Global concerns over anti-microbial resistance was the focus of Prof John Watson’s distinguished lecture at Nottingham Trent University this evening. As Deputy Chief Medical Officer for the Department of Health, Watson shared a candid and revealing account over the growing concerns for global health in the face of the uncertainty and challenge presented by the resistance to antibiotics presented in some microbes. Watson shares how his own professional training in respiratory medicine led to his interest and investment in public health, and how ultimately that passion drives his current professional practice through his work for the UK government.
In a refreshingly accessible scientific public lecture addressing ongoing impacts, research futures and troubling world challenges, Watson highlighted how the concern for a post-antibiotic era is already upon us. While developments in healthcare provision are advancing all the time, the focus of tonight’s lecture lay around somewhat darker matter and worrying developments identified around a decline in susceptibility of some diseases due to the successive use of antibiotics. Watson highlights how through a process of natural selection, some bacteria survive exposure to antibiotics an become resistant against modern medicine. Identifying how the fears of post-antibiotic future represent a very real concern largely as a result of the systematic over and misuse of antibiotics. Recognising the difficulties represented by this need to readdress the issue of antibiotic use and prescription, Watson identified some of the discrepancies at work, and particularly at a time which science recognises a need to minimise the use of antibiotics, but many countries have experienced a marked lack of access to antibiotics in the first place. Drawing attention to Dame Sally Davies’ TEDx talk on the subject, Watson raises concern for the gravity of a need for global debate and action.
Highlighting the issue of concern as a very real and ‘thoroughly global problem’, Watson identifyies how what can begin as an isolated problem in a very specific part of the world can very rapidly become a problem for the United Kingdom, like a game of Pandemic writ-royale. However, while measures of address are being put into place to encourage the restriction of antibiotic use within healthcare provision and medicine, Watson provides us with a timely reminder that the use of antibiotics is not restricted as a problem for humans, but that it is important to be aware of the use of antibiotics within agriculture and the environment mapping how the presence of antibiotics saturates the environment within which we live and immerse our lives, Watson discussed the gravity with which such an issue is addressed by the UK government in terms of policy, practice and funding investment in support of future strategy for risk management in this area.
UK government strategy of recent years has focused its energy around research development and policy production in order to address these concerns. Presenting the UK Five Year Antimicrobial Resistance Strategy, Watson identifies how the government strategy publication sought pursuit of a holistic approach to dealing with the threat presented by serious disease which included preventative measures, a focus upon the preservation of the effectiveness of existing treatment, and an identified need for prioritising the need for new developments. Underpinning the entire approach was an identified need to use disease surveillance as a means of targeting essential areas for development through which, what he terms a ‘one health approach’ was adopted in order to pursue internationally collaborative efforts in the development of strategies for serious disease management, prevention and cure. One such research fund identified, targeted around combating serious disease is available through the Ross Fund. Using the findings of such research offers an opportunity to work directly with companies to develop ‘promising products’ to use in the fight against serious disease.
Part of the problem being addressed by Watson was the need not only for a recognition of the impact of the over-use of antibiotics, but also in the hidden impacts of antibiotic use that as a consequence of taking antibiotics we are not only attacking harmful infection, but we are also, often unwittingly, damaging a large body of friendly microbiome that make up a healthy and functional system. In so doing, there is collateral damage evident in the use of antibiotics and as such future research into the design and delivery for antibiotics needs to account for opportunities for targeting effectively and specifically the infection that you’ve got, and a faster route to identifying the right antibiotic needs to be developed so that antibiotics of the future can be administered quickly and effectively.
When considering work being conducted in the field so far in the UK, Watson identifies that although there have been some increases in drug-resistant infections, including a decline in susceptibility to gonorrhea to successive antibiotics (so watch out students!), there have also been some successes. Watson highlights how prescriptions for antibiotics has gone down, which is a step in the right direction for responsible antibiotic management. Future planning is focusing around the movement to a place where medicine practice is able to diagnose a faster route to the right antibiotic use targets infection specifically in order to avoid the collateral damage of hitting healthy microbiomes.
So is a post-antibiotic era upon us? Quite possibly. Perhaps we should think twice before we ask for a course of antibiotics, otherwise, in the words of Dame Sally Davies, we might wake up to a future where put quite simply, the drugs don’t work!
(So make sure you wash your hands!)