Drug-resistant diseases make it more likely it’ll be the little things that’ll kill us

ONCE UPON A TIME, common diseases and even simple infections were likely to kill you. That time may be returning, however, with invisible little germs potentially posing an existential threat to our merry bunch of homo sapiens.

While we’ve enjoyed the respite known as the age of antibiotics, we’re now solidly embarking on the age of antimicrobial resistance where long-uncommon infections such as pneumonia and tuberculosis are returning, this time immune to the drugs we throw at them. Health officials attribute this to the overuse and misuse of antibiotics, the wonder drugs that came into widespread use with the mass production of penicillin during the Second World War and eventually migrated into many facets of our lives, including the food chain.

Now, anti microbial resistant infections are becoming more frequent and increasingly difficult to treat. While antimicrobial resistance (AMR) can occur naturally, the inappropriate use of antimicrobials in health care, animal health, food production, and sanitation increases the emergence and spread of resistance, officials note.

That’s the reason we now have something called World Antibiotic Awareness Week, which just wrapped up – as I’m sure everyone took note.

The problem even got its own political boost last year when the globe’s heads of state signed on to a United Nations declaration. Nations committed themselves to a coordinated effort to counter the root causes of AMR, principally the overuse of antibiotics, while looking for new solutions to resistant strains of diseases.

This all sounds rather inconsequential – well, until you develop a resistant strain of, say, strep throat – accept for the fact that effective antibiotics are essential to much of modern medicine. Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk, notes the World Health Organization (WHO).

In the absence of effective antibiotics, it becomes much too risky to carry out what we now consider basic medical procedures, essentially returning us to a (deadly) time before the drugs were identified – that bit of modern medicine tied to Alexander Fleming’s 1928 discovery of penicillin.

A 2014 study in the UK, the Review on Antimicrobial Resistance, predicted antimicrobial resistance could lead to 10 million deaths globally each year by 2050, mostly in Africa and Asia, as you might expect, at about four million for each region. The report’s somewhat alarmist tone has met with some resistance of its own.

Nonetheless, the World Health Organization finds that resistant strains of diseases are on the rise, fostering en environment where now some 480,000 people each year develop multidrug resistant tuberculosis, for instance.

While antibiotic use is at the forefront of concerns, resistance is also growing to antifungals, antivirals, antimalarials and anthelmintics (used in the treatment of parasites).

That situation not only portends more deaths, but the cost of health care for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs. Estimates for future health care costs come in at billions of dollars, and increase exponentially if you factor in future lost productivity and other economic spinoffs.

Because there’s a huge connection to our food, the issue is a pressing one today.

Typically, antibiotics see much more frequent use in agriculture than in the human population – in the U.S., some 70 per cent are for animal use. Widespread use has been abated – burger chains, for instance, have committed to antibiotic-free meat – but past and present practices have come at a price.

The U.S. Centers for Disease Control (CDC) notes that the germs that contaminate food can become resistant because of the use of antibiotics in people and in food animals. For some germs, like the bacteria salmonella and campylobacter, it is primarily the use of antibiotics in food animals that increases resistance. Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, the agency recommends more restricted farm use of antibiotics that are medically important to treating infections in humans. Furthermore, antibiotics should only be used to manage and treat infectious disease, not to promote growth, which has been a practice since the 1940s.

The CDS estimates more than two million illnesses each year due to antimicrobial resistance, with some 23,000 deaths in the U.S.

Here, Health Canada has recently put restrictions on antibiotic use in agriculture. Only drugs the agency determines do not pose a risk to human health or food safety may be imported by livestock owners, and only in limited quantities.

A new program that will allow access to low-risk veterinary health products, such as vitamin and mineral supplements, for companion and foodproducing animals has also been put in place to allow manufacturers to import and sell these products. Veterinary health products that pose a low risk to human health when used in food-producing animals and can be used to keep animals healthy may, in turn, reduce the need for antimicrobials, the agency hopes.

The health of animals takes on even more significance when you factor in the increasing risks that come with our encroachment on wildlife habitats. In Pandemic: Tracking

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Contagions from Cholera to Ebola and Beyond, author Sonia Shah estimates some 60 per cent of new pathogens come from the bodies of animals.

She also cites the influence of international travel, especially the rapid movement of air travel, as an important factor in possible future epidemics.

For the dystopically inclined – I count myself among them – the prospect of a pandemic killing of large swathes of humanity gets even more likely as pharmaceuticals lose their efficacy. Even a large outbreak of influenza, such as we saw in 1918, could kill 50 to 100 million people, largely in the developing world.

Those are the kinds of numbers that might have you going out for the flu shot, and perhaps toughing it out through new next minor ailment that might have had you running for (ineffective) antibiotics.