At the time of the SARS-Coronavirus-2 pandemic, all my invitations to give lectures, talks, scientific meetings or international congresses were cancelled.

Only virtual communication and thinking about phages remained instead of audiences. Phages are my great concern.

Instead, a book was created, in style, structure and illustrations like the lectures. It combines prior knowledge, for scientists, medical doctors, to Rotary clubs and concerned lay people. Above all, like a lecture, this book is aimed at students, many of whom wanted to start researching and helping people right away.

This is not about the viruses of infectious diseases, not about the100 million deaths from the Spanish flu (1918), the forgotten Hong Kong flu (1968), or the swine flu (2009), all triggered by influenza viruses that kill up to 650000 people worldwide every year and recur as pandemics about every 40 years. We are not talking about Corona, HIV/AIDS, Ebola, or Zika viruses. This is about the viruses of bacteria, and they have their own name, phages or bacteriophages: that is, bacteria eaters.

Viruses are of much more general importance to our world, our ecosystem, our evolution, even our genetic makeup. They may even have been involved in the origin of life. Viruses are parts of the microbiome, the totality of microorganisms, for 3.8 billion years on our planet. They are the most successful species. For there are about 10³³ virus particles on the Earth, many of them in the oceans. Almost all of them are harmless. Bacteria, their hosts, are almost as numerous.

Phages multiply in bacteria – and can dissolve them. While this is a natural process, it can be exploited. Bacteria, especially multi-drug-resistant bacteria against which antibiotics are ineffective, are becoming a global threat to humanity. Antibiotic-resistant bacteria, the superbugs, catch up with us in hospitals, while traveling, in rivers, in the air or in food. They often end in deadly sepsis. The development of new antibiotics has come to a standstill. Last-resort antibiotics are failing with increasing frequency. 700000 people die from multi-drug-resistant bacteria every year worldwide and are expected to be the number one cause of death with ten million fatalities at the latest in 2050.

Phage researchers keep stressing the motto: “The enemy of our enemy is our friend”. We  should be allies of phages against resistant bacteria.

We need phages at least as interim solutions. Until we get new more antibiotics – which may take long, too long. So, in between the phages may help to fill a gap. Yet, for their use we need personalized treatment and have to overcome bureaucratic obstacles first!

A 100-year-old method is the treatment of bacterial infections by phage therapy. We need to revive it, characterize phages, store them in phage banks, simplify applications, organize production and supply chains and free them from high regulatory burdens. Only then can we find out what phages really will be able to do, whether they will save us – at least as emergency solutions and as a way out of the ongoing antibiotics crisis – until new antibiotics become available.

This book provides clues on what we know and what we should learn and achieve – but also shows how difficult the path is. Several case reports illustrate, how much effort is needed to apply phage therapy, each case is special and personalized medicine. Very recently a new and exciting focus of research has opened up, the role of gut microbiome and phages in cancer immunotherapy. Can one simplify the therapy, standardize it, speed treatments up? Can phages or components thereof be supplied as pills? Combined with new antibiotics? We need new and more antibiotics anyway and then in combination with phages. These are questions presented to the reader waiting for answers.

To avoid a misunderstanding; I am not discussing “alternative medicine” or “complementary medicine” which is not based on science or evidence, not testable or not tested. What is described here is an almost forgotten approach to use viruses for cure.

Perhaps the SARS coronavirus-2 pandemic is a frontrunner, which shows what is possible when things have to happen fast.

It must go fast!

Prof. em. Prof. h. c. Dr. Karin Moelling is a virus and cancer researcher. After studying physics and graduating in astrophysics, she turned to molecular biology and retroviruses in 1969 with a scholarship from the Study Foundation in Berkeley, California, USA. She spent 20 years researching viral cancer genes and HIV/AIDS at the Max Planck Institute for Molecular Genetics in Berlin. She discovered a new viral gene as well as a new cancer gene. In 1993 she became Professor and Director of the Institute of Medical Virology at the University of Zurich with research, teaching and virus diagnostics for the University Hospital – including bioterrorism! She was also appointed an Honorary Professor at the Charité in Berlin. She has published over 250 original scientific peer-reviewed publications. She has published books on the “AIDS Virus”, as well as “Viren – Supermacht des Lebens” (German) and “Viruses – more Friends than Foes” (English) with up-to-date information on Corona viruses. It has been translated into English, Russian and Chinese. Karin Moelling was a Fellow at the Institute for Advanced Study at Berlin and visitor at Princeton, and has received numerous awards such as the German Cross of Merit (2018) and the Swiss Award for “Society” (2007).