The problem with antibiotic resistance is a lot like the problem with climate change: It’s one of collective responsibility. At the individual level, what does it matter that one person drives a car, or takes an antibiotic it turns out he didn’t need? But everybody’s doing it. Just like our moms warned us, we’re jumping off a cliff with all our friends.
“[There’s a] lack of incentives that each of us has to really do the right thing,” said Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics, and Policy, at the Aspen Ideas Festival’s Spotlight Health session. And when we don’t, “we’re just hosts for these bacteria to hop around.”
The overuse of antibiotics, both in human patients and, importantly, in livestock, has led to an explosion of antibiotic-resistant bacteria, both in the U.S. and around the world. Deaths from resistant infections are currently at about 700,000 per year, and estimated to rise to 10 million per year by 2050. If nothing changes, the World Health Organization predicts the future will look a lot like the past—where people die from minor injuries that become infected.
“The problem is so serious that it threatens the achievements of modern medicine,” the WHO wrote in a recent report.
And it really is a group problem. Each person on Earth is at the mercy of everyone else. “Antibiotics are different from other drugs,” Laxminarayan said. “If I were to take a statin, that doesn’t diminish the effectiveness of the statin for any of you.” Not so with antibiotics. “You could get an infection that was drug-resistant even if you’d never taken antibiotics in the past.”
One of the biggest risks people incur is from the feeding of these life-saving drugs to farm animals to promote growth, or to keep them from getting sick in unsanitary environments. According to a 2014 estimate, around 80 percent of the antibiotics used in the U.S. went to livestock, and the amount consumed by animals increased by 16 percent between 2009 and 2012. But according to a study published earlier this year in Proceedings of the National Academy of Science, emerging countries like Russia, Brazil, India, South Africa, and China present the next big threat for antibiotic resistance. The study estimates consumption of antimicrobials in these countries will double by 2030.
Margaret Hamburg, commissioner of the Food and Drug Administration from 2009 until March 2015, said that under her tenure, the agency took steps to curb this overuse in the U.S. It recently released a guidance urging producers to phase out the use of antimicrobials for making animals grow, and just a couple weeks ago released the Veterinary Feed Directive final rule, which will involve veterinarians in the decisions to give livestock antibiotics.
Still, farmers could just say that they need the drugs to prevent their animals from getting sick, and carry on as before.
On the human side of things, in March of this year, President Obama published the National Action Plan for Combating Antibiotic-Resistant Bacteria, which includes $1.2 billion of federal funding.
Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that his agency is using its allocation “to be an important component of the pipeline to develop new antibiotics” and is collaborating with pharmaceutical companies to make it happen. Antibiotics aren’t usually “blockbusters” for drug companies, he said, since people only take them on an as-needed basis.
“We make it less risky for the pharmaceutical company to participate in the production.”
Though new drugs are an important piece of the puzzle, Laxminarayan worried that there isn’t enough being done to monitor the use of the ones we have. “What I worry about more than the development of new drugs is the lack of money for things like surveillance and stewardship,” he said. “You can have a new drug five years from now, but that could go obsolete if we use it inappropriately.”
Examples of inappropriate use include starting patients on antibiotics before test results come back, putting them on a broad-spectrum antibiotic when it’s unclear what bacteria is causing the infection, or keeping them on the drugs even when tests come back negative.
But it’s difficult to curb this kind of behavior when patients come into a doctor’s office convinced they have an infection and unwilling to leave without a prescription. “There is an extremely powerful urge to please a patient and to alleviate the anxieties of the patients,” Fauci said. So doctors think, “‘Just keep ‘em on antibiotics, it can’t hurt.’ Yes it can.”
Fauci said that at the National Institutes of Health, the antibiotics doctors use are monitored, which helps prevent overprescribing. A lot of the efforts to tackle the resistance problem will have to be at the institutional level like this, or higher, at the governmental or international levels. But what can an individual do?
“If [your doctor’s] prescribing the antibiotic, ask about the scientific basis,” Fauci said. “‘What kind of infection do I have? What makes you think it’s bacterial? What kind of bacteria is it and what makes this antibiotic good for this bacteria?’ There should be that kind of dialogue between a physician and a patient.”
Laxminarayan offered another simple way to help.
“I’m vegetarian,” he said.