Illuminating the history and global story of antibiotics

When Rijul Kochhar arrived at MIT to begin his PhD studies, he was already certain about what he wanted to study. Coming from Delhi, where he earned master's and undergraduate degrees and had taught at the Delhi School of Economics, he was eager to begin doctoral studies in MIT’s multidisciplinary program in History/Anthropology/Science, Technology, and Society (HASTS).

Now on track to complete his PhD, Kochhar has been conducting ethnographic and historical research on the global story of antibiotic resistance over the last seven years. He has been especially interested in tracking how antibiotics have, gradually and globally, lost their efficacy over time, and what the consequences of this phenomenon portend for the contemporary world. The “finite but miraculous” life of antibiotics, as Kochhar phrases it, has had a good run for three-quarters of a century in the history of science. But what happens when their protection begins to fray?

Kochhar’s journey is also one of examining the nature of scientific thought as it transforms over many decades and centuries. The spirit that guides such exploration and discovery is central to his own philosophy in the classroom: pursuing greater understanding with inquisitiveness and openness in the face of new ideas.

Changing medical and microbial realities

Antibiotics play a fundamental role as infrastructures of modern human society. From food production to health care to biosecurity, antibiotics are integral to how we live. “Mass meat production, for instance, has depended heavily on the use of antibiotics in avian livestock and cattle,” explains Kochhar. “To provide animal proteins to human populations at the scale we’ve come to expect has required the use of antibiotics at scale. Now we’re dealing with the legacies of that chemical regime.”

Kochhar has been on the ground, doing fieldwork on this topic for over a decade. “Antibiotics are increasingly losing efficacy — less than a century after their development and mass deployment in human society. My job as an anthropologist is to track the ruination of antibiotics in cultural life, and to examine what is being done by various players who are involved in the story at this juncture — whether they are doctors, scientists, biosecurity regulators, or patients. What does it mean to live in this time?”

For Kochhar, part of the answer to that question is structural change in medicine and science: resurrecting neglected — but successful — techniques of the past in order to help control bacterial life in the present.  

His work extends over three continents, with research in India, the United States, and the former Soviet Republic of Georgia, each of which present distinctive-yet-connected evidence regarding how the crisis of antibiotics is articulated and grappled with.

In Georgia specifically, he has been interested in an alternative to antibiotics called phage therapy, which uses bacteriophages — ecologically abundant viruses that infect bacteria — to create a desirable bacterial ecosystem. That is to say, phages are found alongside bacteria, controlling bacterial populations via a predatory but balanced relationship.

This cycle of bacterial culling and rebirth takes place on a grand scale around us continually. “Every day nearly 40 percent of the Earth’s oceanic bacterial cells are killed off by bacteriophages,” Kochhar notes, “and then bacterial life repopulates the Earth’s biosphere — every day!”

Why aren’t phages more widely used in biomedical treatments now? The answer is tangled in human political history. According to Kochhar, phages have had a “split life” in Western versus Soviet settings. In the West, they have tended to be used as model organisms to conduct basic biological research (for example, playing instrumental roles in the decoding of the genetic code). In the Soviet Union, on the other hand, they were accepted as therapeutic agents to combat bacterial infections.

Antibiotics, a product of World War II, became dominant in the West, where they could be produced at scale and deployed much more easily than phages. However, antibiotics lacked the precision of phages. Antibiotics clear bacterial life writ large, a broad and clunky weapon that nonetheless has remained necessary and popular for decades. Of course, times have changed, and modern science now tells us that not all bacteria are harmful. Today’s scholarship also tells us that killing off bacteria indiscriminately can produce problems of their own. This is where research on phages as precision antimicrobials is generating widespread interest.

No prepackaged facts

The nature of scientific research — in addition to the science itself — has opened new vistas for Kochhar as a historically minded anthropologist. “We have long imagined that we live in a unique time when the scientific community is connected across the globe,” he reflects. “But there is evidence that exactly that kind of collaborative work across continents took place through the late 19th and early 20th century — without the internet. You can track that kind of scientific influence, culture, and collaborations all the way back to the Enlightenment, if not earlier, as well as to conversations amongst scientific audiences and subjects during the heyday of planetary-scale colonial enterprises."

"It is exactly this kind of interaction — forged in colonial encounters and within a matrix of scientific rationality and religious belief — that I’ve been exploring in India," Kochhar says. "In order to understand the contexts in which bacteriophage discovery takes place means to chart the complex conditions in which knowledge emerges, and is transmitted transnationally. How does that history, further, influence the cultural uptake of antibiotics and phages today?”

One illuminating truth that Kochhar returns to again and again in his research is that there are sociocultural processes through which prepackaged, fundamental facts are made to appear as stable. “I often find that facts are actually constructed through the labors of many people, on many continents. We have respect for scientific work and fact, but it’s not only because such research is a means to an end. It’s also because it reveals human collaborations across time and space," he says.

“When teaching, I remind my students, who are budding scientists at MIT, of exactly that point; whatever their discipline might be, it’s important to think about the factual architecture of that knowledge domain. What is its foundation? Where do the nuggets of reliable, factual, trusted knowledge emerge from? Who are the players, and who are the players who aren’t awarded status in the process?”

The future of phages

Kochhar is not only concerned with the history of bacteriophages but their future as well, in the face of decreasing antibiotic efficacy. Phages as therapeutic agents are now reemerging in the West, but only under a “compassionate use” regulatory policy. Yet here, too, worldly dynamics impinge on the process. For example, in the United States, insurance companies typically do not cover such lifesaving treatments — a disjuncture that reflects both wider inequities in the health care system, as well as emerging mechanisms of research and funding that are fundamentally altering how future biomedical advances will be brought to the public.

At MIT, Kochhar is positioned at an epicenter for advances in phage technology. Work on phages as precision antimicrobials is occurring at many places within MIT, including research that might potentially lead to a therapeutic option for biotech startups.

Additionally, bacteriophages are centrally connected to the story of CRISPR. Bacteria deploy an adaptive immune system each time bacteriophages attempt to infect them. “If that mechanism of defense can be used in the lab, scientists — including at MIT and the Broad Institute, as well as in California and elsewhere — have been able to find a mechanism to edit the human genome. CRISPR and other forms of such emergent biotechnologies are founded precisely on that relationship that bacteria and viruses share and emerge from a history of scientific work that is much older, and much more complex, than initially meets the eye.”

A historian’s sensibility, an anthropologist’s gumption

When Covid-19 began to unfold around the world in early 2020, Kochhar was faced with the test of many research hypotheses that he had had in the works for years beforehand: pathogens do not acknowledge or obey national boundaries, and yet the human responses to the health crisis were still framed nation-by-nation. Like other planetary crises, including climate change and antibiotic resistance, Covid-19 highlighted how thinking in terms of national boundaries — rather than in terms of planetary ecologies — often falls short in adequately addressing urgent global challenges.

In the course of his academic journey, Kochhar has learned to navigate the roles of student and teacher. “When I first arrived at MIT as a graduate student, I found myself in this liminal space. I was not an undergraduate, nor was I a faculty member. As a graduate student, I had to get comfortable with the idea that I was someone who was in training, a sort of an academic apprentice. Now as I prepare to graduate from MIT’s HASTS program, I have come to value life in this liminal space, one that afforded me a dizzying array of research opportunities and the luxury of constant curiosity.” Such curiosity, Kochhar says, is ultimately vital to giving spirit and purpose to the pursuit of academic work in an imperiled world.

Story prepared by MIT SHASS Communications
Editorial and Design Director: Emily Hiestand
Senior Communications Associate: Alison Lanier
Source: web.mit.edu

Illuminating the history and global story of antibiotics