Sleepwalking towards an antibiotic apocalypse

“Preparedness 101: Zombie Apocalypse” was a blog post written by the United States Centers for Disease Control and Prevention warning Americans to prepare for natural disasters ­– particularly pandemics – as though they were being hunted by flesh-eating zombies.

On the night of May 18, 2011, the blog post generated 30,000 hits, crashing the usually quiet CDC website. More than one million people read the message on Twitter, where zombies briefly outshone newlywed royals Will and Kate. Four months later, in October, the CDC created a Zombie Pandemic graphic novella to reinforce its message of how to prepare for the next plague.

Associate Professor Mark Davis, a medical sociologist at Monash University, has spent his career studying disease and how it interacts with media coverage, public health messaging, patient experiences and clinical responses. He has studied HIV and hepatitis C, and then moved on to viral pandemics – including the swine flu scare of 2009-10. Now he's turning his attention to antimicrobial resistance (AMR), a medical problem with global implications that has, for reasons unclear, failed to capture the public imagination. AMR is a zombie-free zone.

When the media reports a pandemic “the media acts like a pandemic – the story becomes contagious, peaks and ebbs away”, Davis says.

“The spike in the media that we saw with swine flu, we can’t detect with antibiotic resistance,” he says. “In TV news in Australia for the last 10 years, we see very roughly 10 to 30 news items each year on superbugs, flesh-eating viruses and the like.”

Davis is interested in why the issue fails to gain traction in the public mind – why we're sleepwalking towards disaster. For their part, scientists have known about antibiotic resistance since the 1950s; at the same time antibiotics continued to be prescribed widely, even recklessly.

“Antibiotics used to be a huge business for some companies,” he says. “They would put two antibiotics in one drug. In the US they marketed antibiotics combined with an analgesic – 'try this and you will never be sick'.”

Farm animals are also dosed with antibiotics, a practice that has inevitably contributed to antimicrobial resistance in humans. Wherever antibiotics are administered, resistant strains of microbes evolve. “In the waterways around factories that make antibiotics, you find drug-resistant organisms,” Davis says.

If antibiotic-resistant bacteria, viruses, fungi and parasites gain ascendancy, the advances we've seen in public health since antibiotic use became widespread in the 1940s could potentially be reversed.

Complicating the fight

Antibiotics make much of modern medicine possible. Multi-drug-resistant tuberculosis already infects about 480,000 people a year, while drug resistance is also complicating the fight against malaria and HIV. The World Health Organisation warns that AMR has the potential to compromise the success of surgical and chemotherapy treatments in the future.

Watch the latest episode of A Different Lens: Beating the Superbugs 

Only four new classes of antibiotics have been developed in the past 40 years, compared to about 10 a year between 1950 and 1970. At the same time, the number of big companies actively researching antibiotics had dropped to four in 2014, from 18 in 1990.

In these circumstances, publicly funded research becomes crucial. In August 2017, a team led by Professor Jian Li from the Monash Biomedicine Discovery Institute (BDI), was awarded $US1 million from the US National Institutes of Health to further his pioneering work on tackling antibiotic-resistant “superbugs”.

Li is part of BDI’s antimicrobial resistance group. The research aims to improve the use of a class of antibiotics called polymyxins to treat deadly lung infections caused by multi-drug-resistant bacteria. Polymyxins are an early type of antibiotics that were abandoned in the 1970s because they were toxic to the kidneys. Li’s research aims to make them safer and more effective.

"In the waterways around factories that make antibiotics, you find drug-resistant organisms."

Davis collaborates with Monash microbiologist Professor Trevor Lithgow, another researcher from the antimicrobial resistance group. Lithgow mentored BDI researchers Dr Matthew Beloussoff and microscopist Dr Mazdak Radjainia, who led an international effort that uncovered the molecular mechanism used by golden staph to evade antibiotic treatment. The results were published in May 2017.

Davis has received a three-year Australian Research Council grant for his multidisciplinary research, which includes sociology, medical anthropology, health psychology, media and journalism. “This will be an anthropological and sociological investigation. We are going in deep – what do antibiotics mean to people and how do we use them?”