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In the fight against the superbug apocalypse, don’t fall for the idea that infectious diseases only happen somewhere else

With antibiotics’ power on the wane, infectious diseases are increasingly hard to combat. And it is much more than just a third world problem, writes Siouxsie Wiles

Every week they gather. In church halls and bowling clubs, community centres and rest homes. U3A. Probus. Lions. Rotary. Zonta. Groups of people, often retired, meeting to hear an interesting speaker and drink cups of tea, or have dinner together. I’ve found myself on their speaking circuit, regularly asked to talk about my specialist subject: infectious diseases. My talk is called: “Is this the end of the golden age of antibiotics?” The extremely short version is “Yes”.

The slightly longer version of my talk goes something like follows. Antibiotic-resistant superbugs are on the rise all around the world, and we are running out of medicines to kill these superbugs. Most of the pharmaceutical industry pulled out of antibiotics research decades ago, so the medicine cupboard is basically empty. Experts predict that within the next 5-10 years we could see a return to the pre-antibiotic era, when a stubbed toe could mean amputation or death.

After I’ve finished my talk, there is usually a very brief pause and then the questions start. And one in particular keeps coming up, again and again. In essence it goes something like this: if we could just stop all the foreigners immigrating to New Zealand, wouldn’t that solve our problems with infectious diseases? A classic “it’s not us, it’s them” kind of thinking. What’s revealed is an island mentality that believes infectious diseases are a problem created outside of New Zealand and imported here by “foreigners”. How can I put this politely?! I think you’ll find it’s a little more complicated than that!

A stylised scanning electron microscopic image of mycobacterium tuberculosis. This bacterium causes most cases of tuberculosis.

A stylised scanning electron microscopic image of mycobacterium tuberculosis

The phrase “infectious diseases” describes a multitude of life forms which differ in their genetic make-up, life-styles and habitats. These invisible microbes are the most abundant life form on the planet. They lurk, hidden and unseen, up our noses and in our guts. In the noses and guts of our pets and livestock. In our rivers and soils. All over the world. It’s true, some antibiotic-resistant superbugs have been “bred” overseas, especially in countries were antibiotics are available over the counter without prescription. And yes, they can be “imported” into New Zealand by “foreigners”.

But guess who also goes overseas? We do. In droves. According to Statistics New Zealand, in 2014 there were more than 700,000 overseas departures from Auckland Airport by resident New Zealanders going on holiday. Another 600,000 were going to visit friends and relatives overseas. As an island nation, we travel a lot. And each of those trips is an opportunity to bring back an invisible infectious passenger. So, unless you never want to go on holiday again, or visit friends and family overseas, let’s nip that line of thinking in the bud.

new_zealand_resident_traveller_departures_from_k1

I want to tell you a story about something that happened after one of my community talks, and it hints at the stigma attached to infectious diseases. That somehow being infected by an invisible invader is “dirty”. I was talking about the lung disease tuberculosis (TB). It’s a fascinating disease, one that used to be quite sexy back before antibiotics were discovered and TB was thought to be hereditary. TB, or consumption as it was known back then, was the original heroin chic. People wasted away gracefully, before eventually coughing themselves to a bloody death as the TB microbe destroyed their lungs. Now we know it’s an infectious disease, spread through the air by breathing in as few as of the invisible TB bacteria. Each year, there are about 300 cases of infectious TB in New Zealand. After a session speaking to a group of retired wealthy Pākehā women, a member of the audience came up and quietly whispered to me that she had recently been one of those 300. I’ll never forget what she said next: “I was horrified when my doctor told me. People like me don’t get TB!”. Just to be clear, if you are human and breathing, you can get TB.

New Zealand – we’re not immune. The reality is, we don’t need travel or foreigners to bring infectious diseases and antibiotic-resistant superbugs to our Clean Green/100% Pure(TM) island paradise. And before anyone starts thinking infectious diseases are just related to poverty (another variant of “it’s not us, it’s them”), they are not. Yes, we have bugs that cause nasty skin and soft tissue infections predominantly in poor kids. But we also have versions of those very same bugs that circulate amongst the wealthy Pākehā living in rest homes.

As I said before, it’s complicated. It turns out we have higher rates of many infectious diseases than similar countries like the US, Australia and the UK. And our rates are rising. Currently, one in four admissions to our hospitals that involve an overnight stay are because of infectious diseases. Those admissions have risen by 50% over the last two decades. To put that in perspective, overnight hospital admissions related to non-infectious diseases have risen by 7% over the same time.

It gets worse. Because antibiotics are also used to prevent infection, a world without antibiotics also means a world in which it becomes life threateningly risky to do routine operations like caesarean sections and joint replacements, and treatments like chemotherapy for cancer. Margaret Chan, Director-General of the World Health Organization, called this “the end of modern medicine as we know it”. In a series of reports (PDF) commissioned by former UK Prime Minister David Cameron, economist Sir Jim O’Neill has estimated that without urgent action, antimicrobial resistance will kill 10 million people a year by 2050, more than will die from cancer. O’Neill has also put an economic cost on the issue, estimating that inaction will cost the world’s economy 100 trillion USD by 2050.

hospitalisations_caused_by_infectious_diseases_in_new_zealand

So, to sum up. Not only are infectious diseases becoming more widespread here, they are also becoming more difficult to treat. It’s time we stopped thinking of infectious diseases as a third world problem, and have a national conversation about how we all, the public, health workers, policymakers and the agricultural sector, can solve this crisis. At my University of Auckland lab, I’m collaborating with my chemistry colleague Associate Professor Brent Copp and Landcare Research fungi expert Dr Bevan Weir to look for new antibiotic leads. With support from Cure Kids and the Maurice Wilkins Centre for Molecular Biodiscovery, we’re using superbugs we’ve engineered to glow in the dark to test a freezer-full of New Zealand fungi to see if they produce novel antibiotics. As an aside, if you are looking for a present for the person who has everything, how about sponsoring one of the 10,000 fungi we have to test?!

Dr Siouxsie Wiles is Deputy Director, Education and Outreach, of Te Pūnaha Matatini, a Centre of Research Excellence. She describes herself as a microbiologist and bioluminescence enthusiast. Head of the Bioluminescent Superbugs Lab at the University of Auckland, Siouxsie combines her twin passions to understand infectious diseases.

All this week Te Pūnaha Matatini are running InfectedNZ, bringing together leading health, social and economic researchers, and people with personal stories, to write about infectious diseases and what we’re going to do about the looming antimicrobial Armageddon. Follow their blogs here and join the conversation with #infectedNZ. Backing it all up, wherever possible, is data from Figure.NZ. Their charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.


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