IMAGINE a looming global crisis that threatens the health of countless people, confounding scientists and governments with its sheer magnitude and complexity and growing at a pace that will quickly exceed our ability to reverse course.
Sounds a little like climate change, right?
The existential threat I’m referring to in this case is microscopic: antibiotic-resistant bacteria and fungi.
In a way, antibiotic resistance is the climate change of medicine. It has potentially lethal outcomes for individuals, but curbing it requires a collective, multinational effort. And unfortunately, summoning the political will to address the problem has proven difficult.
The WHO doesn’t mince words in describing the gravity of the dilemma we’ve created: “Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.”
The relatively rapid rise of antimicrobial resistance has been attributed to several factors, including antibiotic overuse and misuse—particularly in countries where the drugs do not require a doctor’s prescription—and industrial farming, where livestock are prophylactically injected with common antibiotics to keep them healthy in cramped conditions.
Developing new antibiotics to fight emerging resistant strains is not an attractive proposition for many pharmaceutical companies. Antibiotics tend to be prescribed for a short course, and while no less life-saving than, say, a blockbuster chemotherapy drug, the potential for profit from these medications is significantly diminished.
Like climate change, it can be tough to grasp how one’s personal choices contribute to the larger predicament. From a patient’s perspective, it’s not easy to accept that doctor in the clinic or emergency room telling you that your miserable week of retching, fever and diarrhea is likely a viral illness that will get better on its own and does not require antibiotics. Stay hydrated!
On the other side of the table, a doctor with limited time to argue or explain the molecular biology of extended spectrum beta-lactamases may take the path of least resistance and just write a script. It’s easy, and fast, and there are other patients waiting.
The New York Times has done an excellent job presenting this issue to a general readership in its series “Deadly Germs, Lost Cures,” which includes some top-notch reporting on Candida auris, a virulent and often lethal fungus which has been making the rounds in nursing homes and hospitals, picking off the elderly and immunocompromised.
This is an important first step: awareness. Physicians and scientists have been sounding the alarm on antibiotic resistance for some time, but until the public realizes the full scope of the problem, we are unlikely to see any serious calls to action.
Still, personal experience matters, whether it concerns pesky germs or rising sea levels. Human brains have trouble with abstraction, and often it is not until disaster arrives on the doorstep that people are moved to respond. Most people have not seen their personal health fall victim to a drug-resistant organism, just like most people have not lost their house to catastrophic flooding. But the way we’re headed, both of these misfortunes will become more commonplace. And if it’s not you who they befall, it will be someone you know.
Climate change dominates headlines and inspires advocacy, and rightly so. But if the “post-antibiotic era” the WHO forecasts arrives prior to the post-carbon era, it may be microscopic rather than macroscopic forces that ultimately overwhelm our civilization.
Note: A version of this article appeared on KevinMD.com on February 6, 2020.