by Melissa Lackland.
By definition, the youth of any society bears the burden of its future: they inherit the problems of the past and are faced with the pressing task of finding solutions to those that have grown worse with neglect. This seems clearer today than at any time during the past half century. The bad politics and bad practices that have resulted in a world economy in long term crisis have impacted on so many areas of modern life that the young in 2014 must have insecurity hard-wired into their brains. If the crises in education, employment, pensions and healthcare weren’t enough of a burden, the complex problem of bacterial resistance to antibiotics is set to become one of the most dangerous threats to all our futures.
A timely warning
A report by the US Centers for Disease Control and Prevention (CDC), Antibiotic Resistance Threats in the United States, 2013, gives the first clear summary of the likely impact on our health and the nation’s health services. It estimates that even now 23,000 Americans die each year as a result of antibiotic-resistant bacteria, and a further 2 million develop serious infections. Director of the CDC, Dr Thomas Frieden, warns that swift action is needed or we will no longer be able to rely on the antibiotics necessary to save lives, as there are no new drugs in the pipeline: ‘If and when we do get new drugs, unless we do a better job of protecting them, we’ll lose those also.’
Over-prescription is the main cause of the problem: in response, bacteria mutate into resistant strains. Very few new antibiotics have been developed in the past thirty years, and few companies are working on new drugs to replace those that are becoming ineffective. The widespread practice of the routine dosing of farm animals with antibiotics, which the CDC report judges largely to be unnecessary and which makes up 80% of antibiotics used in the US, has introduced high levels of antibiotics into the food chain and increased the development of resistant bacteria.
Sexually transmitted diseases
The problem of resistance is hitting the younger sector of the population hardest with new strains of the bacteria that cause sexually transmitted diseases (STDs). While infection rates for most STDs have dropped or at least stabilized, the US still has the highest rate of infections in the western world, particularly with the emergence of new antibiotic resistant strains of gonorrhea and Chlamydia. The age group 15-24 make up only 25% of the sexually active population, but contract 50% of STD infections.
Complicating the story is the alarming increases in the number of infections caused by human papillomavirus (HPV), which can cause genital warts and anal, oral, cervical and penile cancers. As a virus, it is not treatable by antibiotics. Although there is an effective vaccine, the number of infections are rising through the lack of effective prevention and awareness programs, particularly those based in our schools. The CDC recommends that the vaccine be given to boys and girls from the age of 11, although debate continues over mandatory vaccination. As things stand, only about 35% of girls and 28% of boys are vaccinated in the US, compared to Australian figures of 72% and 62% respectively. The idea of vaccinating schoolchildren against HPV has been a political hot potato as in some quarters it is seen as encouraging sexual promiscuity.
It’s a similar picture when it comes to discussions of all STDs and children under the age of consent: the moral issues outweigh medical pragmatism; but where the health of the next generation is concerned, can we afford such squeamishness? Stigma is perhaps one of the greatest challenges in reducing infection rates. Testing is vital. The website KwikMed clearly sums up these twin problems: ‘It is clear from the statistics and from anecdotal evidence that a significant proportion across the world would rather avoid the stigma of being tested than look after their own health.’ 25% of US college students are infected with an STD, while 71% use no form of protection. Most STDs are easily curable, but the combination of stigma and denial of the risks to oneself and to partners has helped to produce the current crisis in public health. The CDC has estimated that the cost of treatment for STDs amounts to about $16 billion annually. If for no other reason, the economic impact of this health issue that is now almost out of control shows the urgent need for a solution.
The wider picture
The CDC study into antibiotic resistance was conceived as a vital ‘bringing together’ of current knowledge about drug-resistant bacteria and how to combat the problem, by both developing new drugs and preserving those that are still effective. Alarm has been raised worldwide, with the UK’s chief medical officer describing the problem as a ‘catastrophic health threat,’ following a World Health Organization (WHO) report that brought attention to a situation that is making treatment of bacterial diseases increasingly difficult.
Each year in the US almost 250,000 people are hospitalized with infections due to Clostridium difficile, most of which should have been preventable. The figure for drug-resistant gonorrhea is similar at 246,000. The most dangerous infections are caused by contact with multidrug-resistant bacteria while hospitalized for other issues. These include the most deadly, Staphylococcus aureus (MRSA), with 11,000 deaths per 80,000 cases; Acineobacter with 500 death in 7,300 cases; and E. coli and Klebsiella with 1,700 deaths in 26,000 infections. Among the threats in most urgent need of a solution is Carbapenem-resistant Enterobacteriaceae (CRE) – the cause of a recent outbreak in Illinois. Because of its high resistance to even the most powerful antibiotics, infection can result in 40-50% fatalities.
Much needed political action that encourages testing, the development of preventative and educational programs, a rigorous culture of hospital cleanliness, and in the area of sexual health, a culture of personal and public responsibility, will not only halt the rates of such infections but also reduce the high costs involved, where currently the process is more one of fire fighting rather than fire prevention.
Melissa Lackland is a former finance worker and journalist who gave up the rat race when family life and motherhood beckoned. She now works as a freelance writer, though still maintains a passionate interest in all areas of business.