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Biggest Biosecurity Threat? Antibiotic Resistance

by talk2sarahw1 min read18th Feb 20209 comments


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Is anyone doing or has done research on antibiotic resistance?

Antibiotic resistance is a one of the top 10 public health issues, according to WHO. It is projected to take more lives than cancer to become the leading cause of mortality by 2050 (O'Neill, 2014). It currently takes 200,000 children's lives worldwide (Costello, 2016). However, one in two Americans (K-12 students and adults, separately) do not know appropriate antibiotic use for bacterial, not viral infections (Funk & Goo, ‎2015). Similarly, one in two cases of AR is from antibiotic misuse per year (Ventola, 2015). This association is uncanny and must be remediated with education. Antibiotic resistance is the heart of biosecurity as a global catastrophic biological risk.

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Hi, To be honest I just stumbled across EA from a google search looking for suitable charities to donate a portion of money too concerning the locusts situation in the Horn of Africa. So I'll say its a very impressive forum you have here and well done all for taking part, its great to see personally.

As to the topic at hand as a recent open university mature student one of my projects was on antibiotic resistance in the environment - specifically wastewater concentrations. There is a big problem with antibiotics being used in animal farming and the use in humans leading to environmental accumulations. Human use is often not metabolised by the body and excreted in active form where antibiotic resistance may develop in water treatment plants (WWTP) and water treatment sinks. In general our 1950s style sewage treatment isn't very good at removing these, or other persistent pollutants as well.

One of the papers I found "Review of Antimicrobial Resistance in the environment and its Relevance to Environmental regulators", Singer et al from NERC, wallingford, UK gave a really excellent background. I was deeply impressed as well by Switzerlands plans to upgrade half their WWTPs. Much of how much environmental contamination contributes seems largely unknown - I remember its the above NERC paper that lists heavy metals and other locally occuring conditions as co-factors although there are a few others.

Anyway I'm a big out of my depth for now, I wish I'd found you guys earlier on in my life, but will be keeping an eye out on this as things progress in my life. I hope some of the above is helpful.

This was a really good first comment! Welcome to the Forum, and I hope you continue to read and respond to posts. (I'm the lead moderator here.)

1Philip R1yThank you for the reply, its good to hear the comment was appreciated. I hope this forum may help me continue my interest in environmental issues whilst searching for work and cleaning up after mental health issues the last few years. Its good to hear from you, sorry about the delay in replying to this.

Welcome to the Forum! Thanks for asking an interesting question.

I'm not aware of any EA funding going toward antibiotic resistance, though it was the subject of an Open Philanthropy shallow cause writeup (and there may be funding I don't know about). 

Also, I'd recommend you include links to the papers you are citing to make it easier for people to follow your argument (you can highlight text in the Forum's editor to get a "link" button that lets you add a URL).

Finally, while I don't know much about this topic in particular, "1 in 2 Americans don't know how to use antibiotics appropriately" plus "1 in 2 cases of resistance come about as the result of antibiotic misuse" doesn't seem to necessarily imply that education is the best way to respond to AR issues. 

For example, we could change the way doctors prescribe antibiotics to make misuse less likely without changing the way we educate patients (see this example from the UK's Behavioural Insights team). We may also wind up focusing on resistance that comes from sources other than misuse, if there are effective solutions in those areas. Sometimes, the most effective way to work on a problem doesn't involve tackling its biggest sub-problem.

Hi Aaron, thank you for your thoughtful response! The shallow cause writeup talked about public education on the "stewardship of existing antibiotic resources" ("Antibiotic Resistance," 2013). I do understand that the two statistics may imply separate cases but antibiotic misuse. However, the case study in France, the European nation with the highest antibiotic prescription rates, revealed that an campaign called “Antibiotics are not automatic” administered in France decreased prescriptions by 45% and antibiotic consumptio... (read more)

2Aaron Gertler1yThanks for adding links! Is the school-based work you're doing something you hope will become California policy at some point? If so, is it based on similar policy that was successful elsewhere?

Hi, since half a year back I am running a foundation focusing on prevention of antibiotic resistance and am working very actively with mapping up the area: parfoundation.org Feel free to reach out if you’d like to have a chat about it! I could also write up a forum post on the subject soon-ish!

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Hi, I'm an EA working in a prominent antibiotics resistance lab. From my point of view, antibiotics resistance is a big issue, resistance is growing, HOWEVER, there are actually a lot of medications in the pipeline that are effective but weren't brought to market because it's not financially viable right now (that I heard in a talk by Floyd Romesberg). There are also other interesting therapies like antimicrobial peptides (explanation here: https://www.ncbi.nlm.nih.gov/pubmed/15761415 ). My lab developed an ML model that will help doctors in Israel select the most optimal antibiotic (https://www.nature.com/articles/s41591-019-0503-6 ) and also sequencing is getting so good that it's not improbable that in 10 years, IF THERE WILL BE A NEED you'd come to the Doctor, he'll swab you and get a full antibiotics resistance profile, and prescribe you a medication accordingly.

The reason that these medications and technologies aren't implemented is that antibiotics resistance is still more or less manageable, it is not at a crisis level. Unlike pandemics, a global antibiotics resistance crisis doesn't rise in one day (though it is quick! there was essentially very little 70 years ago) so that means that was the situation to become worse, it is possible to draw on all these technologies to form some sort of defense. However, it is true that many people die of antibiotics a year and it will likely affect developing countries disproportionately. All in all, it is true that antibiotics resistance is a threat, but it's just not a GBCR.

This fits with my general impression that biosecurity experts in EA (at OpenPhil, FHI, and elsewhere) don't generally consider antibiotic resistance to be a top-priority threat.

Reading this question made me realise that I don't have a very detailed understanding of why that is. What you describe sounds like an important part of it.