In 1954, just a few years after antibiotics became widely available, doctors already recognized the growing problem of resistance. Natural selection meant that using these drugs gave an advantage to microbes that could survive them—turning today’s effective treatment into tomorrow’s failure. A British doctor framed the challenge in military terms: “We may run out of effective ammunition. Then how the bacteria and molds will dominate.”
More than 70 years later, that warning seems prophetic. The UN now calls antibiotic resistance “one of the most urgent global health threats.” Researchers estimate it already kills over a million people annually, with that number expected to rise. Meanwhile, new antibiotics aren’t being discovered fast enough—many of the most essential ones were found over 60 years ago.
What makes antibiotics unique is that they don’t work like other medicines. Most drugs tweak human biology—paracetamol dulls pain signals, caffeine blocks drowsiness. Antibiotics, however, target bacteria. And because bacteria spread between people, resistance becomes a shared problem. It’s as if every time you took a painkiller, you increased the chance someone else might need surgery without anesthesia.
This makes resistance more than just a scientific challenge. Yet, like that British doctor in 1954, we still talk about it in military terms—as if we just need better “weapons.” What this overlooks is that antibiotics aren’t purely human inventions. Most originate from substances made by bacteria and fungi, shaped by millions of years of microbial warfare.
This reminds me of another overused natural resource that built the modern world: fossil fuels. Just as ancient plant matter became coal and oil, evolution produced molecules that 20th-century scientists harnessed to save lives. Both promised limitless power over nature—a promise now fading. If we saw antibiotics as medicine’s “fossil fuels,” would we use them differently? Could it help us fight infections more sustainably?
The antibiotic era is barely a century old. Alexander Fleming noticed penicillin’s effects in 1928, but it wasn’t isolated until the late 1930s. Early doses were tiny—just 60mg, a pinch of salt—and so scarce they were worth more than gold. After wartime mass production, they became cheaper than their bottles.
It’s hard to imagine a more anti-capitalist product: one that loses value every time it’s used. Yet their impact went beyond treating infections. Like fossil fuels transformed society, antibiotics enabled modern medicine. Surgery, once deadly due to infection, became routine. Chemotherapy, which weakens immunity, relied on them to prevent deadly complications.
Their influence spread even further—factory farming thrived by keeping densely packed animals disease-free.Antibiotics have played a key role in boosting meat production by preventing disease in livestock and increasing their weight through metabolic effects. This has contributed to the dramatic rise in meat consumption since the 1950s, with all its associated animal welfare and environmental impacts.
Despite growing antibiotic resistance, these drugs remain relatively inexpensive compared to other medicines. This is partly because—much like fossil fuels—the negative consequences of their use (known as “externalities”) aren’t factored into their cost. And just like coal, oil, and gas, antibiotics pollute the environment. A recent study found that nearly a third of the world’s 40 most commonly used antibiotics end up in rivers. Once there, they contribute to antibiotic resistance in environmental bacteria. Research in the Netherlands, for example, showed that certain antibiotic-resistant genes in soil had increased more than 15-fold since the 1970s. Another major source of pollution is antibiotic manufacturing, particularly in countries like India. In Hyderabad, where factories produce vast quantities of antibiotics for global markets, scientists have detected antibiotic concentrations in wastewater up to a million times higher than normal levels.
Like climate change, antibiotic resistance exposes global inequalities. Some wealthy nations have reduced antibiotic use—but only after benefiting from their widespread availability in the past. This makes it difficult for them to criticize antibiotic use in developing countries, a dilemma similar to industrialized nations urging poorer countries to forgo cheap energy despite having relied on it themselves.
However, the comparison only goes so far. While we hope to eventually phase out fossil fuels entirely, antibiotics will always be essential to medicine. After all, most deaths from bacterial infections worldwide are due to lack of access to antibiotics, not resistance. The challenge is making their development and use more sustainable. Currently, many pharmaceutical companies have abandoned antibiotic research—it’s hard to imagine a less profitable product than one that loses value every time it’s used.
We need new approaches. One proposal is for governments to fund an international institute to develop publicly owned antibiotics, rather than relying on private companies. Another idea is to offer substantial financial rewards for new antibiotic discoveries. To curb overuse, economists suggest “subscription” models where health authorities pay a fixed fee for antibiotics, removing the incentive to sell large quantities. A pilot program in England is testing this approach, with the NHS paying two companies a set annual amount regardless of how much they supply.
Finally, we must remember that antibiotics aren’t the only solution. Investing in alternative, “renewable” approaches—like vaccines—can help preserve the antibiotics we have. Vaccines prevent diseases like meningitis, diphtheria, and whooping cough, reducing the need for antibiotics. Some of the biggest reductions in infectious diseases in the 20th century came not from antibiotics, but from improved sanitation and public health measures. (Even in the 2000s, MRSA outbreaks were controlled through basic hygiene—not new drugs.) Given that antibiotics were originally discovered by chance, we should also invest more in exploratory research.
Just as we no longer burn coal without considering the consequences, the era of reckless antibiotic use is over. The belief that we could use them indefinitely without repercussions was always an illusion. But as with climate change, recognizing the limits of our dependence on antibiotics may ultimately be a necessary wake-up call.
Liam Shaw is a biologist at the University of Oxford and the author of Dangerous Miracle (Bodley Head).Further Reading
– Being Mortal: Medicine and What Matters in the End by Atul Gawande (Profile, £11.99)
– Infectious: Pathogens and How We Fight Them by John S. Tregoning (Oneworld, £10.99)
– Deadly Companions: How Microbes Shaped Our History by Dorothy H. Crawford (Oxford, £12.49)
FAQS
### **FAQs: Why Are Antibiotics Similar to Fossil Fuels?**
#### **Beginner Questions**
**1. How are antibiotics like fossil fuels?**
Both are finite resources that we overuse, leading to depletion and environmental harm.
**2. What does “antibiotic resistance” mean?**
It’s when bacteria evolve to survive antibiotics, making infections harder to treat—just like how fossil fuels become harder to extract over time.
**3. Why is overusing antibiotics a problem?**
Overuse speeds up resistance, just like burning too much fossil fuel speeds up climate change—both have long-term consequences.
**4. Are there alternatives to antibiotics, like renewable energy?**
Yes! Alternatives include vaccines, phage therapy, and better hygiene—similar to solar or wind energy replacing fossil fuels.
#### **Intermediate Questions**
**5. How do antibiotics and fossil fuels impact the environment?**
Antibiotics pollute water and soil, harming ecosystems, while fossil fuels cause air pollution and climate change.
**6. Why are both resources hard to replace quickly?**
Society depends on them, and switching to alternatives takes time and investment.
**7. Can we “recycle” antibiotics like we recycle materials?**
No, but we can use them more wisely—like prescribing them only when necessary—just as we conserve fossil fuels.
**8. Do industries profit from overusing both?**
Yes. Pharma and energy companies sometimes prioritize short-term profits over long-term sustainability.
#### **Advanced Questions**
**9. How does antibiotic use in farming compare to fossil fuel use in agriculture?**
Both are heavily relied on for mass production, worsening resistance and pollution.
**10. Is there a “peak antibiotics” crisis like “peak oil”?**
Yes. Just as oil reserves decline, effective antibiotics are running out due to resistance, with few new ones being developed.
**11. What policies could help, like carbon taxes for fossil fuels?**
Stricter regulations on prescriptions, incentives for new antibiotic research, and public awareness campaigns could slow resistance.
**12. Are there “renewable” approaches to fighting infections?**
Research into probiotics, immune-boosting therapies, and
