Antimicrobial resistance marked as concern
Columbus, Ohio – The issue of antimicrobial resistance is of growing concern to animal, plant and human health, according to dean of The Ohio State University College of Veterinary Medicine Lonnie King.
King, a self admitted non-expert on the subject of antimicrobial resistance, says he has looked at the issue through a variety of lenses, from the academic perspective and practitioner viewpoint to that of a regulatory and public health view, and says, “I’m convinced that the multi-perspective view is the only way we will come up with a solution.”
“I have a strong personal feeling that this is one of the mostly singly important issues facing animal agriculture, plant agriculture and public health today,” King comments. “Antimicrobial resistance is never going to go away, and the struggle against antimicrobial resistance is a war we will never completely win.”
However, he notes that there are key battles that must be won for humanity to continue waging the war against the microbial world.
“We are forced to coexist with antimicrobial resistance,” he continues, adding that the interconnectivity of the world today only contributes to the problem. “In our interconnected world, we have given microbes a comparative advantage.”
Despite the inherent imbalance, provided by the ability of pathogens to continually evolve based on selective pressures, King notes that constant adaptation and improvement of human’s position by continually changing strategies for animal and plant agriculture, as well as human medicine.
“Antimicrobial resistance is the acquired ability of an organism or pathogen to withstand an antibiotic that kills all of its sensitive counterparts,” explains King. “It originally arises from random mutations or from intact genes that have similar resistance.”
When microbes are exposed to antibiotics or antimicrobials, King notes that there are selective pressures, allowing those naturally resistant strains to survive.
Additionally, the ability of pathogens to transfer genes between one another using a process called horizontal gene transfer allows resistance to spread even in harmless environments.
“Resistance is often considered simplistic – either an organism is or it isn’t,” says King, “but that is simply not true. Resistance exists as a gradient reflect the phenotypic and genotypic variations in natural microbial populations.”
“The threat of antimicrobial resistance is subtly complex, difficult and can be polarizing,” King says. “It is a hard topic to grasp, understand and convey, and the important messages about antimicrobial resistance are not getting across, not to even to research scientists and infectious disease specialists, let alone the public.”
King explains that the problem is often portrayed as being the product of misuse or overuse of antibiotics, emphasizing that, even without the use of antibiotics, resistance would still occur.
At the same time, antibiotics have greatly improved life for humans, meaning that discontinuing use of antibiotics is neither practical nor a good idea.
“In retrospect, this antibiotic era has two underlying cardinal sins,” he comments. “One is neglect and at time a complete abandonment of preventative measures in favor of a single-minded antibiotic strategy against bacterial infection.”
“Secondly,” King continues, “was the failure to seriously consider the consequences of the fact that the overwhelming majority of antimicrobial products and antibiotics are products of the microbial world itself.”
The result, according to King, is, “These organisms are inherently designed to play the game and to win.”
Then, in the 1960s and 70s, the surgeon general announced that the era of infectious disease had ended because of use of antimicrobial agents and vaccines.
“Disease control, prevention and sanitation were deemphasized because people believed the cure was at hand,” King says. “There has also been a 40 to 50 year gap with minimal discover and approval of new drugs. We need to correct that.”
As the number of factors against the ability of humanity to effectively combat antimicrobial resistance continues to mount, King compares the current situation to the “burning platform” concept.
“When an off shore oil well caught fire outside of Scotland, people were faced with the choice of certain death or to jump into the cold North Sea and face probable death,” King explains, noting that death isn’t the threat with antimicrobial resistance, but rather it is the inability to solve the problem. “I think we can’t afford not to jump.”
A “wicked” problem
“A wicked problem is one that constantly changes and sees unparalleled challenges that often occur in the social context with diverse opinions from numerous stakeholders,” King explains. “Wicked problems represent issues that traditional processes can’t resolve.”
In other words, because the problem of antimicrobial resistance is “wicked,” it will require new thinking by scientists from a variety of backgrounds and a coming together of groups to devise new strategies.
“With a wicked problem, unique and past experiences aren’t helpful, and unexpected consequences are often generated,” he continues. “These problems are complex and entangled, unprecedented, difficult to define and enigmatic.”
King also notes that by taking a One Health approach, or an approach that looks at the problem from a variety of angles, including plant, animal and human health perspectives, environmental and ecological considerations, and social, political and economic implications, antimicrobial resistance will be more effectively addressed.
Interest, right and power
In developing a solution, King mentions that a variety of people will have to come together with a single interest in mind, putting aside the personal angle, as well as the question of who is right or wrong.
“There is nothing personal about this,” he says. “We must be hard on the problem, but soft on people. Don’t get into dialogues or point fingers. It is the problem we are trying to solve.”
He also notes that by focusing on the interest at stake – avoiding antimicrobial resistance – rather than who is right or wrong, or emphasizing the power struggle, the likelihood that all groups who come to the table will be satisfied increases.
“This is a wicked problem that can be successfully ameliorated, although not necessarily completely resolved, and that is ok,” commented King. “I’m a non-expert, but I’ve watched this unfold for a long time, and I truly believe we can solve this issue in a way that will satisfy all of our interests.”