People around the world are becoming resistant to antibiotics, which means that common infections that were once easy to treat could one day become deadly. In fact, drug-resistant tuberculosis, an infectious and sometimes deadly disease, currently poses a serious threat to global health, and just recently, the Centers for Disease Control and Prevention reported a superbug fungus outbreak in the United States.
But how did antimicrobial resistance (AMR) happen and what exactly does it mean?
In recent years, AMR has become one of the biggest health threats around the world. And yet, most people know very little about it.
“People have a face for polio, they have a face for measles,” Jyoti Joshi, the head of South Asia for the Center for Disease Dynamics, Economics & Policy (CDDEP), told Global Citizen. “But AMR is something distant and not personal.”
When someone dies of an antibiotic-resistant infection, she explains, there’s no certification saying that they died from the infection because they were resisting antibiotics — people just see that it was from an infection.
But AMR actually causes 700,000 deaths per year, and by 2050, that number could reach 10 million worldwide, according to the 2014 Review on Antimicrobial Resistance.
Antibiotic exposure breeds resistance. That means that every time a germ is exposed to an antibiotic, its resistance to it increases — it doesn’t mean that a person shouldn't take antibiotics when they are necessary, it just means that patients ought to be more mindful.
Let’s say you have a bad cold that has lasted three days, and you reach for an antibiotic on the fourth day. By then, your infection will already be waning and your immunity will be improving, Joshi explained.
You might be tricked into thinking that the antibiotic cured you, but it's more likely that it had a placebo effect. What you’ll actually have done is exposed your cold to another infection, making it more resistant, and contributing to more resistance in society, she said.
“Capacities might be different … but low-income countries and high-income countries, they are facing similar problems,” Sergey Eremin, a medical officer with the Global Antimicrobial Resistance System (GLASS), told Global Citizen.
The GLASS was launched by the World Health Organization (WHO) in 2015 to collect and analyze global AMR data, with the goal of supporting regional, national, and global actions to tackle it.
“For the developing world … the debate that goes on is between access and excess, because we have rural and remote areas where there is no doctor available or no pharmacy available,” Joshi said. “But that doesn’t justify … making antibiotics available to them when you know you’re exposing them to a long-term infection in some form or the other.”
Through her work with CDDEP, Joshi is currently studying AMR in India. CDDEP helps collect data and provides situational analyses on AMR across various countries. It then works with the WHO to provide guidance on how to implement AMR strategies into existing health programs, like maternal and child health plans, immunization initiatives, or programs working to improve infection rates within health centers.
Since AMR became part of the United Nations agenda in 2016, most countries have plans on paper, but have struggled with actual implementation, Joshi said.
She argues that AMR’s severity is not yet understood by all stakeholders — people don’t truly understand its global implication.
AMR is the result of a combination of issues that create a perfect storm as a global health threat.
For starters, people are reaching for antibiotics far too often in developing countries, where accessing them is easier than accessing quality health services. But they’re overusing them in developed countries, too.
“People often go [to the doctor], and they have an agenda,” Dr. Andrew Morris, medical director of the Sinai Health System-University Health Network Antimicrobial Stewardship Program, told Global Citizen. “‘I’m coming here because I need an antibiotic.’ And so, the expectation — and some degree the measure of satisfaction — will be based on whether or not the antibiotic was prescribed.”
But it’s more than that.
In Canada, for instance, Morris notes that 80% to 90% of antibiotics are used on animals (to increase growth rates or to protect their health), meaning only 10% to 20% are used on humans. The trouble is, about 90% of the Canadian population eats animals, according to research from Dalhousie University. Because humans are regularly ingesting antibiotics through meat in their diets, they're becoming more resistant to antibiotics.
Morris, as well as Joshi, both referenced the need to focus on AMR with the One Health approach, which is the concept of various disciplines working together locally, nationally, and globally to address health care for people, animals, and the environment.
There is a clear connection between people, animals and antibiotics, but AMR in developing countries also derives from larger systemic issues.
“[Antibiotics] are a quick shortcut for not improving infection control practices, for quality of care, or hand hygiene issues,” Joshi explained. “So the policy makers or governments can get away with poor infrastructures or lack of water in hospital facilities because there is an antibiotic available over the counter.”
Again, this comes back to the idea that a comprehensive approach must be taken to combat AMR. Access to clean water and sanitation would reduce diarrheal disease, which would reduce the number of people taking unnecessary antibiotics, which would limit resistance to antibiotics.
There is no smoking gun when it comes to AMR, as it comes from overuse of antibiotics by humans, but also in animals and the environment, due to agricultural practices, food trade, and population migration, Morris said.
So perhaps the most important takeaway is the idea that AMR must be tackled globally, as we’re all in this together, in some way or another.