Re 1) It is useful to keep exploring other means of treatment because at some point you won't have antibiotics left. You want a secondary method that can be deployed instantly once the primary fails. Currently cryptographs are developing Quantum-Computer-resistant cryptographic algorithms not because there is a quantum computer that can crack RSA but because a quantum computer that can is in the not to distant future and if it exists then we need immediate replacement.
Re 2) I don't think that would be a problem considering together with 1 there will simply be a need to develop a quick but reliable method to test for which collection of phages work, probably even develop cocktails of phages for a more broad application. Reducing the amount of antibiotics used would also help reduce the risk of the broad spectrum antibiotic failing because of resistant bacteria.
3) Phages are living things depending on who you ask. Phages are rather simple and will to my knowledge remain viable for a good and long time. Antibiotics may be inert but also have an expiration date, you can't just use an 60yo antibiotic and hope that works. At some point the contents of the antibiotic will have broken down and oxidized.
4)Fair but apparently people have been using it in the Eastern Block for a while with some success. There are some shoulders to stand on and continue R&D.
On 1) I agree, but it's a hard ask in the face of antibiotics being markedly superior as treatments. Because it's not really "a secondary method if the primary fails" (that would be a 2nd class of antibiotics) it's an entirely different paradigm, and one that works less well on the ground.
2) "There will simply be a need to develop a quick but reliable method to test..." is a really big ask. We don't have quick but reliable tests for some common human pathogens. You can't simply posit that a great test will work. You're right about antibiotic stewardship, which is something I work on, but that's orthogonal to how good phage are as a clinical treatment.
3) While yes, in some particularly strict senses they're not alive, the actual point of that is there's currently no phage preparation technique that is not extremely lab intensive at the site of treatment.
4) Agreed - and the Russians and Georgians have some really cool work, but even there, it's for what are, clinically, extremely difficult edge cases, rather than the kinds of things antibiotics are routinely used for.
1) It's a lot cheaper to have antibiotics properly regulated and conservatively prescribed. That's how Norway still manages to do just fine with Penicillin in majority of cases. Voila, no need for phages.
4) USSR jumped onto antibiotics as soon as they were available, and hasn't really looked back.
1) Can you get the industrialized farm lobbies on board with this? How about 3rd world rural clinics? How about 3rd world farmers using powerful antibiotics of last resort to make animals get a little bigger?
Successfully regulating antibiotics is a worldwide effort. I'm not confident we'll ever be more than moderately successful at that.
If that was easy that would obviously been done by now. Doesn't mean the alternatives (like phage libraries in "3rd world rural clinics") are more realistic.
Proper antibiotics circulation is a policy problem; phage therapy is scientific, technological and policy problem.
Re 2) I don't think that would be a problem considering together with 1 there will simply be a need to develop a quick but reliable method to test for which collection of phages work, probably even develop cocktails of phages for a more broad application. Reducing the amount of antibiotics used would also help reduce the risk of the broad spectrum antibiotic failing because of resistant bacteria.
3) Phages are living things depending on who you ask. Phages are rather simple and will to my knowledge remain viable for a good and long time. Antibiotics may be inert but also have an expiration date, you can't just use an 60yo antibiotic and hope that works. At some point the contents of the antibiotic will have broken down and oxidized.
4)Fair but apparently people have been using it in the Eastern Block for a while with some success. There are some shoulders to stand on and continue R&D.