In the city of Tbilisi, Georgia, prescribing patients a vial of yellow liquid, thick with trillions of viruses, is as common as prescribing a packet of antibiotics. In pharmacies, you can buy a virus-infused creams or mouthwash to gargle with. And in several clinics in the city, more serious or chronic bacterial infections are treated with injections of viruses directly into wounds or intravenously.
The viruses are very different to the ones that infect and kill humans. They are bacteriophages, naturally occurring viruses that infect and kill bacteria.
Surprisingly, bacteriophages – often called simply ‘phages’ – were first used in medicine over a hundred years ago, decades before modern antibiotics like penicillin were available. For a few decades, they were manufactured and sold in countries all over the world, including in Britain.
But with the arrival of antibiotics, the idea fell out of favour. Phages were difficult to use and temperamental. Unlike antibiotics, which can treat a broad range of bacterial infections, phages are highly specific in which bacteria they choose to infect.
However, in the former Soviet Union, where the new antibiotics were not always available, the idea of using phages continued to flourish. Thousands of litres of phages were brewed every year in industrial facilities in Soviet Georgia to be distributed across the Soviet empire, and phages were instrumental in helping Soviet soldiers repel infectious diseases during WWII.
In the West, our reliance on antibiotics grew, and the idea of using phages became seen as old-fashioned and backwards. As relations between east and west broke down after the Second World War, few knew that phage therapy was still being used and refined in the Soviet world. It was only in the 1990s, after the fall of the USSR, that western scientists first saw the giant phage manufacturing operations and specialist phage therapy clinics in places like Tbilisi.
Fast forward to the 2020s, and the number of people dying or becoming seriously ill because of antibiotic-resistant infections is now in the millions. Minor infections are becoming harder to treat, and some bacterial strains are resistant to every type of antibiotic in our arsenal. New approaches are desperately needed. And so the idea of using phages is being taken very seriously once again.
While much of the data from Russia and Georgia is not of a standard we can use to licence these treatments in the UK, an ever-increasing number of compassionate use cases of phage therapy in the UK and US is strengthening the body of evidence for phage therapy. Dozens of clinical trials are now underway in Europe and the US, and dozens of private biotech and pharma companies are exploring new phage-based technologies that will make them easier to use medicinally. Small pilots of phage therapy are now being trialled in the NHS.
For the past two weeks phage therapy has been on dozens of radio programmes, print articles and podcasts following the publication of my book The Good Virus, which has brought the amazing story of how phages can be used in medicine to a new audience.
This year, the NHS also appointed its first clinical phage specialist, and the House of Commons Science and Technology Select Committee launched an inquiry into the use of phages in the fight against antimicrobial resistance. Networks such as phage.directory are helping connect patients who have a referral from their doctors to the increasing number of experts and clinics offering this old but experimental treatment.
It all means that despite over a century of false starts, phage therapy could soon be available in mainstream healthcare systems, including the NHS. And who knows, maybe in the future, we’ll be prescribing little vials of viruses instead of pills to patients here in the UK too.
Tom Ireland is a former GP reporter and author of The Good Virus, published by Hodder and Stoughton