“It is clear that we might not ever see global warming, the apocalyptic scenario is that when I need a new hip in 20 years, I’ll die from a routine infection because we’ve run out of antibiotics,” the chief medical officer of England, Sally Davies, observed.

The power of antibiotics has drastically shifted the advancement of public health for the better. The ability to cure infections as well as prevent them through agriculture has saved many lives; however, through our ever so globalized society and interconnectedness of world products and services, antibiotic resistant bacteria has been on the rise. In India, drug companies have been criticized for providing cattle with antibiotics to fatten up livestock because this could lead to a new superbug. Antibiotic-resistant infections associated with hospitals have caused 99,000 deaths in the U.S. annually. South Africa’s antibiotic consumption has increased 60% over the past ten years. This is a global public health crisis that needs to be addressed.

Antibiotic resistance [ABR] has the ability to impact every aspect of our daily lives. Mortality rates will only increase in both developed and developing nations’ hospitals. Those with diseases that weaken the immune system such as diabetes, cancers, chronic lung, cardiovascular and kidney diseases face great danger as there will these cures to infections will no longer be able to work properly on them. Countries could lose money gained from healthcare costs, such as the U.S., which could lose nearly $120 trillion gained from caesareans, joint operations, chemotherapy and organ transplants. ABR increases the length of hospital stays, the primary source of increasing healthcare costs, in both developed and developing nations.

Microbes do not respect national borders and in today’s interconnected world, and we have to take action to combat this upcoming world crisis. Countries and NGOs must cooperate by creating policies and incentives to localize the solution to ensure that each region is tackling the most prominent infections present at the time, encourage companies and farmers to avoid using antibiotics in the agriculture industry, and create a new system to lower the rate of prescription of antibiotics.

What are Antibiotics and how does Antibiotic Resistance Occur?

Antibiotics are a type of medicine that help reduce the spread of infection caused by bacteria. They function by stopping the growth of the bacteria through different methods such as destroying the bacterial cell wall or preventing the generation of energy from glucose to ensure they cannot reproduce. Using antibiotics in situations where it is not necessary such as overcoming the flu, can add to antibiotic resistance.

ABR occurs when bacteria develops the ability to fight against vaccinations and other forms of antibiotics that are used to stop the infection from growing. This type of bacteria can grow freely. The bacteria mutates its DNA after being in contact with the antibiotic, which then allows it to survive or ‘resist’ the antibiotic. Bacteria can then pass down the genes to other bacteria, allowing the resistance to spread to a new-strain of bacteria. When antibiotics are continuously used, it provides a greater chance for a new-strain to occur. As more bacteria become resistant to these vaccines and medicines, doctors will have fewer options available to cure infections that might become incurable in the future.

Fig. 1: Cycle of Antibiotic Resistance
Source: Public Health England (PHE)

ABR is caused in a variety of ways, making it difficult to completely eliminate its spread. The most common way is through the over-prescribing of antibiotics. As bacteria become more resistant, the dosage level needed to stop the infection increases as well. At some point, it will become impossible to cure these type of bacteria, allowing the spread of formerly cured infections to resurface in the future. Patients not following the instructions of the antibiotics prescribed their doctor can also lead to an increased resistance. Poor infection control in hospitals, unnecessary antibiotics used in the agricultural industry, the lack of hygiene and sanitation practices, and the lack of quick laboratory tests all contribute to the spread of antibiotic resistance.

Global Impact

A growing list of common infections such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases are becoming increasingly difficult to treat. These infections can easily spread, especially in our globalized world today. Without controlling the distribution of antibiotics, these common infections that are easily cured now will have the potential to easily kill in the future. At least 2 million people in the U.S. are infected with antibiotic-resistance bacteria, and there are at least 23,000 deaths because of it. In the European Union, 25,000 deaths are caused each year because of this crisis. In India, over 58,000 babies passed away due to antibiotic-resistant bacteria passed down from their mothers.

There has also been a correlation between the use of antibiotics used in agriculture and an impact on human ABR with the possibility of leading to new and more common diseases. One way the use of antibiotics in agriculture can spread disease is through direct infection with resistant bacteria with the animal source. Although there is limited research available exploring the transmission of ABR through agricultural and environmental factors, there is still a possibility of ABR .

According to the World Bank, by 2050, antibiotic-resistant infections can cause a global economic disaster equivalent to 2008 financial crisis. Low-income countries have the potential to lose 5% of their GDP and place 28 million people into poverty. Global increases in healthcare costs could range from $300 billion to over $1 trillion by the year 2050. The global livestock output could decline from 2.6% to 7.5% a year.

The impacts of ABR demonstrate that is has ability to affect everyone worldwide. be a global solution to solve this growing problem to ensure that society can still function in the long run.

Localize the Solution

Creating an international solution to be applied to every country might be a bit difficult, so we must start by creating a difference in small areas where ABR is highly present due to lack of sanitation and clean water. India, which is a hotbed for ABR, is already seeing the rise of resistance against bacteria that causes pneumonia.

Fig. 2: Percent Resistance to Klebsiella pneumoniae (pneumonia)
Source: Center for Disease Dynamics, Economics & Policy

Although doctors are searching for new cures to antibiotic-resistant infections, we have to find a preventative approach to ensure that people won’t fall victim to these infections in the first place. NGOs and the WHO must work together to create more sanitation projects to prevent the rise of infections to begin with. There needs to be cleaner toilets, greater access to potable water, and safer foods available to civilians. The WHO can provide funding to these organizations, so they can make a stronger impact worldwide.

The WHO can also provide a direct foreign investment to these country’s government to eliminate the third party; however, because many developing nations are run by corrupt governments, it’s safer to leave the money with a reliable international organization that has the goal of helping these other nations.

In addition, industrialized nations should focus on creating national campaigns to support practices that will reduce antibiotics from being needed in the first place. Encouraging people to wash their hands instead of using antibacterial hand sanitizer is just one way to reduce the spread of ABR. There should also be a greater priority in ensuring the cleanliness of public transportation. As every aspect of the world is interconnected now, there will be greater opportunities for infections to spread, especially through public transportation.

Incentives to Limit the Presence of ABR

Corporations and other smaller businesses should be involved to help fight ABR. By creating incentives encouraging them to cut out antibiotics from in agriculture, we can help limit the spread of this issue.

Because the farmers are the one who aren’t making as much money as the corporations who are bringing their products to the market, one way we can limit the use of antibiotics is by providing tax breaks or tax credits to the farmers that do not use them on animals or produce. Farmers make contracts with larger corporations that force them to upgrade their equipment, costing them a great amount of money. In 2014, only 56% of intermediate-sized farms reported any actual income from their farming work.This will help them save money and encourage them to find other ways to produce their products in a safer manner for the market. This model can also be applied to businesses who choose not to sell products from farmers that used antibiotics in the process. Both of these mechanisms will allow corporations and small-businesses to receive help, while allowing them to help with this public health crisis.

In addition, the WHO should provide grants to research and other corporations to find green alternatives for antibiotics. Probiotics and prebiotics are other forms that can be used to eliminate the presence of antibiotics in the agricultural industry. Vaccinations to present diseases in cattle can prevent infections that arise in the first place, which lead to the transmission of ABR. There is already research being conducted regarding ways to create synthetic molecules to kill infected bacteria from the inside out.

Lower Rate of Prescription of Antibiotics

Lastly, the WHO needs to promote the practice of a new antibiotic distributing system to limit the amount of antibiotics being used on a daily basis. At least 30% of all antibiotics prescribed in the U.S. are unnecessary. Limiting the amount of antibiotics prescribed can make a major difference in the fight against ABR.

The WHO must implement a new action plan for doctors to only prescribe antibiotics based on level of severity. Many sicknesses that can be cured by antibiotics will go away eventually, and prescribing this medicine in a situation like this will destroy the healthy bacteria as well. They can create a list of symptoms that pertain to certain illnesses. Once the sickness reaches a certain point that would require antibiotics, doctors can then prescribe this source of medicine. Countries distribute it to doctors to reduce the amount of antibiotics used in basic sicknesses.

The WHO should encourage countries to pass laws that require doctors to sign a contract to ensure that they will not over-prescribe medication. Although it can be subjective about what it means to “over-prescribe,” it will at least be known to them that it is a rule that they have to follow. Making them more aware of this will ensure that they pay more attention when they’re prescribing these medications.

In addition, doctors should be required to fill out information about why they are prescribing antibiotics in a health record. Doing so would require them to go out of their way, making it possible that they would be less likely to hand out antibiotics for simple cases. This would make it more inconvenient for them to prescribe these medicines, overall decreasing their distribution in the first place.

Lastly, we have to find a way to educate people about the distribution of antibiotics. Because many doctors prescribe them due to pressure from their patients, there must be a global health campaign informing the public about the dangers of overusing antibiotics. This can be done through public advertisements, or patients can be informed of the dangers at a doctor’s office before being prescribed antibiotics. If there aren’t as many people begging for these medicines, there won’t be nearly as many prescribed.

Conclusion

If there is not action taken quickly enough to combat this growing public health threat, our world is facing a growing number of deaths worldwide which could’ve been prevented with proper sanitation improvements to promote immunization. In the agriculture industry, the possibility of a superbug can strongly impact the economies of countries that depend on livestock as a main source of revenue. Action must be taken to limit the amount of antibiotics used in animals and help farmers ensure they can still make enough money to survive. Lastly, there needs to be a change in the way doctors prescribe medicine to minimize the risk of ABR in the future. ABR has the power to cause a major health risk worldwide, so we have to combat this before it’s too late.

Featured Image Source: Friday Magazine/Getty Images

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