As we approach two years since the world was turned upside down by the Covid-19 virus, Siouxsie Wiles and Toby Morris explain a related and very serious threat – antimicrobial resistance.
Each year in November, the WHO-backed campaign World Antimicrobial Awareness Week aims to make more people aware of the global threat that is antimicrobial resistance and to encourage everyone to use antimicrobials more wisely.
This isn’t a new issue. In fact, it’s almost five years to the day since I first wrote about it for the Spinoff. My piece was part of a week-long Te Pūnaha Matatini-backed campaign called InfectedNZ where I asked lots of experts from all around Aotearoa New Zealand to write about the issue from different perspectives.
Dr Jonathan Skinner, a paediatric cardiologist, wrote about what would happen to children’s heart surgery without effective antibiotics. Dr Anita Muthukaruppan and Professor Andrew Shelling wrote about infectious diseases and infertility. And Tiff Mora wrote about what it’s like living with the superbug MRSA. Her incredible daughter and one of my heroes, Eva, was born with a hole in her diaphragm and has battled MRSA infections many times. So much so that Tiff can smell when the superbug is back.
In December 2016, a month after InfectedNZ, I started writing my book Antibiotic resistance: the end of modern medicine?, which was published in early 2017 and has just been reprinted. Things haven’t improved much in the intervening years. In fact, I think it’s safe to say the pandemic has just exacerbated the problem.
What are antimicrobials?
Antimicrobials are chemicals that kill or stop the growth of microbes. They are used to treat and prevent infections in humans, animals and plants. Microbes is the generic term for a multitude of life forms, including bacteria, fungi, parasites and viruses. These all differ in what they are made of, their genetic makeup, and their lifestyles and habitats, so antimicrobials can be divided into different categories depending on what type of microbe they target.
Some antimicrobials work against all microbes, but others are much more specific. Antivirals are compounds that target viruses, by stopping them from being able to enter a host cell or by messing with their ability to replicate their genetic material. Similarly, antifungals target fungi, antiparasitics target parasites, and antibiotics target bacteria. That specificity is why antibiotics are no use at all for viral infections and why the antiparasitic ivermectin hasn’t so far been found to be an effective treatment for Covid-19.
As an aside, here’s an interesting little fact I recently found out about the word antibiotic. I always thought it was coined by microbiologists in the 1940s during the golden age of antibiotic discovery. But according to American doctor and medical historian Professor Howard Markel, it was an American naval commander called Matthew Fontaine Maury who first used the word in his 1860 book Physical Geography of the Sea and Its Meteorology. He took it from the Greek word biōtikos, which is about the ability to live, and was using it to describe his argument against the existence of extraterrestrial life!
What is antimicrobial resistance?
Antimicrobial resistance is what happens when microbes develop the ability to stop antimicrobials from affecting them. Toby Morris and I have explained before one of the ways this process happens, as it’s how new variants of the Covid-19 virus arise. Unlike us, most microbes replicate their genetic material quite rapidly. Some take just a few minutes to make new copies of themselves. Microbes can also easily reach population sizes in the billions if they have the right growth conditions. That means there are plenty of opportunities for chance mistakes to get made in that replication process and for resistant variants to arise.
These variants then grow quite happily in the presence of the antimicrobial, replacing the microbes that can’t. This happens wherever microbes encounter antimicrobials – in human and veterinary medicine, in agriculture, but also in sewage systems and out in the wider environment. Bacteria have an extra and very worrying trick up their sleeve. They can share the ability to share their resistance between each other on mobile bits of genetic material. Then they don’t even need to be in the presence of the antibiotic – they just need to meet the right kind of resistant microbe! This is called horizontal gene transfer and can happen between completely unrelated bacteria.
Why you should care about antimicrobial resistance
Antimicrobials are used to treat people with infectious diseases. They are also used to prevent infections in people, like those undertaking chemotherapy for cancer, or those who need to have surgery. This is especially true for antibiotics. If we lose these incredible medicines, we don’t just lose the ability to treat infected people, we lose our ability to do the medical treatments that form the basis of modern medicine. Antimicrobial resistance already means some people need to be treated with medicines that are less effective, more expensive, more inconvenient, and have more side effects. Some bacteria are now almost untreatable. This impacts all of us, even if you are someone who has never needed to take antibiotics before.
What can we do about antimicrobial resistance?
Antimicrobial resistance is a big problem that is hard to solve. Like the pandemic and climate change, it requires coordinated global effort. And just like the pandemic and climate change, that global action is missing in action. The World Health Organisation released its first report on the issue in 2014, with the organisation’s director-general Dr Margaret Chang saying antimicrobial resistance could bring about “the end of modern medicine”. In July 2014, the UK prime minister, David Cameron, commissioned economist Sir Jim O’Neill to investigate the problem and propose concrete actions to tackle it internationally. The final report and recommendations were released in 2016. We also knew long before the pandemic that making healthcare and the development and delivery of medicines and vaccines a for-profit industry would be disastrous for global health and wellbeing. The pandemic has shown just how true this is. None of us are safe until we are all safe.
This year I’ve been one of the many people working with Dame Juliet Gerrard, the chief science adviser to the prime minister, and her office this year on a major project looking at the issue of antimicrobial resistance and its relevance for Aotearoa New Zealand. We’ll soon be reporting back with a whole bunch of recommendations on how to tackle it, so keep an eye out for that.
But for now, here are a few concrete things you can do that will help. Don’t demand antibiotics for you or your animals when you or they are unwell. So many antibiotics are prescribed to people who simply don’t need them because they have a viral infection. So, if your doctor or vet says no, don’t pressure them. If they do prescribe you antibiotics, ask them if they are following the most up-to-date prescribing guidelines. These guidelines change all the time, and it can be hard to keep up to date with the changes, so a gentle inquiry could prompt your doctor or vet to check.
Another problem is the use of similar antimicrobials in human medicine and in agriculture, aquaculture and horticulture. If you can afford it, choose food that’s been produced without the use of antibiotics. Also look at what products you use in your garden. A fungus commonly found in soil has become resistant to the antifungal pesticides used not just in horticulture but in gardening too. Azoles are one of the things to look out for here. Because similar antifungals are used in human medicine, these resistant fungi are now able to cause almost untreatable infections in some vulnerable hospital patients. And these patients can become infected just by being in a bed next to an open window that looks out onto a garden!
Lastly, if, like me, you think you are allergic to penicillin, there is a very high chance you aren’t. Penicillin is a very safe and effective antibiotic and is used to treat all sorts of infections. Around one in 10 of us think we’re allergic to penicillin because we’ve had some sort of reaction to it in the past. The problem with being labelled as penicillin-allergic is that if you do need antibiotics, you’ll have to be given ones that are less effective and may have more side effects. But studies have shown that when most people are retested, they are no longer allergic and can safely take penicillin and related antibiotics. So, if you think you are allergic to penicillin, talk to your doctor or pharmacist to see if you can have your allergy status reviewed. It’ll be better for your health and help our doctors use antibiotics more wisely.