Written by Lindsey Kaufman, BA candidate in Anthropology, Global Health & Environment at Washington University in St. Louis and participant in the 2021 Institute for Public Health Summer Research Program
Caline Mattar, MD, assistant professor of Medicine and infectious disease expert, opened a presentation to our IPH Summer Research Program-Public and Global Health Track cohort on antimicrobial resistance (AMR) with the above image, showing that AMR is an immense yet very sneaky threat that often escapes the public eye. As more and more infections become untreatable as a result of microbial resistance to our limited lineup of drugs, antibiotics continue to be misused in human and livestock populations. Tackling this problem will require extensive collaboration, as there is no single actor that holds all of the responsibility, and there is no single solution that can overcome the issue alone.
According to the World Health Organization, antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death. This puts us in a bind wherein we need to use antibiotics to overcome infections, but the more we do, the more infections become untreatable as the bacteria responsible become resistant to the drugs. This means we have to be careful and not misuse antibiotics, or the progress they have allowed us to achieve in treating infections will be lost.
Unfortunately, we are not being careful. Livestock are being fed antibiotics as a growth promoter and preventative measure to infection because it is easier than maintaining hygiene. According to Dr. Mattar, 63,200 tons of antibiotics were consumed by livestock in 2010, which was more than all human consumption in that year. Human use is also troubling. Patients often request prescriptions for assurance that they will get better, and doctors may overprescribe to appease their concerns even when an antibiotic will not be effective on, for example, their viral infection. As a result, antibiotics are being misused and overused, which greatly threatens their effectivity.
The effects of antimicrobial resistance are severe and jeopardize existing medical achievements as well as future goals. As shown below in the graphic provided by Dr. Mattar, AMR threatens several Sustainable Development Goals including poverty reduction, clean water and sanitation, economic growth, and, of course, good health and well-being. One of the problems Dr. Mattar outlined is the supply chain of drugs. Pharmaceutical companies are generally not interested in making generics because they are not highly profitable. As a result, there is not enough product to reach everywhere, and the cost may not be accessible to consumers. When the drug needed is not available, a patient may have to level up to a different drug, which could have otherwise been reserved. Colistin is a key example. While it has been used as a last resort for treating infections that are resistant to other drugs, it too has run into AMR as we become increasingly reliant on it.
The wide array of issues leading to antimicrobial resistance requires a multifaceted solution that brings together multiple stakeholders and disciplines. Dr. Mattar outlined five strategic objectives including improving awareness, strengthening knowledge through surveillance and research, reducing the incidence of infection, optimizing the use of antimicrobial medicines, and ensuring sustainable investment. This will require action by the agriculture industry, public health and policy professionals, doctors, patients, and more. As Dr. Mattar expressed, antimicrobial resistance is the greatest threat to modern medicine, and fundamental changes are critical.