeed, these three signs have been features throughout most of human history. But, the account suggests these are factors that will worsen over time as we come nearer to Christ's return.

The account in Revelation 6 is even more explicit. John's vision, inspired by Christ Himself, projected him forward in time to the "Lord's day" (Revelation 1:10). In the context of the book, this refers to an unprecedented series of events that signal the end of humanity's rule over planet Earth and the outpouring of God's intervention in world affairs. It is a time of such great trouble that unless Christ intervened, all life would be extinguished from the earth (Matthew 24:21–22).

The first four seals depicted in Revelation 6 are commonly called The Four Horsemen of the Apocalypse. The figure sitting on the white horse has a bow (the symbol of conquest) and a crown. He goes forth bent on conquest. The rider of the red horse brings war. The rider of the black horse brings famine. The rider of the pale horse brings death (Gr. thanatos) and the grave. Although not directly referred to as the bringer of pestilence or disease, this is the strong inference (see NIV and ESV translations). In the Old Testament, the Hebrew term for pestilence, deber, is translated in the Septuagint by the Greek word thanatos, meaning death.

Importantly, these four horses ride together, killing as they go with the sword, with famine, with death (pestilences) and with wild beasts. These four scourges ravish "the fourth part of the earth." This phrase carries the chilling connotation that one out of four human beings on planet Earth will die at this time, just prior to Christ's intervention. If so, the loss of life would be truly "off the scale" and unprecedented in all of human history. Interestingly, Scripture does not tell us the precise size of the "wild beasts" that will kill so many human beings. Superbugs remind us that the tiniest microorganism may prove just as deadly as the largest carnivore!

But There Is Good News!

To our modern generation, brought up to believe that diseases are being conquered, and will continue to be conquered, the Bible's account may scarcely seem believable. Yet it is often when civilized society becomes seriously disrupted that the horsemen of war, famine and disease ride together. From time to time one horse or another may take the lead; war, after all, can lead to famine and disease, but famines and disease can also precipitate wars. If superbugs become part of the mix (and why not?), the combined effect will be even greater.

No doubt many of you reading these words will be alive to witness these earth-shattering events. On God's own authority, the Holy Bible, the day will come when the thin and delicate "crust of civilization" we enjoy will crumble and disintegrate before our very eyes. Arguably, this is already happening in several countries! But war, famine and pestilence will run amok when The Four Horsemen commence their fateful ride across planet Earth.

Thankfully, the good news is that the suffering they inflict will come to an end when Christ intervenes to save the world and establish God's Kingdom over all the earth. At that time He will usher in an unprecedented age of peace and happiness, when wars, famines, pestilences—superbugs included—will cease to be a problem.