The evolving response to antibiotic resistance (1945-2018)

The intensity and character of concerns about antibiotic resistance, over the past nearly seventy-five years, have depended on a series of linked factors: the evolution and distribution of resistant microbes themselves; our differential capacity and efforts to detect such microbes; evolving models of antibiotic resistance and the related projected impact of antibiotic resistance on medical, social, and economic futures; the linkages of antibiotic prescribing and usage to the prevailing practice and identities of the medical and veterinary professions, and to the practice of agribusiness; the projected capacity of biomedicine (and especially the pharmaceutical industry) to stay ahead of such developing resistance; the perceived global context in which such resistance has developed; and the coordination of efforts and the development of infrastructure and funding to draw attention to and confront such microbial resistance. This paper traces the evolving response to antibiotic resistance through what at this point appear to be five eras: that between 1945 and 1963, a relatively optimistic period during which time the pharmaceutical industry appeared to most as capable of keeping up with antibiotic resistance; that between 1963 and 1981, characterized by increasing concern (though limited reformist activity) in the wake of the discovery of the transmission of antibiotic resistance via extrachromosomal plasmids; that between 1981 and 1992, notable for the explicit framing of antibiotic resistance as a shared global problem by such reformers as Stuart Levy and the Alliance for the Prudent Use of Antibiotics; that from 1992 through 2013, during which time antibiotic resistance became linked to larger concerns regarding emerging infections and received increasing collective attention and funding; and that from 2013 through to the present, with antibiotic resistance still more palpably and publicly embedded within larger concerns over global emerging infections, social justice, and development goals, attracting interest from a diverse cohort of actors.