How did you first get involved with microbiology?
When I was seven years old a relative visited and he brought my father a microscope. The first time I looked into it I observed an ant. To this day I remember the image exactly — the way it looked so big and the way it moved. I realized there are many things in the world that we cannot really observe with the natural eye, yet they are very complicated and very interesting to study.
When did you decide to make superbugs the focus of your career?
Ten years ago, I was at the end of my microbiology degree at Umm Al-Qura University in Saudi Arabia and doing a practical internship in a clinical laboratory. I started reading about cases in the medical world of people being infected with antibiotic-resistant bacteria.
I decided to learn more about this [so I] worked as an infection control trainee in a hospital in Jeddah. Patients were going into hospitals for crucial operations like hip replacements or eye surgery and they would catch a superbug. These people were already very sick and suffering, and the last thing they needed was a subsequent infection given to them by the health care services that could lead to disability or even death. And it's all avoidable. This realization was enough for me to pursue my first infection control research project.
How big is the superbug threat?
To this date we find them on every continent and in many different countries. The situation of superbugs is bad all over the world so the global attention is on. With my background [in Saudi Arabia] I know what's going on there in terms of antibiotic use; people can buy antibiotics over the counter sometimes and I've seen a lot of hospital-acquired infections. So we focused our research on the Gulf to fill the gap in knowledge and research in that part of the world.
The image of health care in the Gulf is that it's all quite clean, modern and advanced. But you're saying health care workers' failure to clinically clean their hands — something we learned about a century ago — is contributing to superbug infections?
Yes. Compliance of hand-washing is low, but not just in the Gulf — all over the world, even in the most advanced countries. That is why in very fancy hospitals in the U.S. they have electronic devices that measure how frequently doctors wash their hands to enforce compliance.
What role can education play in the war against superbugs?
I believe the general public has a huge role to play in battling superbugs worldwide, especially in places where people can buy antibiotics without medical consultation. Self-prescribing antibiotics can eradicate normal friendly bacteria that lives in our body and give evil bacteria the chance to move in.
One of the reasons superbugs are gaining so much ground is that no new class of antibiotics has been developed since 1987. Why don't we make new ones anymore?
A lot of pharmaceutical companies are stepping out of the business because they believe making antibiotics is not as profitable as making other drugs. But there are other regulatory reasons. The F.D.A. makes it very difficult for pharmaceutical companies. It takes 10 years and billions of dollars to take a chemical compound antibacterial properties from the lab through clinical trials and all the way to market.
What's the worst-case scenario if governments and institutions stop investing in superbug research?
The worst-case scenario is we enter the post-antibiotic era which looks just like the pre-antibiotic era when people died from little things like cutting their hand or getting a sore throat. We would also lose almost all advanced forms of medicine. Heart transplant surgery, for example, depends on antibiotic treatment beforehand to prevent potential infections. We estimate the human lifespan has increased by up to 20 years because of antibiotics.
And the best-case scenario?
The best case is we don't lose any more ground. The threat of superbugs will still be here but we will still have some antibiotics that work. Either way the war will never finish — my work will never finish — because even if we have new antibiotics, bacteria will figure out a way to overcome them.
Do you think you will continue to work in the field of antimicrobial resistance for the rest of your career?
I think there’s a lot of research that needs to be done and I am also very keen to work on different elements. I like to step away from my lab and talk to the general public, give speeches, but at the same time I need to get the work done.
But I think we are in an excellent position. I am working with world-class researchers who know exactly what they are doing. They are giving me the freedom to pursue whatever is needed, with their guidance, and that is such a valuable thing. I think through collaboration, teamwork and funding to maintain the team, hopefully we can achieve this.
Interview by Ian Lloyd Neubauer. This interview has been edited and condensed