Using Antibiotics Wisely
LONDON
– To solve the problem of antimicrobial resistance, the world needs not
only new drugs, but also new behavior – by all seven billion of us.
Because of the misuse and overuse of antibiotics, common infections such
as pneumonia and tuberculosis are becoming increasingly resistant to
existing treatments; in some cases, they have become completely immune.
The threat is global in scale. According to the Review on Antimicrobial Resistance,
which I chair, drug-resistant infections kill at least 700,000 people
every year. By 2050, if nothing is done to address the problem, some ten
million people a year could be dying from maladies that were once
treatable.
Developing new drugs
is an important approach in a coordinated response to fight
antimicrobial resistance. But it will not be enough. We also need to
reduce our demand for antibiotics and understand that they can sometimes
do more harm than good. According to one estimate,
nearly half of all prescriptions for antibiotics in the United States
are inappropriate or unneeded. So the steep rise in antibiotic
resistance is hardly surprising.
Improving people’s understanding of the problem will be crucial to reversing this trend. Most people are either completely oblivious to antimicrobial resistance or incorrectly believe
that it is an individual’s body that becomes drug resistant – not the
bacteria itself. A better understanding of when to use antibiotics, and
how to use them effectively, will help people use them responsibly.
We need campaigns like the one introduced by the Australian charity NPS MedicineWise, which held a competition for videos promoting public awareness of antibiotic use. The result was a series of short, witty films explaining simply and humorously how antibiotics can be misused.
These types of
efforts are needed worldwide, particularly in the largest and most
rapidly growing countries. The BRIC countries – Brazil, Russia, India,
and China – consume fewer antibiotics per person than the US. But they
are rapidly catching up as the rate of antibiotics consumption outstrips the pace of economic growth.
Pessimists will claim
that behaviors are hard to change, especially when doing so depends on
explaining the science of germs to uneducated audiences. That line of
thinking brings to mind one of the most abhorrent arguments against
making HIV medicines affordable for patients in lower-income countries:
People in Africa have no watches, so they will not be able to take their
antiretroviral medicine three times a day.
The truth, as researchers have shown,
is that Africans are perfectly capable of reliably adhering to
antiretroviral therapy – often more so than North Americans. Indeed, in
July, UNAIDS announced that the goal of having 15 million people on life-saving HIV treatment by the end 2015 was met ahead of schedule.
Every year on
December 1, World Aids Day highlights the issue and raises global
awareness. We need a similar effort to address the perils of
antimicrobial resistance. European Antibiotic Awareness Day, on November 18, is a good start; but we must also find new, creative ways to spread the message.
Technological
innovation brings unprecedented opportunities to reach people directly.
Roughly 95% of Chinese and 75% of Indians use mobile phones regularly.
In areas where literacy rates are high, sending text messages can be a
rapid and effective way to spread a message. Research in Europe and the US shows that 90% of text messages are read within three minutes of being received.
Social media are
another powerful and relatively cheap tool to reach millions of people.
In China – home to the world’s largest Internet base, with 641 million
users – 80% of doctors use smartphones for professional purposes,
including by providing medical advice via social media, with some
practitioners attracting millions of followers. Enlisting these medical
social-media superstars to educate the public on the urgency of
antimicrobial resistance is an exciting opportunity.
An anti-smoking social-media campaign
led by the World Health Organization provides another model that could
be followed. Posts by Chinese celebrities were used to increase
awareness of a law banning smoking in indoor public spaces.
In some parts of the
world, the best way to combat drug resistance will be to encourage
changes in behavior that reduce the spread of infections and minimize
the need for treatment. Proper hand washing is a great place to start.
In India, a clever campaign called SuperAmma
used images of people exposed to unsanitary situations to encourage
hand washing. The campaign successfully and sustainably increased
regular hand washing from 1% of the groups involved to about 30%.
The cost of a global
effort to raise awareness of the threat of antimicrobial resistance
would be miniscule compared to the amount being spent to develop new
drugs and technologies, which in any case will take years to become
available. Countries should urgently put in place educational campaigns
and begin to change behaviors. Together, we can break our bad antibiotic
habits.
Jim O'Neill, a former chairman of Goldman
Sachs Asset Management, is Commercial Secretary to the UK Treasury,
Honorary Professor of Economics at Manchester University, a visiting
research fellow at the economic think tank Bruegel, and Chairman of the
Review on Antimicrobial Resistance.
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