Antimicrobial resistance stands out as one of the most formidable challenges confronting society. “When this happens, our medicines stop working to treat infectious disease,” said Isaac Weldon, a Ph.D. graduate from York University. “What makes it a problem is that human activities are making this process happen much faster, worsening the problem.”
Weldon is part of a group of researchers who argue that efforts to address antimicrobial resistance as only a medical problem are falling short. Instead, what is needed is a shift in attitude to mitigate the most severe outcomes.
“We propose a paradigm shift where we approach the problem of [antimicrobial resistance] as a sustainability challenge rather than a medical challenge,” said Weldon. “Antimicrobials are crucial for promoting human health, but the problem of [resistance] arises as part of the fundamental relationship between human societies and invisible microbial.
“When we see microbes are part of the planet’s ecosystem, we can see the problem […] as a challenge about our never-ending relationship with the natural world, much like climate change and biodiversity loss,” he continued. “This different perspective opens the possibility of focusing on the social drivers of antimicrobial use, rather than solely on the medical response to infectious disease.”
How do we live with microbes?
The COVID-19 pandemic demonstrated how quickly germs can spread globally as a result of our interconnectedness. “If a highly infectious resistant pathogen emerged, then it could follow the same paths of human movement as COVID-19 and spread rapidly around the world,” said Weldon.
Antibiotics are among the most effective and widely used medicines, playing a crucial role in treating infections. However, when they stop working, formerly manageable infections transform into untreatable and often fatal conditions. This circumstance also elevates the risk associated with routine medical procedures like chemotherapy and surgery.
According to Weldon, the prevailing issue lies in the fact that global attention is mainly focused on developing new drugs to treat resistant microbes. Although new drugs are undeniably essential, he contends that it constitutes only a partial solution.
“The problem is that existing medicines are becoming ineffective faster than new drugs are coming out, which means that if we only focused on innovation for new antimicrobials, the already inadequate rate of innovation would need to be radically and perpetually accelerated to keep pace with the rising demand for new therapies,” he said. “Instead of trying to innovate our way out of this challenge, our approach suggests that we need to create more sustainable practices so that we are less reliant on antimicrobial drugs. Less use means less resistance.”
This approach ultimately means that society must learn to live alongside microbes. But what does this mean exactly? “To some extent, antimicrobial resistance is inevitable,” said Weldon. “However, whether it turns into a big social problem depends on how humans and germs interact. Currently, we use antimicrobials in so many different aspects of life that we are interacting with germs in an unsustainable way.
“Living more harmoniously with microbes means recognizing that our actions affect microbial ecosystems, which in turn affect us through resistant or new zoonotic diseases. [We] call into question the underlying social reasons for our currently high use of antimicrobials. Transforming these practices to be less reliant on antimicrobials is crucial.”
Breaking out of “one-size-fits” all solutions
Weldon and his colleague Steven Hoffman argue that our current global approach to tackling antimicrobial resistance needs an overhaul in order to properly address the issue.
They say that the causes and consequences of antimicrobial resistance make it simultaneously a human health, animal health, agricultural, environmental, developmental, and trade issue, with no single global institution poised to comprehensively address it.
“[Furthermore,] there are several instances of overlapping and sometimes conflicting principles, norms, rules, and procedures across [the globe],” they wrote in their their paper published in Perspectives on Politics. “These overlaps and conflicts […] have been found to have both positive and negative consequences.”
The duo underscores that there are no “silver bullets” and that problem solving will need to incorporate the situations and health challenges of diverse populations — a contrast to current approaches that tend to try and apply one-size-fits-all solutions. They also argue that while the best was to tackle antimicrobial resistance remains unknown, diversifying approaches and practices could help us discover what works when and where.
“Instead of engaging in an unwinnable arms race — where microbial evolution typically outstrips our ability to develop and distribute new therapies — shifting our approach to designing social systems that can optimize antimicrobial use, minimize [resistance], and maximize the time-limited effectiveness of antimicrobial drugs offers better chances of achieving sustainability,” they wrote. “Without such changes, our response […] will remain a reactive one, always struggling to outpace microbial evolution rather than sustainably managing it.”
Reference: Isaac Weldon, Steven J. Hoffman, “Fit for Purpose?” Assessing the Ecological Fit of the Social Institutions that Globally Govern Antimicrobial Resistance, Perspectives on Politics (2024). DOI: 10.1017/S1537592723002906
Feature image credit: Roberto Sorin on Unsplash