来源：《经济学人》
原文见刊日期：2023年5月6日
Antibiotics are vital to modern medicine. Their ability to kill bacteria without harming the patient has saved billions of lives directly and made everything from caesarean sections to chemotherapy much safer. Life expectancy would drop by a third if they did not exist. But after decades of overuse their powers are fading. Some bacteria have evolved resistance, creating a growing army of “superbugs” against which there is no effective treatment. Antimicrobial resistance is expected to kill 10m people a year by 2050, up from around 1m in 2019.
抗生素对现代医学至关重要。它们在不伤害病人的情况下杀死细菌的能力直接挽救了数十亿人的生命，并使从剖腹产到化疗的一切都更加安全。如果它们不存在，人类预期寿命将下降三分之一。但经过几十年的过度使用，它们的力量正在减弱。一些细菌已经进化出耐药性，形成了一支不断壮大的“超级细菌”大军，目前还没有有效的治疗方法。预计到2050年，抗菌素耐药性每年将导致1000万人死亡，远高于2019年的100万人左右。
It would be unwise to rely on new antibiotics to solve the problem. The rate at which resistance emerges is accelerating. Some new drugs last only two years before bacteria devise counter-measures. When new antibiotics do arrive, doctors often hoard them, prescribing them only reluctantly and for short periods when faced with the most intransigent infections. That helps limit the spread of resistance to new drugs. But it also limits sales, making new antibiotics an unattractive proposition for most pharmaceutical firms.
依靠新的抗生素来解决这个问题是不明智的。耐药性出现的速度正在加快。一些新药只能维持两年，细菌就会产生对抗机制。当新的抗生素确实出现时，医生往往会囤积它们，在面对最顽固的感染时，他们只会不情愿地在短时间内开处方。这有助于限制对新药的耐药性的传播。但这也限制了销售，使得新抗生素对大多数制药公司来说是一个没有吸引力的提议。
Governments have been trying to fix the problem by funnelling cash into research and taking stakes in drug firms. That has produced only limited improvements. But there is a promising, if obscure, alternative that is also worth a look. Microbiologists have known for decades that disease-causing bacteria can suffer from illnesses of their own. They are susceptible to attack by bacteriophages (“phages” for short): specialised viruses that infect bacteria, and often kill them.
各国政府一直试图通过向研究投入资金和入股制药公司来解决这个问题。这只带来了有限的改善。但是，还有一个很有希望的替代方案，虽然鲜为人知，但也值得一看。微生物学家几十年前就知道，致病细菌本身也会患上疾病。它们容易受到噬菌体的攻击，噬菌体是一种感染细菌并经常杀死细菌的特殊病毒。
Using one disease-causing organism to fight another has several advantages. Like antibiotics, phages are picky in their choice of target, leaving human cells alone even as they infect and destroy bacterial ones. Unlike antibiotics, phages can evolve just as readily as bacteria can, meaning that even if bacteria do develop resistance, the phages may be able to evolve around it in turn.
用一种致病生物来对抗另一种致病生物有几个好处。就像抗生素一样，噬菌体在选择目标时也很挑剔，即使它们感染并摧毁细菌细胞，也会对人类细胞置之不理。与抗生素不同，噬菌体可以像细菌一样迅速进化，这意味着即使细菌产生耐药性，噬菌体也可以反过来进化。
That, at least, is the theory. The trouble with phages is that comparatively little is known about them. After the discovery of penicillin, the first antibiotic, in 1928, they were largely ignored in the West. Only the Soviet Union, powered by research and production facilities in Georgia, continued to use them. Given the gravity of the antibiotic resistance problem, it would be a good idea to find out more.
至少，这就是理论。噬菌体的问题在于，人们对噬菌体的了解相对较少。1928年，第一种抗生素青霉素被发现后，噬菌体在西方基本上被忽视了。只有苏联在格鲁吉亚的研究和生产设施的支持下继续使用噬菌体。考虑到抗生素耐药性问题的严重性，对噬菌体了解更多是个好主意。
The first step is to run more clinical trials. Interest from Western firms is growing. But it is being held back by the fact that phages are an even less appealing investment than antibiotics. Since they are natural organisms there may be trouble patenting them, making it hard to recoup any investment.
第一步是进行更多的临床试验。西方公司的兴趣正在增长。但由于噬菌体的投资吸引力甚至不如抗生素，这一事实阻碍了它的发展。由于噬菌体是天然生物，申请专利可能会遇到麻烦，因此很难收回任何投资。
Governments can help. They could fund basic research into phage therapy, and clarify the law around exactly what is and is not patentable. In time they could set up phage banks and manufacturing processes, so as to make production cheaper. And they could spread awareness of the risks of overusing antibiotics, and the potential benefits of phages. If you are put off by the thought of ingesting a virus, consider that penicillin was a mould.
政府可以提供帮助。政府可以资助噬菌体疗法的基础研究，并明确法律规定哪些可以申请专利，哪些不能申请专利。假以时日，政府可以建立噬菌体库和生产流程，从而降低生产成本。政府还可以让人们意识到过度使用抗生素的风险，以及噬菌体的潜在好处。如果你对摄入病毒的想法感到反感，想想青霉素是种霉。