Is the Antibiotic Apocalypse Nigh? We Explore Antibiotic Resistance with the Surgeon X Team

By Abigail Chandler on at

As much as we’d all like to believe that a chemical spill could give us amazing superpowers at any moment, we sadly have to accept that comic book science isn’t always grounded in fact.

Which is why it’s such a surprise to see a comic book tackling the hottest issue in medicine right now – antibiotic resistance – and getting it right.

Surgeon X is the debut comic by writer and filmmaker Sara Kenney, published by Image Comics but funded by an arts grant from medical research charity the Wellcome Trust. It launches us into a dystopian near-future, where antibiotics have become next to useless in the face of resistant bacteria. As society crumbles, a surgeon named Rosa Scott decides to use her medical skills to save the people who really deserve to be saved – and quickly starts to develop a bit of a God complex.

Kenney is joined by a seriously impressive team, from Vertigo founder (and comics legend) Karen Berger on editing duty and former Sandman artist John Watkiss providing the art, to a remarkable team of microbiologists, psychologists, historians and philosophers bringing their expertise to the table.

Kenney has written in the medical field before (including working on Casualty) so she already knew enough about antibiotic resistance to pique her interest. “We have had quite a lot in the news and the media,” she says, “even using the term ‘antibiotic apocalypse’, but I guess it’s only when you actually speak directly to the scientists, get the information straight from the horse’s mouth, so to speak, that you realise just how bad it’s getting.”

An estimated 700,000 people currently die annually from antibiotic-resistant bacteria and the situation is getting bad enough for a UN General Assembly to be held on it. The only previous UN General Assemblies on health issues have been for Ebola, AIDS and noncommunicable diseases like cancer, which gives you an idea of just how serious this is.

“Antibiotic Resistance is a huge threat,” microbiologist Dr Laura Bowater stresses. “Dame Sally Davis, the Chief Medical Officer for England, was not exaggerating the scale of the problem when she described it as a catastrophic threat to be ranked with terrorism and climate change on the list of critical risks to the UK.”

The problem of antibiotic resistance has arisen thanks to two factors: Bacteria are becoming resistant to existing antibiotics, and we’ve stopped looking for new ones. Dr Bowater explains that, to put it bluntly, “we began to rely on these drugs as quick and easy cure-alls and we used them casually and excessively and sometimes inappropriately.”

Professor Alan Johnson tells us that levels of resistance vary in different parts of the world, but resistant bacteria can easily be carried from country to country thanks to air travel. It’s especially bad on the Indian subcontinent, for instance, and cases are worse in southern Europe than in northern Europe, because “for many years [antibiotics] have been available over the counter rather than being regulated by only being obtainable through doctors writing a prescription.” As for why drug companies haven’t been actively seeking out new antibiotics, that’s a purely financial decision. Antibiotics are only prescribed in short doses, and doctors are discouraged from prescribing it unless absolutely necessary, to stave off resistance. “From a commercial perspective it’s phenomenally expensive to develop new antibiotics,” Professor Johnson explains, “and if you get a new drug but you’re hardly ever going to use it, it’s actually, from a commercial point of view, quite difficult to even recoup your investment costs, let alone make a profit. So there’s not a huge incentive for drug companies to spend their research money on developing new antibiotics.”

A lack of antibiotics doesn’t just mean that your UTI will get out of hand. For instance surgery would become far riskier and cancer patients would face additional health worries as chemotherapy reduces the immune system’s ability to deal with harmful bacteria. “For a lot of cancer patients having effective antibiotics could be life-saving,” Professor Johnson says, “and were we to see really high rates of resistance among the different sorts of bacteria, [cancer treatment] would be compromised severely.”
If doctors were unable to rely on antibiotics as heavily as they currently do, they would have to start looking back at some medical techniques that have all but died out – which is partly where Surgeon X’s historical consultant, Dr Harriet Palfreyman, comes in. “The antibiotic 'revolution' has obliterated older treatments for certain diseases, treatments that Rosa Scott and her colleagues are forced to relearn in the face of increased antibiotic resistance in the world of Surgeon X,” she explains.

But Dr Palfreyman was also responsible for advising on Surgeon X’s wider world, a world plunged into chaos in the wake of a health crisis. “If we look back to the last major plague epidemic in London, in 1665, we see a significant death toll – estimates reckon around a quarter of London’s population died – as well as total transformation of everyday life. Restrictions were placed on trade and movement, quarantines were used, animals thought to carry the disease were culled, the rich could afford to leave but the poor had to stay and suffer; really there would have been no one in the city unaffected in some way, even if they were not sick.” The same thing happens in Surgeon X, which is just as interested in the societal fall-out from such a crisis as in the medical side-effects.

Writer Kenney adds that “there’s psychological aspects to it as well in terms of how the general public perceive the science and the scientists and experts, whether they believe them or not, things from climate change to anti-vaccination to ozone depletion.” This growing distrust of science is a problem we’re facing today. Can we really rely on politicians to preach scientific best practice when even US Presidential candidates are denying climate change?

Surgeon X is set in a world where global powers didn’t do anything until it was too late, but is it an authentic version of a possible future we’re facing? “I think the future world presented by Surgeon X is realistic,” Dr Bowater says. “As with the best science fiction it gives society a window into future possibilities. The data we have that models predictions for a future society indicates that if we do nothing about this crisis now, by 2050 we will be living in a world where antibiotic resistance will impact dreadfully on our lives.”

Kenney, for her part, views Surgeon X as a thought-experiment. “I think actually by thinking about those scenarios and thinking about how bad things could get, you start to think of solutions and you start to think about, right, how do we stop going there? How do we put things in place to mitigate that?”

The world has finally woken up to the threat of antibiotic resistance 71 years after Alexander Flemming famously warned of it in his Nobel Prize acceptance speech. Surgeon X is a fascinating glimpse into a possible future – but let’s hope it’s eventually proven wrong.

Surgeon X is published today by Image.