Imagine a world where that strep throat turns into scarlet fever, or a world where you break a tooth, it gets infected, and you die from sepsis (blood poisoning). And there is nothing you can do about it.
Antimicrobial resistance is shaping up to be the defining public health and medical issue of the century. You may argue that emerging infectious diseases or the rising number of people diagnosed with non-communicable conditions are more pressing issues. Or that smallpox eradication or the discovery of penicillin have greater historical importance. I would agree with you that all of those events, and many more, are very important developments of the last century or two, but they pale in comparison to antimicrobial resistance.
Experts predict that by 2050 over 10 million people will die each year from drug-resistant infections. To put that into perspective, around 5 million people die each year from the big three (malaria, HIV/AIDS, and tuberculosis). So 10 million people dying each year from previously treatable or preventable conditions is an astonishing number. And we should all be concerned.
Antimicrobial resistance occurs when bacteria, fungi, viruses, and parasites become resistant to antimicrobials that are used to treat them or prevent them from infecting people or animals. These resistant microorganisms are sometimes referred to as “superbugs”. Without effective treatments even the most routine procedures, such as a cesarean section or organ transplantation, become very high risk. Although antimicrobial resistance occurs naturally over time, the misuse and overuse of antimicrobials has sped up the process. Antimicrobial resistant-microbes are found in people, animals, food, water, soil, and air. They can spread between people, between people and animals, and between people and the environment.
Antibiotic resistance is found in every country. In January a woman in the US died from an infection caused by a bacteria that was resistant to 26 different antibiotics, and was only susceptible to one type of antibiotic. The patient died before her doctors could even discuss using this one remaining antibiotic. E. coli resistance has become very widespread. Tuberculosis is also becoming resistant to the first-line drugs used to treat it. The malaria parasite is becoming resistant to drugs commonly used to treat it. HIV/AIDS and influenza are also becoming resistant to the drugs used to treat them.
But all is not lost. Individuals can make sure they take their antibiotics exactly as prescribed (no more no less) and do more to prevent infection, like handwashing, proper food preparation, etc. Policy makers can ensure they have a plan to deal with antimicrobial resistance, improve surveillance of these diseases, and make sure infection prevention measures are in place. Health professionals can prevent infection by handwashing and making sure cleaning procedures are followed, only prescribe antibiotics when necessary, and make sure patients understand the importance of following directions when taking antibiotics. The healthcare industry can work to develop new vaccines, new antimicrobial drugs, and new diagnostics.
The WHO has come up with a “Global action plan on microbial resistance” that includes many of the concepts mentioned above. Heads of State at the UN General Assembly in September 2016 committed to doing more to combat antimicrobial resistance.
But will that be enough? Only time will tell.