The future of medicine: the flu and antibiotics

Infection expert Dr Frank Bowden turns his microscope to the risk of a modern-day influenza pandemic and the fading effectiveness of antibiotics.

Health Agenda magazine
October 2016

When he was 14, Dr Frank Bowden’s mother died after a long battle with cancer. A childhood spent with his mother in and out of hospital might have put him off medicine for life. Instead, he found his vocation. “It was what put me on my path,” he says.

Born and raised in Melbourne, Dr Bowden is now a professor at the Australian National University and an infectious diseases specialist at Canberra Hospital. In his new book Infectious, he paints a picture of modern-day disease, the over-use of antibiotics and the new vaccines in development that could save millions of lives.

Contagious pathogens: bacteria vs viral

In Infectious, Dr Bowden discusses the difference between diseases that are transmitted by insects, such as malaria and Lyme disease, those caused by bacteria, including pneumonia; and diseases for which a definitive cause is still unknown, like chronic fatigue syndrome.

And that’s before we even get to viruses. Not all receive equal attention. Some viruses, such as Ebola, have dominated headlines with their horrific impact but, as Dr Bowden points out, other viruses are far deadlier.

The worst outbreak of Ebola, the epidemic that began in 2014 in West Africa, caused 11,300 deaths. Yet around 800,000 people die globally every year from hepatitis B, a fact that doesn’t generate a media frenzy or public panic.

Influenza: a potential pandemic

“The biggest threat to international health is most likely another influenza pandemic,” Dr Bowden believes. The last worldwide flu pandemic was the Spanish flu of 1918 to 1919, which killed three to five per cent of the world’s population. Today a similar flu would spread even more quickly, thanks to international air travel.

“The worst case scenario is an influenza in which bird flu recombines with the human flu and we get an extremely high mortality rate from a highly infectious virus,” Dr Bowden hypothesises.

If this terrifying scenario makes you feel like entering voluntary quarantine, Dr Bowden indicates researchers are developing a better flu vaccine. The improved formula will provide much longer protection than those now in use, which work for only a year and against only a limited number of strains. “There is tantalising evidence of vaccines that are effective against all flu viruses and could last five to 10 years.” Dr Bowden hopes they will be available within the next decade.

A post-antibiotic world

Meanwhile, a more insidious health crisis is underway: the increasing number of antibiotic-resistant bacteria. In Infectious Dr Bowden stresses antibiotics are effective only against bacteria, yet many people request them when they have a cold or the flu, both of which are caused by viruses. Due to rampant overuse and inappropriate prescription we may soon enter what he describes as “a post-antibiotic era”.

Dr Bowden likens this encroaching situation to climate change, saying that for years, “people who were talking about the emergence of antibiotic-resistant bacteria were voices crying in the wilderness”. As with climate change, he adds, “I think we are at a point wherewe can slow it down but we are not going to be able to stop it.”

Antibiotic-resistant bacterial infections are already prevalent, and no new classes of antibiotics have been developed since the 1980s. Dr Bowden hopes this will soon change. “I'm very confident that once resistance gets to a point that people can no longer ignore it – and this is already happening – companies will start to reinvest in the development of antibiotics.”

In the meantime if you’re feeling sick ensure bacteria is to blame before you reach for the antibiotics.

Cold vs Flu

• There are no nasal symptoms with the flu – if your nose is running you have a cold.
• A cold usually lasts three to 10 days (but 25 per cent of people can feel unwell longer).
• Pneumonia is a serious secondary infection that requires antibiotics.