MEDICINE IS ONE of the few goods that we think of as universal across all cultures. The World Health Organization maintains a list of what it deems essential medicines — the absolute basics for a functioning health-care system — that every country should have. No matter what nation you may reside in, for example, ibuprofen is widely available and is deemed safe for most patients. Atropine is used as an antidote for pesticide poisonings around the world. Medicine may have a few qualities of an art, but the field is still a science. Nevertheless, there are historical exceptions to the standardization of treatment and access to pharmaceutical drugs all over the world. Throughout the new book Cold War Resistance: The International Struggle over Antibiotics, Marc Landas demonstrates how antibiotics are a prime example of this phenomenon.

Landas gives an extremely detailed history of antibiotics and their discoveries in the years leading up to and during World War II. Some of this detail is quite excessive (more than 40 pages are dedicated to explaining the difficulty a British scientist had in securing funding for the production of penicillin, which was then newly discovered) and dreary. It is an important part of the story, but it takes quite some time for Landas to build the narrative and thesis. Fortunately, his thesis is an important one. Landas demonstrates how antibiotics became a political tool during the Cold War and how the American policy of restricting (and sometimes blocking) the export and production of antibiotics throughout most of the Cold War led to the creation of one of the world’s biggest public health crises: antibiotic-resistant bacteria.

Some of the fiascoes that created antibiotic-resistant bacteria were simply caused by scientific miscalculations and errors: pharmacologists and other scientists tended to pursue “broad-spectrum” antibiotics that killed a wide range of bacteria, rather than a specific bacteria that was causing a patient’s illness. Still, by the 1970s, scientists had quite a lot of evidence that new hard-to-kill bacterial infections were largely being caused by an American policy on antibiotics rooted in nationalism rather than global public health. Although many Western nations had some amount of antibiotic production capability in the aftermath of World War II, mass production was only occurring in the United States. The Soviet Union, in need of antibiotics, attempted purchase of the necessary equipment. Much of that necessary equipment, however, was American. The United States had no interest in selling this kind of equipment to the Soviet Union. Large-scale production of antibiotics was outside of Soviet capabilities, and what little antibiotics were produced had variable efficacy and quality. When those antibiotics were given to patients, the bacteria was simply wounded, ready to mutate into something stronger.

To some nations, however, antibiotics were nothing more than a product to be bought and sold. Just a few years after Mao Zedong ejected Chiang Kai-shek and his army out of mainland China, Britain was selling his government antibiotics through Hong Kong. This wasn’t motivated by humanitarian concerns. While British production of antibiotics was small compared to the United States, it was still profitable to secretly sell it to China. Britain’s pharmaceutical industry grew significantly. Profits, apparently, mattered far more to them than following any American guidelines about the proliferation of antibiotics.

Landas’s book is timely in the COVID-19 era, not just because it shows how much control pathogens have over our lives but also because it shows how every country on earth will suffer in some way if an antimicrobial drug isn’t accessible to everyone. Science became politicized: the Soviet Union rejected “Western” conceptions such as Mendelian genetics; instead, they embraced quack theories of Lysenkoism — a syncretic theory in biology that rejected the use of statistical analysis and denied the link between genes and heredity. The United States, meanwhile, rejected the Soviet discovery of bacteriophages, a type of virus that acts as a parasite on bacteria. While they weren’t always practical, they did have a serious clinical use, and Soviet scientists had the evidence and data to back it up. The United States and the rest of the Western world, however, never studied bacteriophages or ran clinical trials; to do so was to admit that “communist” scientists had maybe discovered something that we did not.

Medicine was not just politicized but also weaponized in the Cold War era. A desire to retain superpower status led the United States toward overdependence on antibiotics in factory farming and limitations on the number of antibiotics available in unfriendly countries. Yet pathogens cannot be entirely tamed by human beings. They have no respect for nationality, borders, or multicountry alliances. Hospital-acquired infections, almost always caused by antibiotic-resistant bacteria, sprung up everywhere.

These shortsighted policies had consequences for the entire world, but the lessons went unlearned. “Medical nationalism” is already the defining policy of the COVID-19 pandemic. China sees an opportunity to expand their influence with a vaccine. Major powers fret that their research will be stolen. As multiple vaccines begin to be approved across the world, we will likely see governments using a vaccine as a tool for expanding their geopolitical influence. Governments will do anything to get their hands on the vaccine.

Landas exposes the nationalist medical policies that created the antibiotic-resistant bacteria that is becoming more common every year. The world should hope that when it comes to the current pestilence, we put global public health above the urge for power. Otherwise, it is only a matter of time before some sort of pathogen, viral or bacterial, kills us all.


Nicholas Greyson Ward is a journalist and writer based in Modesto, California. You can follow him on Twitter @ngward94.