With how far we’ve come thanks to medical interventions, antibiotics deserve their standing ovation as one of the most impactful pharmaceutical inventions in history. In the U.S. alone, 256 million antibiotics were dispensed in outpatient facilities, and approximately 50% of all long-term hospital patients were prescribed at least one type of antibiotic in 2024. It’s hard to imagine a world where we don’t rely on the most basic illness prevention measures, but if we continue to misuse antibiotics and lack sufficient intervention, we won’t have to imagine that world. We’ll be living in it.

In 2019, an estimated 1.27 million people lost their lives due to antibacterial-resistant bacteria (ABR), with an additional 3.68 million deaths having ABR be a significant contributor. Approaching solutions to antibacterial resistance is complicated on every level, from the bacterial biology to the medical application, all dictated by economic and political involvements. On the scientific level, ABR is incredibly difficult to predict and mitigate due to the inherent defense mechanisms of bacteria. Their incredibly adaptable genetic code allows them to rapidly evolve resistance to our antibiotics. There are several mechanisms that aid their ability, including but not limited to frequent mutations in the proteins that antibiotics target and horizontal and cross-species gene transfer.

If it was just for the complications arising from their impressive, albeit dangerous, evolution patterns, matters would not be as dire as they are now. As with every single biomedical concept, the policies and economics that control our world unfortunately control the mechanisms behind any possible intervention or solution. There are three overlapping factors at play: the economic perspective, the current policies dictating ABR research and use and the underlying global health threat looming over the former.

Economically speaking, there is little motivation for any private biotechnology companies to develop antibacterial therapies: the monetary rewards for a drug that will likely be useless in the coming decades is simply too low to invest in. This is especially devastating with the recent National Institutes of Health (NIH) and national STEM grant funding being drastically cut. Since the majority of ABR research resides in the academic sphere and these programs provide immense funding to academic labs across the country, there are now even less resources being devoted to the study of possible ABR treatments.

To further exacerbate this issue, current U.S. policies do not properly mediate antibiotic use, according to the Association of American Medical Colleges. At least 28% of antibiotics prescribed to outpatients are seen as unnecessary. While there are some proactive measures put in place over the past decade, without proper funding, medical awareness or agricultural awareness, bacteria can easily adapt against the common antibiotics we’ve grown accustomed to using. Antibacterial resistance, while not an imminent threat, will undoubtedly be the worst case scenario if it gets out of hand. By the end of the century, it’s entirely possible we’ll be living in a world where the risk of any invasive surgeries outweighs the benefit, individuals with compromised immune systems are left even more vulnerable and a once treatable common infection—say from slicing your finger on the edge of a book—results in a deadly, untreatable bacterial disease.