Biofilms — the hidden pandemic nobody is talking about

When COVID emerged, the world quickly learnt the importance of viruses. When antimicrobial resistance became a global concern, governments, healthcare systems and industry began paying attention to bacteria. Yet there remains another microbial threat hiding in plain sight — one that costs the global economy trillions of dollars every year, contributes to chronic infections, delays wound healing, damages industrial infrastructure and protects bacteria from some of our most powerful antimicrobial tools.

That threat is biofilm.

The popular model of bacteria is wrong

We're taught to picture bacteria as individual organisms floating around waiting to be killed by antibiotics or disinfectants. In reality, that free-floating (planktonic) state is often temporary. When bacteria find a suitable surface they attach, then produce a sticky protective matrix made up of sugars, proteins, DNA and other biological materials. That structure is a biofilm.

Inside a biofilm, bacteria behave very differently. They form organised communities, communicate, exchange genetic information, share nutrients and protect one another. I think of a biofilm as the bacterial equivalent of a fortified city — once that city is built it becomes incredibly difficult to break down, and the bacteria inside are far more tolerant to antimicrobials than they would be in their free-floating state.

Not just a healthcare issue

Biofilms are a major industrial problem. They form inside pipework, water systems, tanks, heat exchangers, food-processing equipment, pharmaceutical manufacturing environments and marine infrastructure. They contribute to contamination events, reduced efficiency, equipment failure, corrosion, product losses and costly downtime. Globally, the economic burden associated with biofilms has been estimated at over $4 trillion annually.

The healthcare cost is even more serious

Chronic wounds already represent one of the fastest-growing healthcare challenges globally, affecting more than 40 million people worldwide. Research suggests that approximately 78% of chronic wounds contain biofilm, with some experts believing the figure is even higher in hard-to-heal wounds. When a wound looks clean but stubbornly refuses to heal, biofilm is a strong suspect.

Biofilm hides in plain sight. A wound may not look dramatically infected, yet bacteria sit protected within a matrix that blocks normal healing. The immune system recognises the problem but struggles to clear it. Antimicrobial treatments may reduce some bacterial activity but fail to fully disrupt the structure. The result is a wound trapped in a cycle of inflammation, tissue damage and delayed healing — and even after debridement, biofilm can begin reforming within hours.

The trend lines are bad

• Populations are ageing.
• Diabetes is increasing — projected to affect ~783 million adults globally by 2045.
• Obesity and vascular disease remain major risk factors for chronic wounds.
• Antimicrobial resistance continues to accelerate.

Many of these patients will be at increased risk of chronic wounds, and many of those wounds will involve biofilm. This is a perfect storm for healthcare systems that are already under pressure.

Why MGO-rich Manuka still matters

This is one of the reasons I remain so interested in Manuka honey and in particular methylglyoxal (MGO). Manuka is different from most honeys because much of its antimicrobial activity is linked to naturally occurring MGO, and research has demonstrated MGO has antibacterial and antibiofilm activity against important wound pathogens — Staphylococcus aureus, MRSA and Pseudomonas aeruginosa.

What makes Manuka particularly interesting is that it doesn't rely on one mechanism. Low pH, osmotic activity, a complex phytochemical profile and MGO content create multiple simultaneous stresses on microorganisms — it attacks the problem from several directions at once. That may help explain why meaningful bacterial resistance to Manuka honey has remained uncommon despite decades of clinical use.

Biofilm management won't be solved by one silver bullet. It will require better understanding of biofilm behaviour, more effective disruption of the protective matrix, appropriate debridement, good clinical practice and technologies that help prevent biofilm re-establishing between treatment cycles. That's where MGO-rich Manuka honey continues to have a role.

Something new on the horizon

Over my career I've reviewed many antimicrobial technologies and product claims. Most are interesting, but very few make me stop and think. Recently, however, I've become aware of a patent-pending technology currently under development that is demonstrating highly impressive antibiofilm activity in laboratory testing. I can't discuss the details at this stage, but it is one of the most exciting developments I've seen in many years — and if the early findings translate into practical applications, the implications could extend far beyond wound care, into medical devices, industrial manufacturing, water systems, food production and pharmaceutical environments.

Biofilms are not tomorrow's problem. They are today's problem. They are already impacting healthcare, industry, infrastructure and global economies. Most people still don't know they exist — and that may be the most concerning fact of all.

First published on LinkedIn. See also our biofilm + MGO evidence roundup and what medical grade honey actually means.