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Using Antibiotics Wisely

LONDON – To solve the problem of antimicrobial resistance, the world needs not only new drugs, but also new behavior – by all seven billion of us. Because of the misuse and overuse of antibiotics, common infections such as pneumonia and tuberculosis are becoming increasingly resistant to existing treatments; in some cases, they have become completely immune.

The threat is global in scale. According to the Review on Antimicrobial Resistance, which I chair, drug-resistant infections kill at least 700,000 people every year. By 2050, if nothing is done to address the problem, some ten million people a year could be dying from maladies that were once treatable.

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Developing new drugs is an important approach in a coordinated response to fight antimicrobial resistance. But it will not be enough. We also need to reduce our demand for antibiotics and understand that they can sometimes do more harm than good. According to one estimate, nearly half of all prescriptions for antibiotics in the United States are inappropriate or unneeded. So the steep rise in antibiotic resistance is hardly surprising.

Improving people’s understanding of the problem will be crucial to reversing this trend. Most people are either completely oblivious to antimicrobial resistance or incorrectly believe that it is an individual’s body that becomes drug resistant – not the bacteria itself. A better understanding of when to use antibiotics, and how to use them effectively, will help people use them responsibly.

We need campaigns like the one introduced by the Australian charity NPS MedicineWise, which held a competition for videos promoting public awareness of antibiotic use. The result was a series of short, witty films explaining simply and humorously how antibiotics can be misused.

These types of efforts are needed worldwide, particularly in the largest and most rapidly growing countries. The BRIC countries – Brazil, Russia, India, and China – consume fewer antibiotics per person than the US. But they are rapidly catching up as the rate of antibiotics consumption outstrips the pace of economic growth.

Pessimists will claim that behaviors are hard to change, especially when doing so depends on explaining the science of germs to uneducated audiences. That line of thinking brings to mind one of the most abhorrent arguments against making HIV medicines affordable for patients in lower-income countries: People in Africa have no watches, so they will not be able to take their antiretroviral medicine three times a day.

The truth, as researchers have shown, is that Africans are perfectly capable of reliably adhering to antiretroviral therapy – often more so than North Americans. Indeed, in July, UNAIDS announced that the goal of having 15 million people on life-saving HIV treatment by the end 2015 was met ahead of schedule.

Every year on December 1, World Aids Day highlights the issue and raises global awareness. We need a similar effort to address the perils of antimicrobial resistance. European Antibiotic Awareness Day, on November 18, is a good start; but we must also find new, creative ways to spread the message.

Technological innovation brings unprecedented opportunities to reach people directly. Roughly 95% of Chinese and 75% of Indians use mobile phones regularly. In areas where literacy rates are high, sending text messages can be a rapid and effective way to spread a message. Research in Europe and the US shows that 90% of text messages are read within three minutes of being received.

Social media are another powerful and relatively cheap tool to reach millions of people. In China – home to the world’s largest Internet base, with 641 million users – 80% of doctors use smartphones for professional purposes, including by providing medical advice via social media, with some practitioners attracting millions of followers. Enlisting these medical social-media superstars to educate the public on the urgency of antimicrobial resistance is an exciting opportunity.

An anti-smoking social-media campaign led by the World Health Organization provides another model that could be followed. Posts by Chinese celebrities were used to increase awareness of a law banning smoking in indoor public spaces.

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In some parts of the world, the best way to combat drug resistance will be to encourage changes in behavior that reduce the spread of infections and minimize the need for treatment. Proper hand washing is a great place to start. In India, a clever campaign called SuperAmma used images of people exposed to unsanitary situations to encourage hand washing. The campaign successfully and sustainably increased regular hand washing from 1% of the groups involved to about 30%.

The cost of a global effort to raise awareness of the threat of antimicrobial resistance would be miniscule compared to the amount being spent to develop new drugs and technologies, which in any case will take years to become available. Countries should urgently put in place educational campaigns and begin to change behaviors. Together, we can break our bad antibiotic habits.