Drug-resistant infections vs a change-resistant public
Edmund Stubbs, 11 December 2014
Today, the findings of a government commissioned report led by economist Jim O’Neill exploring the growing threat of drug resistant infections have been revealed. The results warn that drug resistant infections could cause 10 million global deaths annually by 2050, with a subsequent colossal impact on the world’s economy.
On a societal level, it seems that once again we are confronted by a threat arising from the limits of what biomedical science is able to achieve in health care without public involvement through behavioural and lifestyle change.
In a similar way to affluent western lifestyles leading to increases in non-communicable diseases, our unthinking over use of antimicrobials (due to a lack of easily available information as well as a frequent failure to finished prescribed courses of treatment) has made a sizeable contribution to the enhanced drug resistance of many pathogens, especially bacteria, the results of which we are now beginning to experience.
It is inevitable and to be expected that some drug resistance will occur. For example, the selective effects of antibiotic therapy on the many millions of bacteria present in our bodies during an infection means wholly resistant bacteria will remain, and that, after less resistant strains have been destroyed, they will survive to be transmitted to another individual. However, partly resistant bacteria might simply require more lengthy treatment to be eradicated. It is for this reason that patients need to persevere with their course of antibiotics long after symptoms have disappeared.
It is not widely known that antibiotics and other antimicrobials are commonly added to animal feed in intensive farming. Concerns arise from this with regard to the effect this is having on the increased resistance of the pathogens they are intended to destroy. All classes of antibiotics are being so used, making each class gradually less effective, with obvious repercussions on their effectiveness for treating human disease. We may need to consider further limits on antimicrobial animal feeds to protect both humans and animals in the long term.
Once again it appears that policy makers have avoided the tough decisions necessary to shift the emphasis of health care to meet 21st century conditions. Transferring funding from “damage repair” medical services to preventative and improved public health is not a priority for governments with only a 4-5 year mandate and wishing to be reelected. Similarly, tackling public expectations by limiting antibiotic use to the treatment of severe cases and vulnerable groups could make a government unpopular in the short term.
O’Neill’s report emphasises that efforts to stem the progression of antibiotic resistance make long term economic sense. However, as observed in the case of preventative health initiatives, this by no means equates to the rapid implementation of restrictions by policy makers.
Professor Tim Dyson of the LSE draws a parallel between the over use of antibiotics and the issues of climate change and combatting the spread of the AIDS virus. Where people are confronted with difficult global issues requiring radical behavioural changes there is usually a period of denial and an avoidance of taking action until the consequences of not doing so become increasingly threatening. There then follows a period when different groups blame each other for inaction before finally, a stage may be reached where restorative measures are taken. Worryingly, in relation to tackling the drug resistance problem, I fear we are still at an early stage in this social process.
Edmund Stubbs, Healthcare Researcher, Civitas
The idea that bacterial immunity to antibiotics can be meaningfully prevented by restricting their use is a pipe dream because all countries would have to agree to such a regime and enforce it.
In many countries, including a good number in Europe, antibiotics do not require a prescription and they can be purchased as easily as a pack of aspirin in Britain. If one country or even a group of first world countries, say 15, were to restrict antibiotic use it would make no difference because bacteria know no boundaries. Eventually, bacteria with immunity would take as hosts those whose countries who had restricted the use of antibiotics.
The other fly in the ointment is the widespread use of antibiotics in animal husbandry. When animal products from such animals are eaten they will pass on small but significant amounts of antibiotics. That will over time will build antibiotic resistance.
In both the case of restricting direct antibiotics to humans and their indirect transmission through animal products there is zero chance of getting global agreement to restrict their use and to enforce the restriction. Therefore, it is pointless to try to restrict their use. Therefore, it is pointless to even discuss such measures.
What should be done? Governments need to initiate a large and perpetual publicly funded programme of research to firstly constantly search for new antibiotics and secondly to examine new approaches to attacking infections. If it is left the Big Pharma insufficient will be done by way of research.