8 October 2019
In this blog, Matthew Edwards, Chair of the Antibiotic Resistance Working Party, discusses the discovery of things unlooked for.
The quotation is a famous line of Sir Alexander Fleming, the discoverer of penicillin – of course referring to his serendipitous discovery of this first major antibiotic while engaged in research on bacterial behaviour. (Indeed the serendipity was extraordinary – the phenomenon occurred only from a bizarre combination of circumstances, including what the laboratory downstairs had been dabbling in, Fleming’s absent-mindedly leaving the petri dish outside the incubator, its non-disturbance while he holidayed, and a sequence of unusually cool days followed by warm days. Which is why penicillin had to be largely ‘rediscovered’ ten years later by Harold Florey and Ernst Chain in Oxford!)
The line makes me think of three related points: the serendipitous nature of medical advances regarding antibiotics – what we found by luck, will we ever find again, given that we don’t seem to be successful at engineering new antibiotics? And so will antibiotic resistance grow exponentially, killing all of us before climate change, malfunctioning AI, or social media vitriol?
The two other points of finding what you’re not looking for relate to the working party itself – discovering the need for it, through discussions in the Mortality Research Steering Committee and a related ABR event at Staple Inn in 2016, and then discovering the other thing not looked for – the surprisingly low impact of ABR, despite all the headlines – of which more below.
So, the working party arose after we’d arranged an ABR evening of presentations and discussion. It was a well attended event and most participants voted for us to look at developing an ABR modelling framework. So that was the ‘actuarial petri dish’ from which the idea grew! Although some modelling had been done as part of the O’Neill review, for instance, the models were not readily usable – but many actuaries wanted to be able to explore plausible trends and quantify the impacts across various product types. And of course there’s a ‘public good’ aspect of our being able to provide further perspective on this topic.
Moving to the ‘spoiler’, then, what else did we discover that we hadn’t been looking for? I think we all started assuming, partly by exposure to such work as the O’Neill review and its headline figures of 10 million deaths annually worldwide (as a feasible outcome barring major changes), that we would have more doom and gloom to spread, perhaps to rival the climate change ‘apocalypse generators’.
But our work found that, for a developed country such as the UK, the impact of ABR is likely to be very minor. Even in the extreme scenarios considered, ABR deaths would be almost negligible compared with major causes of death such as cardiovascular disease and cancer. The low impact of ABR in the UK is primarily due to the well-developed health infrastructure, in particular vaccination programmes and good general public hygiene / sanitation. Conversely, in less developed countries where infectious disease is already a major cause of death, ABR poses a much greater challenge.
Although that’s good news, both from a human perspective and an actuarial perspective (at least for protection actuaries, perhaps less so for pensions actuaries!?), it did feel strange coming up with something that runs counter to the current thread of medical ‘perceived wisdom’.
But part of the strength of the actuarial profession should be to provide independent thinking, and to challenge a ‘tabloid headline’ mentality – and societal groupthink – where appropriate.
Our report and associated models are now out, available at https://www.actuaries.org.uk/practice-areas/health-and-care/research-working-parties/antibiotic-resistance