It’s a pretty standard ritual, especially at this time of year: A cough develops and isn’t going away, a fever spikes a little too high, a scrape begins to ooze a little too much, and before you know it, a provider like me is writing a prescription for an antibiotic. We’re all creatures of habit (patients and docs alike) and we expect antibiotics will work because they generally have in the past. So patients seek them out, and doctors lean on them when they have to.
As we head into the season of peace, joy and infectious diseases, it’s a good time to reflect on how we got here.
But as with all good things, nothing lasts forever. This decade is ending with a dubious distinction: Deaths from antibiotic drug resistance have now reached an all-time high, with 35,000 people dying in the U.S. each year alone, according to a new study from the Centers for Disease Control and Prevention. This spring, the United Nations declared this problem an urgent global crisis in need of immediate action.
As we head into the season of peace, joy and infectious diseases, it’s a good time to reflect on how we got here — and what we can do to reverse a trend on pace to claim 10 million lives annually by 2050 if we don’t use the next decades more wisely than the past one.
Sadly, there’s little hope of doing better on the national scale needed so long as President Donald Trump remains in office. As dire warnings about bacteria becoming more resistant to antibiotics have reached a fevered pitch, the response of the White House has been utter indifference.
In fact, the policy steps that the Trump administration has taken have worsened the problem, including proposing budget cuts to nationwide, hospital-based programs dedicated to the issue and ignoring World Health Organization guidelines on ways to minimize the use of antibiotics in agriculture, a key contributor to this growing epidemic.
Antibiotic resistance means that the bacteria that exist all around us, such as E. Coli and MRSA, are mutating in ways that make existing medications like penicillin ineffective. Mutations are changes in the genetic makeup of bacteria, a literal rearrangement of genes to improve the chances that bacteria can survive exposure to an antibiotic. The odds that they develop resistance increase the more antibiotics are used in daily life. It’s like any threat that exists in this world: The more you’re exposed to it, the more you can learn to adapt.
Which means the more we receive antibiotics in clinics and hospitals, the more likely we are encouraging the development of resistance. Thankfully, there’s significant room to decrease the amount of antibiotics in circulation: A major study in the Journal of the American Medical Association showed that nearly 1 in 3 antibiotics prescriptions in the U.S. from 2010 to 2011 were inappropriate and should not have been given to patients. (Full disclosure: As I call out this problem, I am guilty of this sin, too).
Yet this is only one reason why some forecasts estimate up to 10 million people will die annually from antibiotic resistance by 2050, in addition to a loss of nearly $100 trillion in economic productivity between now and then.
Another major cause is the public health malpractice of using antibiotics as pesticides to maximize crop yields, as noted in the November CDC report. But the practice has been expanded under the Trump administration’s Environmental Protection Agency. Medications like oxytetracycline and streptomycin are being sprayed on citrus crops from California to Florida, much to the pleasure of the agribusiness lobby.
The current administration’s pandering to the agriculture lobby isn’t limited to thumbing its nose at the guidelines produced by its own CDC. Rather, the Department of Agriculture directly rejected guidelines from the World Health Organization (WHO) last year limiting the use of antibiotics in livestock feed, formerly a widespread global practice to enhance animal growth (and subsequent profits) that’s come under greater scrutiny as an avoidable cause of antibiotic resistance.
It wasn’t always this way. Just four years ago, under the Obama administration, a well-resourced national action strategy was developed that specifically sought to reduce inappropriate use of antibiotics in clinical settings. Such initiatives would leverage the expertise of local infectious disease specialists to flag misuse by prescribers and serve as a watchdog to improve future antibiotic utilization. Having federal resources to bolster these efforts in every community nationwide is exactly the type of presidential leadership needed to address this crisis.
Some forecasts estimate up to 10 million people will die annually from antibiotic resistance by 2050, in addition to a loss of nearly $100 trillion in economic productivity.
The Obama strategy was also willing to take a stand against the indiscriminate use of antibiotics to maximize crop yields and meat production. Upon his election, Trump abandoned Obama’s national action strategy, sought deep budget cuts to programs that tackle this crisis and has appointed agency heads to the EPA and USDA who seem to lack any understanding or willingness to engage with the public health community.
Our world is begging for the opposite, for principled leadership guided by core convictions, rooted foremost in a desire to protect the public’s health and safety, even if it means sacrificing political interests in the process. Otherwise, we’ll have a new ritual awaiting us at the doctor’s office: getting a prescription that days later leaves us feeling no better, only worse.