Student Life - Keith Woods Essay Prize (Antibiotics, will they be the death of us?)

Receiving my prize from Eric Rooney MBE (BASCD President)

Introduction

I recently received the Keith Woods memorial essay prize from the British Association for the study of Community Dentistry (BASCD) for my essay discussing the crisis of emerging antimicrobial resistance entitled 'Antibiotics, will they be the death of us?'.

What IS antimicrobial resistance and why is it a problem?

Excerpt from 'Introduction':

'In 1347 the world was on the brink of perhaps the single most devastating pandemic in recorded history. The Black Death is thought to have eradicated 30-50% of the human population, amounting to some 200,000,000 dead. 8+9 The cause of this plague was Yersinia pestis, a Gram-negative bacterium harboured by rat fleas. Fleas were carried by rats and fed on humans consequently spreading the infection.

If Bubonic plague returned in the 21st century it wouldn’t be unreasonable to assume that it would be swiftly dealt with by the modern-day counterparts of Penicillin - drugs such as Doxycycline or Ciprofloxacin.

For years this has been true, and we still live in relative antimicrobial comfort, safe in the knowledge that most infections are at the mercy of our antimicrobials and hygiene practices. Consider an alternative reality in which bacteria such as Yersinia pestis could adapt to evade our drug therapies. Imagine the potential for mass casualties and then consider that this is already a reality. 10 Today over a half of deaths from clinical infections in Europe alone are a result of multi-drug-resistant (MDR) bacteria. 11 The estimated economic impact of treating MDR infections in the EU amounts to €1.5 billion a year in increased healthcare costs and reduced productivity. 12 In the US, treatment of MDR bacteria requires an annual spend of around $1.87 billion, which is more than the annual spend on influenza. 13'

So, will they be the death of us?!

Excerpt from 'Conclusion':

'So, is antimicrobial resistance(AMR) going to be the death of all mankind? Have antibiotics consigned the human race to bacterial oblivion? The author believes that, fortunately, this is not likely to be the case. Whilst the developing problem of AMR worldwide is a huge cause for concern and has the potential to cause significant financial and human losses, the overwhelming body of evidence 13, 20 + 30 suggests that antibiotics will not “be the death of us”.

What, in that case is the potential scale of this problem? The O’Niell report was commissioned by the British Prime Minister David Cameron in 2014 to “Examine and boost awareness of the economic issues surrounding the development, spread and containment of antimicrobial resistance”. The final report was published in early 2016 and contained detailed and evidence-based projections of the potential impact that AMR could have. Based on rising AMR in 6 key pathogens the report projected that without action the resulting death rate could rise to 10 million a year by 2050. Subsequent associated economic losses were valued at $100 trillion a year. 30 An infographic produced by the report represents perhaps the grizzliest prospect of this potential future. (Fig 4.)

Fig 4. Promotional material from the O’Neill report illustrating the potential reality of a future where AMR infections could kill up to 10 million people a year, or one person every 3 seconds.Source: O'Neill, J., Tackling Drug Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Resistance (2016).

In conclusion, it seems unlikely that AMR will end the human race in a 21st century black death’esque pandemic. However, if allowed to develop unhindered, the effects will be far-reaching and deadly. Prolonged courses of treatment, increased surgical morbidity/mortality and deaths from previously treatable infections may become a reality for millions. These are the risks if the world does not now act appropriately, proportionally and promptly in the face of this advancing antimicrobial dark-age.So, is AMR going to be the death of all mankind? Have antibiotics consigned the human race to bacterial oblivion? The author believes that, fortunately, this is not likely to be the case. Whilst the developing problem of AMR worldwide is a huge cause for concern and has the potential to cause significant financial and human losses, the overwhelming body of evidence 13, 20+30 suggests that antibiotics will not “be the death of us”.

The BASCD

'The BASCD is the UK’s professional association for the science, philosophy and practice of promoting the oral health of populations and groups in society. The British Association for the Study of Community Dentistry was founded in 1973 by leading dental professionals concerned with the needs of populations and groups in society, with a specific emphasis on preventing and controlling oral diseases and conditions.'

The BASCD were kind enough to invite me along to their winter meeting which was both interesting and informative. I learned a great deal from working on this essay and i made some great friends and contacts at the conference. I can heartily recommend entering this prize to any ambitious undergraduates who are reading this. See below for this years title.

Link to the 2017 Keith Woods essay title: www.bascd.org/news/keith-woods-essay-competition-2017

Thanks for reading guys,

Bye for now.