CHENNAI: The news that London-based political consulting firm Cambridge Analytica had harnessed our Facebook data to help politicians do better in elections has outraged us. An online campaign called #DeleteFacebook cropped up in no time and thousands, including celebrities, publicly killed their Facebook accounts in protest.
Most of us are outraged, and for good reason. Yet, when it comes to an issue that deserves the same amount of concern, if not more – the growing threat posed by multidrug-resistant bacteria -- there is little indignation or worry. There is no popular campaign on social media to discourage the abuse of antibiotics -- no hashtags, no debates, and hardly anybody is even interested in talking about it.
Last week, a man in the UK was diagnosed with a type of gonorrhea (health experts are calling it super gonorrhea) that has so far resisted treatments using all available antibiotics. For a world drown in the news about data theft, this was no big deal.
Gonorrhea is a sexually transmitted infection, which is normally treated using antibiotics. Until now, it was an illness taken lightly, and for which, effective treatment was easily found. Not anymore, it appears.
Why is it a big deal?
Gonorrhea is one of the numerous diseases, which are becoming untreatable, because the antibiotics, which we have relied on for cure, are no longer effective. In fact, as early as 2012, the WHO had warned that the world is running out of ways to treat gonorrhea – a disease contracted by nearly 80 million people around the world each year. By 2015, Cefixime, hitherto the most widely prescribed drug for gonorrhea was by and large ineffective. Doctors were then told to prescribe ceftriaxone and azithromycin -- two more powerful antibiotics. However, the latest case in the UK is proof that a new strain of bacteria has emerged that is resistant to the two.
The advent of multi-drug-resistant bacteria is one of the biggest public health crises facing the world in decades. It is not just gonorrhea, but a vast majority of diseases caused by bacteria are becoming difficult, if not impossible, to treat. These include common infections like pneumonia and tuberculosis.
According to the World Health Organisation (WHO), nearly half a million cases of multi-drug resistant TB were reported from around the world in 2016 alone. In February 2017, the UN released a list of 12 deadly superbugs. “Antibiotic resistance is growing and we are running out of treatment options. The pipeline is practically dry,” Dr. Marie-Paule Kieny, a senior WHO health expert, warns.
Deadlier than climate change
Most educated people are informed about the growing threat posed by climate change. What about antibiotic resistance? Not many are aware, but the superbugs are a far bigger and more immediate threat than climate change (This is not to say that climate change doesn’t matter. Of course, it does!). Not convinced? Consider this: The WHO estimates that between 2030 and 2050, climate change-related factors would kill, on an average, 250,000 people a year.
What about superbugs? At present, infections that aren’t responding to antibiotics already kill more than 700,000 people each year, according to the UK Review on Antimicrobial Resistance , a 2017 study funded by the UK government. That’s more than one death every minute. In fact, the superbugs kill far more people each year than the Syrian civil war has done in seven years. Experts predict that by 2050 as many as 10 million people would die annually as a result of untreatable infections. That’s the entire size of Sweden’s population being wiped out every year.
The cult of antibiotics
The discovery of penicillin – the world’s first antibiotic –by British microbiologist Alexander Fleming in 1928 was a landmark point in human history. The advent of antibiotics revolutionised medicine. All of a sudden, there was a cure for infections and diseases that were previously incurable and led to death. The story of how the wonder drug saved the lives of thousands of World War II soldiers is well known.
So, without hesitation, the world embraced antibiotics. It has become a part of our daily lives. Have a common cold or flu? Antibiotics are our medicine of choice despite the fact these are viral infections, against which they don’t work.
Why do we love antibiotics? Due to their ability to tackle infections quickly and decisively (The rise of superbugs may change all that), antibiotics have acquired a cult status. Strangely enough, there have been reports about doctors in the UK being bullied into prescribing them.
A 2016 report published by the BMJ says 55 per cent of 1,000 physicians surveyed in England felt “pressured” by patients to prescribe antibiotics although they were “unsure” about their effectiveness to cure the given illness. Shockingly, 45 per cent said they prescribed antibiotics for a viral infection “fully aware” that they wouldn’t be effective. In other words, they did so solely to satisfy their patients.
The cult of antibiotics has led people to blindly trust them and expect them to cure even those diseases against which they don’t work. A survey by the British Society for Antimicrobial Chemotherapy found that one-third of the people in the UK still believe that antibiotics “somehow” help cure cold and coughs.
Things are no different in the US or India. Nearly half of all antibiotic intake in America is unnecessary or even downright inappropriate according to a 2016 study published in the Journal of the American Medical Association.
Being the world’s largest consumer of antibiotics, India is at the epicenter of the current crisis. The country is known as the world’s antibiotic capital. The National Academy of Sciences, a US non-profit organisation based in Washington DC, has found that antibiotic consumption in India has doubled between 2000 and 2015. During the same period, there was a 65 per cent rise in worldwide antibiotic sales.
In India, the misuse of antibiotics is higher than in any other parts of the world -- thanks to a large, relatively unhealthy population and easy access to antibiotics.
We ignored the warnings bells
Antibiotics are useful and have saved millions of lives. Without them, many of the modern medical procedures, including surgeries, would be unthinkable.
However, when they first burst onto the scene, antibiotics came with a piece of advice-- use sparingly. But over the years, we ignored the advice and continued our mindless consumption of the wonder drug. As a result, we are slowly but steadily hurtling to a crisis, which, many medical experts fear, may reverse all the significant gains made in the field medicine in recent decades.
“Antimicrobial resistance will seriously jeopardize progress in modern medicine," says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.
The problem of resistance
Bacteria, like all other organisms, are subject to evolutionary pressure. Remember the Darwin’s theory of natural selection? Certain bacteria change over time and develop resistance to drugs. Microbiologists say, in any large colony of bacteria, there are those that have evolved and acquired resistance. When we take an antibiotic, it kills nearly all bacteria, leaving behind only those with resistance genes. They would then make full use of the environment to grow quickly and multiply into large numbers.
Eventually, when they come into contact with non-resistant bacteria, they would pass on the resistance genes, adding them as well to the club of superbugs.
So, what happens when when we take antibiotics for diseases caused by viruses? When we do that, it puts selective pressure on bacteria present in our bodies. The weaker ones would die off as a result, leaving the stronger ones to flourish.
If we use antibiotics only when absolutely necessary, the emergence and spread of the superbugs can be greatly slowed down.
“The pipeline is practically empty”
Bacteria resistant to antibiotics have popped up several times in the past decades. For instance, resistance to penicillin was discovered as early as 1947. So why is drug resistance an issue now?
If we could keep developing newer and more powerful antibiotics, then we can greatly rid ourselves of the challenges posed by the superbugs.
However, the WHO warns that the pace of the discovery of new antibiotics is not keeping pace with the development of resistance . To our collective dismay, only one new antibiotic has been discovered since since 1987.
If we continue the misuse of antibiotics at the current pace, then in about two to three decades, we would find ourselves facing an existential threat, given no new set of antibiotics are discovered.
Life in a post-antibiotic world
Medical experts are bracing for a post-antibiotic world, which, they fear, is right around the corner. In a world where antibiotics no longer work, infections would take much longer to cure or maynot cure at all, leading to deaths. Health experts highlight the three major outcomes associated with growing drug resistance: longer hospital stays, higher medical costs, and increased risk of death for people suffering from bacterial infections.
What’s more? After you did C-section last time, your doctor must have given you antibiotics to prevent infections. In a world where antibiotics no longer work, medical procedures like caesarian, chemotherapy and organ transplant may become far more difficult and could lead to complications arising out of infection.
Dr Ramanan Laxminarayan, director of Washington-based Centre for Disease Dynamics, Economics and Policy told UK’s Guardian newspaper that “a lot of common surgical procedures and cancer chemotherapy will be virtually impossible if antibiotic resistance is not tackled urgently.”
According a study published in The Lancet Infectious Diseases, a further 30 per cent dip in the effectiveness of prophylaxis, an antibiotic given to people who have undergone chemotherapy, would result in 120,000 additional surgical-site infections per year in the US and over 6,000 deaths. The authors of the study warned, “the declining efficacy of existing antibiotics potentially jeopardises outcomes in patients undergoing medical procedures.”