United Nations inspires renewed talk about antibiotic resistance

From the PBS Newshour to AllAfrica.com and from the Toronto Star to Politico , newly elevated United Nations attention to antibiotic resistance is renewing media attention to that international problem. But does the boost in attention foreshadow constructive action?

Early on 21 September, the day of the UN’s High-Level Meeting on Antimicrobial Resistance , the Guardian posted this headline: “UN agrees to fight ‘the biggest threat to modern medicine': antibiotic resistance.” Concerning what Newsweek was calling a “landmark agreement,” the Guardian‘s subhead announced, “All 193 UN member states are set to sign a declaration to fight drug-resistant superbugs that are estimated to kill more than 700,000 people each year.”

A day earlier, a Los Angeles Times editorial had called attention to the meeting and summarized its implications:

Warning about it for decades? Alexander Fleming, having shared a Nobel Prize for inventing penicillin, spoke in 1945 of the “danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Over time, the warnings have become emphatic. Three years ago an article in Nature spoke of “last resort,” “horror,” “nightmare,” “catastrophic threat,” “dire trend,” and “alarm.” It predicted that “if antibiotics become ineffective, everyday operations such as hip replacements could end in death for as many as one in six.” It lamented that “perversely, the rapid advance of resistance and the consequent need to use these drugs sparingly has convinced pharmaceutical companies that antibiotics are not worth the investment.”

Earlier that year, Dame Sally Davies, Britain’s chief medical officer, had described a future “apocalyptic scenario.” In 2012, Margaret Chan, director general of the World Health Organization, warned that a “post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.” She added that some “sophisticated interventions” like organ transplants, cancer chemotherapy, and care of preterm infants “would become far more difficult or even too dangerous to undertake.”

In the current renewal of media attention, the Condé Nast magazine Glamour called the resistance challenge “totally terrifying.” In the UK, the Daily Mail‘s regular format of a headline followed by bullet-list subheads conveyed still more alarm:

The reporting of experts’ findings and judgments constitutes a form of emphatic language too. Vox invoked a Centers for Disease Control and Prevention (CDC) public statement reporting that each year in the US, “at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die ... as a direct result of these infections,” with many more dying “from other conditions that were complicated by an antibiotic-resistant infection.” A CDC news release , cited by Ars Technica, calls at least 30% of antibiotics prescribed in the US “unnecessary” and reports that in “most” cases, the prescriptions target viruses—which don’t respond to antibiotics.

Two days before the 21 September UN meeting, Reuters distributed a news report about a JAMA Internal Medicine study declaring that overall antibiotic use “among hospitalized patients in US hospitals has not changed significantly in recent years,” that use “of some antibiotics, especially broad spectrum agents ... has increased significantly,” and that this trend is “worrisome.” A Daily Mail subhead for the Reuters piece cautioned, “Experts warn this is an ominous sign we are not taking resistance seriously.” A government report in the UK, widely reported in the media, predicts that by 2050, antimicrobial-resistant infections will annually kill some 10 million people worldwide, a figure exceeding current annual cancer deaths.

Before the UN meeting, NPR interviewed Keiji Fukuda, the World Health Organization’s special representative for antimicrobial resistance, who summarized what was hoped for from the UN meeting: “What we want to see is that the high level people attending the meetings—and this is basically heads of state—really recognize that we have a large global issue, something on the order of the emergence of HIV or climate change and that they are committed to addressing this.”

The meeting did produce a declaration , which in turn inspired a new round of news pieces. Some began by adopting the emphatic language of an inundation metaphor. Here’s the “lede” from a CBS report : “World leaders approved a wide-ranging declaration Wednesday aimed at addressing the rising number of drug-resistant infections—something the World Health Organization says has the potential to kill millions and undermine the global economy, likening it to ‘a slow-motion tsunami.’”

Some of the coverage has focused on possible measures. Vox summarized three:

• Conserving antibiotics by removing financial incentives for overuse, phasing them out of food production, and improving public awareness.
• Innovation of new antibiotics and better diagnostics.
• Improved access to antibiotics, sanitation, and vaccines.

On the eve of the UN meeting, Business Insider and others reported that 13 major drug companies had just listed key commitments to uphold by 2020. They included the following:

• Make sure only patients who need antibiotics get them.
• Increase access to treatments.
• Collaborate more with government organizations.

A fourth commitment—"Cut down on the impact that producing antibiotics has on the environment"—calls to mind a somewhat extraordinary contribution to the media coverage, by a blogger at Scientific American.

The author is Laurie Garrett , who runs the global health program of the Council on Foreign Relations. The council calls her “the only writer ever to have been awarded all three of the Big ‘Ps’ of journalism: the Peabody, the Polk, and the Pulitzer.” The magazine headlined her online posting “Antibiotic-Resistant Bacteria and the World’s Peril: The U.N. General Assembly is taking on a danger that threatens the health of our entire species.”

Garrett presents the issue as not just about humans, but about the planet itself. She begins, “Welcome to the Anthropocene, the era in which one species—human beings—so utterly dominates the planet that all of the driving forces of climate, oceans, geology, air and every other life form on Earth are controlled by the activities of humanity.” Citing general human thoughtlessness, she introduced her argument:

The planet “has its own microbiome,” she emphasized, “representing about a third of the weight of all biological material and life forms.... And it is every bit as indispensable to the planet as your microbiome is to your personal health.” She continued:

Her conclusion merits quoting and use as the conclusion here too:

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Steven T. Corneliussen, a media analyst for the American Institute of Physics, monitors three national newspapers, the weeklies Nature and Science, and occasionally other publications. He has published op-eds in the Washington Post and other newspapers, has written for NASA’s history program, and was a science writer at a particle-accelerator laboratory.