‘Biography of Resistance’

Review by Bill Doughty

Viruses and bacteria are different but can be interconnected. As the world races for a vaccine and an effective treatment for COVID-19, we have to be alert to the possibility of other types of pandemics, including the possibility of one caused by bacteria, including antibiotic-resistant bacteria. 

Fortunately, brave men and women dedicate their lives to discovering how bacteria evolve and we can protect ourselves. But we must remain humble in our persistence to understand the nature of disease and how to prevent and fight outbreaks.

“Bacteria cares not at all for the politics of nations or the egos of scientists, and in its unrelenting drive to endure, it cares not at all for the timelines of human beings,” H. Muhammad Zaman writes in “Biography of Resistance: The Epic Battle Between People and Pathogens” (HarperCollins; 2020).

Zaman traces the history of antibiotics from ancient history, starting with Hippocrates and Maimonides, through Hooke, Leeuwenhoek, Klebs, Pasteur, Gram, Kitasato, and Nobel laureate Alexander Fleming through World War II, when British bacteriologist Dr. Mary Barber discovered penicillin-resistant bacteria in London in 1946.

Albert Schatz

Zaman features other Nobel laureates Albert Schatz, who discovered streptomycin; Paul Ehrlich, whose “magic bullet” hypothesis paved the way for chemotherapy; and Joshua Lederberg, who discovered bacterial conjugation.

In remarkably readable standalone chapters, Zaman tells the story of the evolution of understanding of disease and resistance. Brigadier General George Sternberg of the U.S. Army, was an early explorer of the cause of disease from bacteria microbes in the late 1800s. He worked in the shadow of Louis Pasteur, nearly simultaneously making similar discoveries.

In September 1918, Lieutenant Governor Calvin Coolidge of Massachusetts, future president of the United States, signed a proclamation shutting down all schools, parks, theaters and other places of congregation as one hundred Bostonians a day died from the Great Influenza Pandemic of 1918 (misnamed the Spanish flu). That pandemic a century ago would kill more than 50 million people worldwide. It provides an insight into the interconnectedness of viruses and bacteria.

“While the world remembers the Spanish flu as the killer, most people didn’t actually die of the viral disease. They died of complications due to pneumonia, a bacterial infection. The flu virus weakened the immune system, providing an opportunity for the pneumonia bacteria to enter and thrive. In the absence of antibiotics to kill the bacteria, pneumonia proved to be a death sentence.”

Fast forward to post-World War II, and the Navy’s Lt. King K. Holmes, an intrepid and fearless scientist, who served with the Public Health Service Commissioned Corps.

A task group of nuclear-powered surface ships operates in formation in the Mediterranean Sea, June 18, 1964. The ships are the aircraft carrier Enterprise (CVAN-65), left; the guided-missile cruiser Long Beach (CGN-9), center; and the guided-missile frigate Bainbridge (DLGN-25), right. (Naval History and Heritage Command)

Holmes served aboard USS Enterprise (CVN-65) and did research in Pearl Harbor, Hawaii, and Subic Bay, Philippines, during the Cold War and in the middle of the Vietnam War.

“So during the war, Holmes was stationed on the USS Enterprise, a naval vessel with an illustrious past. The name has been reserved for special ships over the course of U.S, History –– eight American naval vessels have been given this name, beginning with a British ship that the Americans captured in 1775. At the height of the Vietnam War, the name had been given to one of the prides of the U.S. fleet, the first-ever nuclear-powered aircraft carrier deployed in the Pacific. Holmes was assigned to the preventive medicine unit on the USS Enterprise, where the doctors encountered the problem of recurring infections among the sailors.”

Dr. King Holmes

Holmes helped write worldwide guidelines for the treatment of drug-resistant gonorrhea throughout the world. “Through his research, Holmes realized that discovering new ways to prevent the spread of infections was just as crucial as discovering new lines of antibiotics,” Zaman writes. Earlier this year Dr. King Holmes, University of Washington’s Director of Research and Faculty Development and inaugural Chair of the UW Department of Global Health, was named Distinguished Professor Emeritus.

Not surprisingly, many discoveries in fighting disease and disease resistance came during times of war.

“Wars and infections have always accompanied each other. In the twentieth century, infecting among the wounded created a new challenge as drug-resistant infections became a serious issue for the patients and the army medics. These resistant infections were seen by Cutler in the battlefields of Europe during World War II, were investigated by Holmes during the Vietnam War, and had now appeared in their nastiest form during the Gulf War. Indeed, it is one of the points of war. Unquestionably, when invading Iraq, America, like invaders from time immemorial intended to degrade the country’s ability to resist. The bombs dropped, the weapons used, were for the purpose of inflicting harm and trauma. And during occupation and enforced international isolation, the goal, again, was to inflict on Iraq harms sufficient to cause it to behave in ways more aligned with American interests.”

Acinetobacter baumannii in Iraq became known as “Iraqibacter,” first seen in field hospitals and eventually even at Walter Reed Army Medical Center. “It’s considered opportunistic because it doesn’t case a disease on its own, but if there is an existing infection –– pneumonia or an infected wound, for example –– it thrives.” Though the problem is no longer affecting military personnel, it persists within the local population, according to Zaman, a possible residue war.

“But is war the cause of resistance? Or is there just a correlation between the two? No one can do a clean experiment here to find out. The answer is unclear and perhaps always will be. And the bacteria don’t care. Causation or correlation, they are presented with circumstances and enough of them take advantage. They evolve, and evolve toward resistance. However material ascertaining blame and responsibility for the problem is (and for those suffering, having the answer would be profound), for the ever-increasing population of resistant bacteria, it is of no interest whatsoever.”

U.S. Navy Seaman Steven J. Madson, a preventive medicine technician, Task Force Al Asad, tests water from a newly functioning well aboard Al Asad Air Base, Iraq, March 3, 2015. The water sample was tested for PH levels, chlorine levels and bacteria to ensure safety of the water supply. (Cpl. Tony Simmons, USMC)

Among the dozens of heroic scientists and thinkers spotlighted in this book is German Wolfgang Witte, who developed vaccines during the Cold War and who faced down pressure from the Soviet Union and German Democratic Republic (East Germany). Witte spoke truth to power about the efficacy of vaccinations against Staphylococcus aureus infections.

“Witte also knew that the Soviets performed unethical clinical trials with its vaccines in orphanages and in prisons, where resistance to TB drugs was particularly high,” according to Zaman. Witte advanced the study of antibiotic resistance in the face of lies of an authoritarian government that tried to control its population with misinformation. Right matters. Truth counts.

Stalinist communism was decidedly anti-genetics and anti-science. Scientists and free-thinkers were persecuted and punished for telling the truth. “But, once more, bacteria don’t care. They obey no borders, harbor no national loyalty, and are always self-preserving, self-advancing, and self-replicating.”

Along the Amazon in Brazil, Dec. 6, 2017. (MC2 Andrew Brame)

“Biography of Resistance” is not only a great history and biography of inspiring scientists, it is also a travelogue throughout the world: Amazon, Mumbai, Western Australia, Mongolia, Nova Scotia, Norway, Denmark, Tokyo, Niger, and Zaman’s home country of Pakistan. Readers discover natures gifts, miracles, and dangers, including the risks of climate change and human manipulation of the food chain using antibiotics on animals.

Zaman writes this about animal-to-human epidemics and pandemics after periodic reports of avian influenza outbreaks in Asia:

“The public was afraid of new diseases jumping to humans from birds, pigs, and cattle. The Food and Agriculture Organization (FAO) saw an opportunity to make animal health and welfare part of the global debate on antibiotic resistance and became an early advocate of One Health, and so did the world Organization for Animal Health (OIE). The CDC also created a One Health office in 2009. For the next several years, pandemic preparedness became an area of focus, including surveillance, diagnostics, and containment.”

Antibiotic resistance became part of the initiative in 2015, and the world became more aware of the dangers of animal-to-human transmission of disease –– and the likelihood of pandemics –– both viral and bacterial, or both. The future depends on understanding and respecting the interconnectedness and interrelatedness of nature.

The Obama-Biden administration staffed and strengthened a pandemic response office that was virtually dissolved by the Trump-Pence administration in 2018.