In the recent, alarming words of Britain's Chief Medical Officer, antibiotic resistance should be ranked with terrorism as one of the major threats to society. Equally concerned, the World Health Organisation made the issue the focus of World Health Day 2011, warning that inaction today will lead to many deaths in future.
In barely two generations, modern society has simply forgotten how many people used to die from coughs, cuts, and general injuries. Nowadays we take it almost for granted that we will survive surgery – which wasn't always the case in the pre-antibiotic era. The prospect of Australian life expectancy – currently about 82 years – sinking back towards 56 years, where it was in the early 20th Century, is real.
In the words of WHO Director-General Margaret Chan: "Unless we solve the problem of antimicrobial resistance to drugs, we will be facing a post-antibiotic era where things as common as a strep throat infection or a child's scratched knee could once again kill." Many infectious diseases may one day become uncontrollable and could rapidly spread throughout the world, WHO says.
These are not trivial warnings, yet Australia seems indifferent to the need to play its part on combatting this global menace. A recent study, Culture of Resistance, by Kerrie Tucker for The Australia Institute finds that little effective action has been taken since an expert committee made 22 recommendations 14 years ago.
The irony of the tide of antibiotic resistance now bearing down on us is that, like obesity and diabetes, it is a consequence of our quest for cheapness, convenience and self-gratification. Like the food issue, it means that many will 'die by their own hand' – albeit unintentionally – without understanding the role their consumer habits have played in their demise.
Antibiotic resistance is Darwinian evolution in action. If you kill 99.99 per cent of the bugs that cause an infection with an antibiotic, the ones you don't kill have a very good chance of being resistant to the drug, multiplying and passing it to other microbes in little gene satchels. The result is the superbug, a partly or totally resistant brute now infesting our hospitals and – it is feared – our livestock farms in ever increasing numbers and species.
Around 80 per cent of our national antibiotic consumption is routinely fed to healthy pigs, poultry and feedlot cattle ostensibly to prevent disease, but really because it causes them to grow faster. In other words, like the European horsemeat scandal, the antibiotic shower to which modern meat is subjected is a direct result of the pressure applied to supermarkets by consumers for cheaper, more convenient food, and the industrial systems devised to supply it. While superbug infections from animals to humans are not yet common here, cases are starting to emerge. However, as our food is not regularly tested for superbugs, nobody knows the extent of the threat.
Likewise the patient's perennial plea to doctors "C'mon doc, give me an antibiotic for this sore throat – I can't be sick for work/sport/holiday" lays the ground for mass deaths in the future, as over-prescribing accelerates the rate at which the bugs learn to resist more and more antibiotics. What many people do not realise is that there have been no new classes of antibiotic released anywhere in the world in over a quarter of a century: we are, essentially, stuck with those we have got.
Multiple drug-resistant infections used to be something Australians brought home from overseas trips to dodgy destinations. "Rather scarily in the last year or so we've started to see Australians coming in with multi-resistant infections where they haven't travelled at all," Professor Lindsay Grayson of Melbourne University told the ABC. Several big hospitals have recently found their intensive care and other units contaminated by superbugs.
If you catch a superbug like methicillin-resistant golden staph your chance of dying is currently about one in 4 or 5, according to the Medical Journal of Australia. However the actual number of Australians whose demise is due to superbugs remains unknown, or else is being kept very quiet: the WHO records 'no data' from Australia (along with other Third World countries). In Europe an estimated 25,000 people die every year and in America, 90,000 people. Extrapolating from the US data, there could already be as many as 4,400 Australian annual fatalities – or around three times the current road toll. Hopefully the actual number is far lower due to better hospital hygiene here. But it gives a clear indication of what lies ahead if we do not start to take this deadly threat more seriously, and of the urgency of establishing proper national surveillance.
According to The Australia Institute most of the factors listed by WHO as drivers of drug resistance are present in Australia. They include: inadequate national commitment to a comprehensive and coordinated response; ill-defined accountability and insufficient engagement of communities; weak surveillance and monitoring systems; inappropriate use of medicines, including in farming; inadequate infection prevention and control practices and insufficient research.
Beating AB resistance isn't simply a health issue. It will require co-operation across the board from consumers, parents, the food industry, farmers, chemical companies, drug companies, pharmacists, federal and state government departments, hospitals, doctors, nurses and patients. Above all it involves the public: if we fix the regulations but do not change our mindset as consumers and patients, we will fail to fix the problem and thousands will die needlessly as a result, including a great many babies and children.
Several generations ago most Australians were taught to wash hands, use handkerchiefs when coughing or sneezing and not to spit in public, to prevent the spread of infectious disease. Not only are those lessons now fading, making ours a less hygienic generation than the previous two, but we are storing up infinite trouble for future Australians by the way we eat and consume medical antibiotics. Do we really have the right to gamble with the lives and longevity of our children and grandchildren?
If ever there was a case for a national public health action and awareness, this is it.