The drug-resistant bacteria crisis no one’s talking about

COVID-19 has wreaked havoc on the world for the past two years, but there’s a potentially deadlier threat creeping across the globe right now that hardly anyone is talking about. According to a recent report in the medical journal The Lancet, drug-resistant bacterial infections were linked to five million deaths worldwide in 2019. According to a UK government study, antimicrobial resistance (AMR) could kill ten million people annually by the year 2050. Moreover, as with COVID-19, drug-resistant bacterial infections aren’t equitable, and poor and marginalized populations are the hardest hit, both in North America and around the globe. TRNN correspondent David Kattenburg speaks with Dr. Shira Doron and Dr. Tomislav Meštrović about the growing AMR crisis, why it has garnered so little public attention, and what can be done to address it.

Dr. Shira Doron is an Associate Professor of Medicine at Tufts University and the Director of the Antimicrobial Stewardship Program at Tufts Medical Center. In 2021, Dr. Doron co-authored a letter to the journal Nature Medicine entitled “Antibiotic Resistance: A Call to Action to Prevent the Next Epidemic of Inequality.” Dr. Tomislav Meštrović is a medical doctor and clinical microbiologist, and an associate professor at University North in Croatia. He’s also a scholar at the Institute of Health Metrics and Evaluation at the University of Washington.

Pre-Production/Studio: David Kattenburg
Post-Production: Adam Coley


TRANSCRIPT

David Kattenburg: Welcome to The Real News Network. I am David Kattenburg.

It is a staggering statistic. This past May, US officials announced that COVID has killed a million Americans. The number is likely higher. Globally, over 6 million have died since the pandemic began in January 2020. Meanwhile, a potentially deadlier pandemic is sweeping the planet: bacterial infections, untreatable with antibiotics. According to a recent report in the medical journal The Lancet, in 2019, drug resistant bacterial infections were linked to 5 million deaths worldwide. One and a quarter million deaths were directly attributable to drug resistant bacterial infections. According to a UK government study, by 2050, antimicrobial resistance, or AMR, could kill 10 million people annually. As with COVID, drug resistant bacterial infections are not equitable. The most marginalized are the hardest hit in North America and globally.

Joining me to talk about the drug resistance crisis, two experts in the field: Shira Doron is an associate professor of medicine at Tufts University in Boston, and the director of the Antimicrobial Stewardship program at Tufts Medical Center. In 2021, Dr. Doron co-authored a letter to the journal Nature Medicine entitled “Antibiotic Resistance: A Call to Action to Prevent the Next Epidemic of Inequality. Shira Doron joins us from Boston.

Tomislav Meštrović is a medical doctor and clinical microbiologist, and an associate professor at University North in Croatia. He’s also a scholar at the Institute of Health Metrics and Evaluation at the University of Washington. He’s worked closely with the authors of that Lancet study on the global burden of drug resistant infection. Tomislav Meštrović joins us from Seattle, Washington.

Hello to the two of you. It’s good to have you. I’d like to ask you to start off, is the drug resistance crisis receiving the media attention it deserves? And is it a crisis? Is it a global crisis? Shira Doron, why don’t you start?

Shira Doron: Yeah, it is a crisis, and it isn’t receiving the attention it deserves. People like me who work in a hospital and take care of patients with complicated infections, we see it every single day, and increasingly we see patients who have infections for which we have no antibiotics. We have nothing in the arsenal. And yet it isn’t in the media, and why is that? Maybe because it isn’t novel. Maybe because it’s been happening very gradually and worsening over time, and therefore it doesn’t get the same kind of attention as something like COVID-19, a novel virus, obviously, that can affect everybody. And maybe it’s because people don’t feel like it touches them. But it will ultimately touch people in all walks of life eventually, and that’s why these calls to action are so important.

David Kattenburg: And it’s amazing. 160,000 deaths in the United States each year attributed to or directly linked to antibiotic resistant infections. 160,000 deaths each year.

Shira Doron: Yeah. And we feel that. And to me that’s not a surprising number given what I see every day. I wonder if people think there will always be another antibiotic developed by pharmaceutical companies, but I don’t think we can count on that. I know we can’t.

David Kattenburg: Tomislav Meštrović, your thoughts on this?

Tomislav Meštrović: Yeah, I completely agree with what Shira has said, and AMR is definitely one of the biggest threats of this century, and also poses a threat not only to human health, but also to animal health, to food, to our environmental security, and of course global economy also. But the news media coverage and how the AMR is conveyed or framed in the media can then powerfully shape public perception of AMR risk. But, as Shira said, in many countries, news coverage on this issue is very sparse, and articles commonly represent AMR as a social problem, that it’s mainly caused by, for example, dirty hospitals, or by some others who misuse or overuse antibiotics.

But the role of many important social actors is neglected. The role of social determinants of health that have a role in AMR are marginalized, and a lot of media coverage revolves around new scientific discoveries [inaudible] related to AMR and AMR solutions. But as Shira mentioned [inaudible] new antibiotics won’t be always available, and this sometimes puts individuals in the position of ignorance, and then they lack agency for the AMR agenda. And maybe sometimes how the stories are covered may even undermine the public’s motivation for taking collective action to tackle AMR, and maybe sometimes even can trigger feelings of helplessness, paralyzing individual actions. This is something that we have to take into account, especially now when we know the full scope of this problem and of this issue, we have to work on the public understanding of AMR and exactly what drives it forward.

David Kattenburg: And how is AMR covered in the media in your view, Tomislav, that is misleading or not helpful?

Tomislav Meštrović: Media attention mainly fluctuates around either official reports or scientific discoveries, but seldom around, for example, reports of inappropriate antimicrobial use. And for example, despite a growing research interest in the epidemiology of AMR in low and middle income countries, the limited research in media representation of AMR risk in these countries may be, for example, due to a general overlook of the importance of media context in shaping public perception, policies, and stakeholder engagement in these countries regarding the AMR, and this is a problem that we need to be mindful of.

David Kattenburg: Shira Doron and Tomislav, what drives antimicrobial resistance? So we’re talking about bacteria that are out there. They’re common. Common species, common strains. But the emergence of strains that are resistant to some or numerous or even all antibiotics, we call these superbugs. What drives the proliferation of antibiotic resistance? What makes it happen? Shira?

Shira Doron: Well, mainly, it’s antibiotic use, antibacterial drug use. And I like to say it isn’t overuse of antibiotics that causes resistance, it’s use of antibiotics that causes resistance. And some of it we have to do, some of it is absolutely necessary, so we better not do the antibiotic use that isn’t necessary.

That antibiotic use is happening in healthcare settings, actual antibiotic prescriptions. It’s happening when people take unprescribed antibiotics. It’s happening when people give antibiotics to animals, both agricultural and companion animals. And then it’s happening in the environment. Run-off from farms where antibiotics have been used. Or even just, and to a small extent, people dumping unused antibiotics into landfills, et cetera. And then there’s a little bit of use, actually, in plant agriculture as well. So there are just so many places along that route now where we’re essentially pumping antibiotics into our environment, changing human and animal microflora under that evolutionary pressure, and that’s only going to get worse over time.

David Kattenburg: Because when you expose bacteria to antibiotics, the ones that don’t die, proliferate. What doesn’t kill them makes them stronger. Some of them, they just naturally develop mutations that make them resistant, where use of antibiotics is selecting for resistant strains, isn’t it?

Shira Doron: That’s evolution 101. The bacteria are going to try to survive, and they will mutate accordingly.

David Kattenburg: And so let’s take this apart a little bit. You’re talking about misuse of antibiotics. Break this down a little bit for us. Tomislav, using antibiotics to treat viral infections, or broad spectrum versus narrow spectrum and all this, is the basics.

Tomislav Meštrović: Yeah. Really important points that Shira has covered.

David Kattenburg: Run through that.

Tomislav Meštrović: Yeah. When we talk about misuse or overuse, sometimes of antibiotics in humans that pertains to, for example, not finishing a course of antibiotics. And like you mentioned, taking antibiotics for viral rather than bacterial infections. And then also –

David Kattenburg: Because viruses are impervious to antibiotics.

Tomislav Meštrović: Yeah. It’s completely different. Bacteria are prokaryotic cells that we can use some of the structures to target with our antibiotics that viruses just don’t have. Viruses have to enter human cells to reproduce. So these are completely different organisms, and this is why antibiotics won’t work for viral infections.

But also, Shira covered some other important points of general use of antibiotics. For example, we sometimes, even in whole states and countries, have mass drug administrations. Which means regular provision of antibiotics to a large group of people to treat an infection, regardless of whether individuals are ill or not. This is one also important drivers of resistance.

David Kattenburg: Run past this. Go through this for me. What happens? Just mass provision [inaudible]?

Tomislav Meštrović: Yeah, so sometimes you have public health programs that are based on mass provision of antibiotics to, in a way, you try to prevent certain infections. People may not even be ill but they receive antibiotics, so this is also something that can be considered as one of the potential drivers of antimicrobial resistance. And here we see it’s antimicrobial use, like Shira has mentioned. Not misuse or overuse, but just use in a preventive sense, but then you can end up with an antimicrobial resistance problem as well. So these are some important points that need to be considered when we talk about using antibiotics.

But if we look at the drivers of AMR, it’s not just antibiotics. For example, sometimes we lack quick, accurate tests to diagnose infections, which can then have a propensity to further foster the spread of AMR and resistant microorganisms. We don’t have enough effective vaccines, or even the ones we do have there is a poor uptake of those. And of course, human travel today. We live in a globalized world, and when people travel from one area of the globe to another they can spread these resistant microorganisms. So they’re spread in the community, not only in the healthcare system. These are all, I think, important drivers of AMR on top of the overuse or misuse or just use of antibiotics.

David Kattenburg: Shira, talk a bit about the problem of the prevalence of antibiotic resistant infections in hospitals.

Shira Doron: The problem is that it is so prevalent that we see a patient with an infection and we must cover them with antibiotics, what we call empirically, before we know what the organism is. Cultures, unlike other lab tests, have to cook. They take time to grow. And only once you grow them can you then test them for what genus and species of bacteria you have and then what antibiotics will work against it. It can take usually about three days to get that answer. In that time you need to give them something. When you have seen over and over again that the bacteria that your patients have been growing are resistant, you are very much inclined to give them the broadest spectrum antibiotic possible so you don’t get caught with your pants down not treating the resistant organism.

And so, my role in the hospital is antimicrobial stewardship, making sure that antibiotics are being used in a prudent fashion. Right dose, right selection of antibiotic, right duration, right diagnosis. And what I fight against all day long is clinicians wanting to be sure that they don’t get it wrong who will use overly broad or very broad antibiotics so that they don’t miss the organism. And yet what we need to do – And it’s difficult – Is we need to try to keep antibiotics as narrow as possible using statistics, sometimes missing the organism, but trying to mostly capture the organism that the patient is likely to have.

So, broad spectrum versus narrow spectrum. Broad spectrum covers a lot of organisms, a lot of genus and species combinations. And even if they happen to harbor resistance mechanisms, narrow spectrum means it might only cover the most likely organism that that patient has given their most likely site of infection, and every single time you prescribe an antibiotic, it’s a balancing act.

David Kattenburg: So I remember once going into the doctor. I had a horrible throat, and I thought I must have a strep throat. I stuck my tongue out in the mirror and it looked awfully red and I went into my doctor. I said, Jack, I got a strep throat, and he says, well, what makes you think that? I said, oh, I feel awful. So in the office he did a little swizzle with a stick and stuck it in a tube and he said, go sit out in the office for 10 minutes. And 10 minutes later he calls me back and he says, bah, it’s a viral infection. Go home. I’m not going to give you any antibiotics.

Shira Doron: And on the other side of the spectrum, that’s a good doctor. He knew that it was likely to be viral and he didn’t give you any antibiotics. On the other side of the spectrum are doctors that would say, okay, well, you could have a virus, you could have strep, or you could have something else. So instead of nothing or penicillin for strep, I’m going to give you a broad spectrum antibiotics like Z-Pack that covers more things, because I don’t want to get it wrong, and I don’t want you to get sicker, and I don’t want you to come back.

The physicians these days, prescribers often say, I’m going to do this just to be safe. And what they fail to realize is that giving overly broad antibiotics or giving antibiotics when they’re not indicated isn’t the safest option. And this is really a behavioral science thing. It’s a psychology thing. What makes us prescribers say, the safe option is to give you too much treatment. The safe option is to give you something that I know is going to promote resistance. Why isn’t the safe option to give you nothing and see how you do for a couple of days and have you call if you’re not well?

David Kattenburg: Well, let’s come back to some of these very practical, grassroots, down-home ways to approach antibiotic resistance. But Tomislav, can you tell me a bit about the… Briefly, it was a large study published in The Lancet, “The Global Burden of Antimicrobial Resistance,” studies done around the world. Tell me about this study and what the results were. I gather the highest burden of antimicrobial resistant infections or resistant infections are in West Sub-Saharan Africa, but tell me about this study briefly and what it found.

Tomislav Meštrović: Yeah. Thank you, David, for highlighting this study and this paper, because it is today the most comprehensive approach. It says the global burden of AMR. Before that we had a frequently cited review on antimicrobial resistance, also known as the O’Neill paper from the United Kingdom, that estimated that by 2050 we will have the loss of 10 million lives per year due to AMR. That paper was heavily criticized. It was not a primary analysis. It was not peer reviewed, and many wondered whether the threat here was overestimated.

But then, the Institute for Health Metrics and Evaluation, since they’re invested in the global burden of disease study, I understood that the full picture of the global burden of disease cannot be painted without the insights into the AMR problem, and this is why this huge collaboration with the University of Oxford and many other partners started. And when the paper was published, and even before that when we had the results, even then everyone were astonished that the estimations reveal that almost 5 million people who died in 2019 had some drug resistant bacteria, and that AMR directly caused approximately 1.3 million of those deaths, making it a leading cause on a global scale. The magnitude of the problem was shown to be at least as large as some other major diseases such as HIV and malaria, and potentially much larger. Which means the figure that I mentioned from IHME, we are much closer to that figure than we previously thought, and that over a million people per year are already dying due to infections such as lower respiratory, bloodstream, and intra abdominal infectious syndromes that are further complicated with the AMR. And…

David Kattenburg: [inaudible].

Tomislav Meštrović: Yeah, of course. So first I would like to emphasize that this study estimated both pathogens and specific pathogen drug combinations. So when we look at the separate pathogens, six of them were each responsible for more than a quarter of million deaths associated with AMR. And these were the Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae or strep pneumo, Acinetobacter baumannii, and Pseudomonas aeruginosa. And in seventh place, it’s also, I want to emphasize, it was Mycobacterium tuberculosis, the causative agent of tuberculosis. And within this pathogen, of course, some pathogen drug combinations are very pervasive. Like you said, MRSA, and this is methicillin-resistant staph aureus. Or for example –

David Kattenburg: For staphylococcus aureus, it is resistant specifically to methicillin.

Tomislav Meštrović: Yeah. And by that, we mean also then that this resistance, these strains are resistant to many beta-lactam antibiotics. Some of these beta-lactam antibiotics were the first ones to be introduced into clinical practice historically, and now we see that we are losing the battle here and that many pathogens are resistant to them now. And also –

David Kattenburg: These are the penicillins.

Tomislav Meštrović: Yes, yes, yes. And this study showed, for example, even E. coli is very resistant to aminopenicillins, the high burden of that, which is also the same group. So we lose a lot of antibiotics here, and this study has shown that. And on top of that, what’s important to emphasize is that out of these seven deadliest bacteria that I have mentioned, vaccines are currently available for only two of them, for staphylococcal pneumonia and for mycobacterium tuberculosis. Of course there are some vaccines in development, and there is a problem because some of these bacteria can be a normal flora, like part of our microbiomes, so it’s sometimes cumbersome to develop vaccines against them. But yeah, we have to be cognizant. These are huge numbers. And now we see the threat is real. The pandemic is not silent anymore. It has a true voice, and –

David Kattenburg: Where’s the burden the greatest? Where in the world are people dying the most from these drug resistant infections?

Tomislav Meštrović: Yeah. So it was really sobering to see that Sub-Saharan Africa and South Asia faced the highest burden of AMR, and also one of the most worrying signs was that AMR disproportionately affects young children. So in 2019, one in five deaths attributable to AMR occurred in children under the age of five, especially in these regions. This is very problematic.

We also found very high AMR burden in Eastern Europe and Southern Latin America regions. And maybe on the first glance, it seems counterintuitive. We would expect that when you have a high antibiotic consumption in high resource settings, the burden would be disproportionately higher in these settings. But as mentioned, the rates are highest in Sub-Saharan Africa and South Asia, so we here have to observe the bacterial AMR burden as a function of both prevalence of resistance and the underlying frequency of these critical infectious syndromes in these regions. In other words, there are very, very high rates of infection in these regions, so of course high rates of AMR will also be a problem in these regions. And of course –

David Kattenburg: So in Sub-Saharan Africa and South Asia you get lots of people getting infected with all sorts of things. Respiratory infections, gut infections, is a larger total number of infections. And so although antibiotic use is less, you’re going to get a higher absolute number of drug resistant infections.

Tomislav Meštrović: Yeah. That’s exactly it. And also the fraction of the resistant infection is also high in these regions, and they further complicate the clinical course of the infected individuals. So this is a problem that will have to be addressed definitely in the future.

David Kattenburg: Shira Doron, you’ve written with a pair of colleagues, “The COVID-19 pandemic has revealed the deadly impacts of structural racism and systemic health inequalities on racial and ethnic minorities in the USA.” Can you super quickly elaborate on this vis-a-vis COVID, but then make the leap to drug resistant bacterial infections? These infections, neither COVID nor drug resistant bacterial infections are affecting populations in the United States equally, that Black and Latino and Latinx populations seem to be the most susceptible. Talk about this, if you can.

Shira Doron: Yeah. It didn’t take long for us to figure out that something was happening here with COVID and inequality, and I don’t think we really expected it. Right from the beginning we were seeing that Black people were dying at over two times the rate of white people, and that Latinx people, they couldn’t stay home for the most part. They were working outside the home in essential jobs that can’t be done from their laptop at a greater rate than white people. And they lived in certain communities where cases of viruses were just exploding.

So we started to think, we work on AMR, and that is the next pandemic, and that is also killing people at a high rate. And yet, although there are geographic differences in AMR that we just spoke about and in morbidity and mortality due to AMR, what about when you’re talking about our country, our wealthy country, for the most part, one sort of geographic area that has minoritized individuals within it. Could it be that, like COVID-19, we have disparities in terms of rates of AMR, and in terms of the impact of AMR?

And so we wrote this paper really as a call to action. And what we did is we came up with essentially eight reasons why we thought it was entirely possible for AMR to have issues of inequity related to racial and ethnic minoritization of certain groups, and I can list what those are real quickly.

David Kattenburg: Please do.

Shira Doron: Living in crowded or multi-generational homes. That was a huge driver of COVID-19 morbidity and mortality, and stands to reason could also be a driver of spread of AMR. Differences in non-prescribed antibiotic use. And this is particularly in our minority populations where they or their parents or their grandparents come from other countries where it is common to take antibiotics without a prescription. Differences in socioeconomic status we certainly know just in general drive a lot of differences in health outcomes. Foreign travel to regions with a high burden of resistant infections. Again, amongst our minority populations that are minorities because they come from other parts of the world.

Differences in health literacy, which are really enormous between different races and ethnicities, and how that affects their understanding of antibiotic resistance and therefore how they access and utilize the healthcare system. Barriers to accessing medical care. And differences in prescribed antibiotic use. Namely, how the prescriber views the patient, and how they view different patients differently, and how that might impact how likely they are to give that person antibiotics, since we spoke about the fact that some people who don’t need them actually get prescribed them. And then lastly, employment in food animal production or meat processing, which we actually know to be hotbeds of antibiotic resistance because of what we talked about. Antibiotics being used very extensively in food animal production.

David Kattenburg: And I read in your letter to Nature Medicine that community spread antibiotic resistant infections that spread through the community as opposed to in hospital are higher within Black and Latino and Latinx populations.

Shira Doron: Well, certainly when there’s more crowding, there’s more spread. And so really what this particular paper did was just lay out the potential reasons why there may be a difference. And it is a roadmap for further research, and certainly my group is embarking on some of that research now. So for example, we are doing a scoping review and ultimately a systematic review to try to characterize all of the differences in AMR that may have been found and published in the literature. But we are also looking at, across our healthcare system, positive urine cultures. And are our patients with antibiotic resistant bacteria in positive urine cultures more or less likely to be of a racial minority and ethnic minority, live in certain ZIP codes associated with higher and lower socioeconomic status? We can do some comparisons between those ZIP codes and certain job types, et cetera. We’re really just scratching the surface here in terms of what may be the truth, and it really has barely been studied to date.

David Kattenburg: And this is a point that you raise in your letter, that you’re trailblazing in this area. There’s been very, very little published in the medical literature about the disproportionate prevalence of antimicrobial resistant infections and COVID infection, I guess, in marginalized populations. Why is this? Why is there so little published in the literature about this?

Shira Doron: I think that we weren’t thinking about it. Like I said, it was surprising to me that COVID outcomes were so different, and then it was really just a light bulb that went off to try to apply those same concepts to AMR. And I think that we are going to need to apply that same lens to many public health problems. Some of the things that I mentioned that could be drivers of differences, inequities in antimicrobial resistance, we know that there are differences. So, employment in food animal production, we know that those people are more likely to be from the Latinx community. Differences in how prescribers view patients and treat patients by race. There’s plenty of literature saying that there are differences, but no one’s taken it to that next level to see if that affects AMR. So there’s just a lot of opportunity here for future study.

David Kattenburg: So this kind of brings me to my last question: What do we need to do to tackle this global infectious crisis? It’s a huge question. I guess we’ve got to do everything. We’ve got to pull all the levers. But perhaps a good place to start is to try to reduce the social inequities, and by reducing social inequities in the United States and North America and globally, that we can actually reduce the burden of this crisis. And not just vis-a-vis, bacterial resistant drug infections, but just boosting health just generally speaking by eliminating social and economic disparities. Thoughts on that?

Tomislav Meštrović: Yeah, definitely. I completely reflect everything that Shira has said. I am also aware that even the CDC now has nice programs in place to tackle health equity issues across antibiotic resistant threats. For example, they have the project Firstline to address training apps. They have an antibiotic resistance laboratory network to analyze patient demographic data alongside laboratory test results in order to give a full picture, and also some other programs. So this is important.

Even in “The Global Burden of Antimicrobial Resistance Study,” what is the problem? Are these patient level data that link antimicrobial resistance to patient outcomes? And I will be the first proponent to try to also implement these important sociodemographic factors also to be analyzed. And in our new cross country analysis studies that we are pursuing now, we also are looking at AMR in the context of, for example, socio-developmental index and some other important factors to see how the countries differ here, which in a way will be a way forward on how to approach this issue from this perspective as well.

David Kattenburg: Shira, a final thought on this?

Shira Doron: Yeah. I 100% agree. We need to tackle this problem at its root. We need to work on the social inequity problem. I think that here in the United States we have an opportunity to try to improve access to healthcare, regular preventative healthcare. Everyone should have a primary care doctor, and they don’t, and that is not distributed equitably. Those primary care providers should be properly educated both in issues of diversity, equity, and inclusion, and in issues of AMR and how to prevent AMR and how to use antibiotics prudently. There are many things that we can do here that would have an impact, and we just need to start tackling it.

David Kattenburg: Because it’s a frightening prospect, like going back to where I began. We kind of take for granted one of the benchmarks of global development in the 21st century is the great accomplishment of having reduced the global burden of infectious disease, and people don’t die of infectious diseases anymore in the so-called developed world. They die of lifestyle diseases, heart attacks and atherosclerosis and all those kinds. Cancers. But they don’t die of preventable infectious diseases anymore. Of course we know they do, approaching now surpassing a million deaths from COVID, but we’ve kind of taken this for granted that we beat infectious disease. And with the advent of drug resistant infections, this new era is looming where we’re going back to a period where a simple infection turns out to be fatal. You get a little nick while you’re shaving yourself if you’re a man, or some other trivial injury, and you get infected with a drug resistant bacterium, and you end up dying.

Shira Doron: We call that the post antibiotic era. So, the extreme is a simple scratch could kill you. But imagine that we were in an era where performing surgery was too dangerous because we can’t prevent a postoperative infection. Or doing a transplant, or giving somebody chemotherapy is too dangerous because those things suppress the immune system and allow infection, and we don’t have antibiotics to treat those infections. We would really have reversed so many decades of medical progress if we get to a post antibiotic era.

David Kattenburg: Tomislav, final thought?

Tomislav Meštrović: Yeah, I agree completely, and I think from my perspective, this is important to emphasize that we need to continue with this stringent surveillance and monitoring the global burden of disease. At the same time, addressing this intertwined nature of AMR. This means encompassing AMR in human health, animal health, in the environment, within the framework of One Health. And this also means multi-sectoral partnerships between the research community and other experts, many experts like physicians, pharmacists, public and global health experts, veterinary specialists. And global actions should consolidate access to effective antimicrobials with infection prevention strategies with responsible use of existing antimicrobials. And yeah, bridge all the domains that I have mentioned, too, in this One Health approach to this important issue.

David Kattenburg: Shira Doron is an associate professor of medicine at Tufts University in Boston and the director of the Antimicrobial Stewardship program at Tufts Medical Center. She co-authored a letter to the journal Nature Medicine entitled “Antibiotic Resistance: A Call to Action to Prevent the Next Epidemic of Inequality.” We’ll link to that letter at The Real News website.

Tomislav Meštrović is a medical doctor and clinical microbiologist, and associate professor at University North in Croatia. He’s also a scholar at the Institute of Health Metrics and Evaluation at the University of Washington. We’ll also link to that Lancet study that Tomislav has helped to promote and is helping to promote about the global burden of drug resistant infection.

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David Kattenburg

David Kattenburg is a journalist, human rights advocate, and science educator based in Breda, Netherlands.