Killer Bacteria: AMR Messaging

White Coats at Dawn by Dr Jenny Rohn

Billions of people will die if we don’t take action now. 

Did that grab your attention?

One of themes I frequently discuss in my public engagement talks is the antimicrobial resistance crisis (AMR) – in other words, the fact that the key drugs we use against bacterial infections are becoming increasingly useless. This concerning global trend is driven by the bacteria themselves, which become resistant either through mutations or through acquiring handy bits of DNA that allow them to evade the drugs.

These genetically altered bugs are then favoured in a scenario where people all over the world are taking too many antibiotics for the wrong reasons, or not taking them properly — and where farmers everywhere are dosing their healthy herds and flocks with drugs to confer a competitive advantage. The more drugs flood the planet, the more the resistant bacteria are selected, causing them to flourish and spread like wildfire. So with people’s behaviour being a worthwhile target for effecting change, there’s all to play for.

And change is urgently needed, along with innovative scientific solutions. Bacteria, unleashed and unopposed, are responsible for some of the deadliest diseases in history, diseases that have not actually gone away: Bubonic plague. Cholera. Typhoid. Leprosy. Tuberculosis. Hundreds of thousands of people worldwide already die as a result of resistant infections that can’t be stopped with any known antibiotic. But we, as a society, stopped making new antibiotics last century, assuming that the problem had been “solved”. And while our drug discovery pipeline is mostly empty, the problem continues to accelerate. The 2016 O’Neil Report projected that if nothing is done, ten million people will die each year from drug-resistant infections, with an annual economic cost of $100 trillion, by 2050.

These are big, scary numbers, and hard to wrap your head around. Maybe they make you want to bury your head in the sand and forget about it.  Indeed, there’s currently some controversy about how to communicate the threat properly. Many communicators — and headline writers — favour the doom-and-gloom approach. If you’ve been paying attention for the last five years, you will have seen politicians, civil servants and media outlets use language such as “apocalypse”, “worse than terrorism and climate change”, and the “medical dark ages”.

The scientific funding charity Wellcome Trust has recently released a report into the best way to “message” about AMR in the most convincing fashion, along with a toolkit of recommendations for communicators. Most of these recommendations are common sense: use plain language, focus on the human impact now, emphasize how the problem undermines modern medicine, remind people that it can affect anyone, not just other people, and show what practical things we can do to fight it.

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But – don’t mention the apocalypse.

In what looks to be a carefully performed and comprehensive study, comprising focus groups and surveys, researchers investigated the views of people from seven countries. Doom-and-gloom messaging got more attention, but managed to induce apathy and switch people off in the process.

In my own communications work about AMR with high school students, I do everything that the Wellcome recommends – except the no-apocalypse rule. Embedded within the science, the personal stories and the promising solutions, I drive home the urgency of the situation and the – yes, potentially catastrophic consequences if we don’t take action now. I end my talks with a call-to-arms: the fact that we need fresh ideas from the next generation of smart students to come up with innovative solutions to “save the planet”.

So is this the truly wrong approach? I am not convinced. Or at least, I am not convinced that doom-and-gloom is any less effective than playing it conservatively. If you look at the media mentions about this problem in the 20th century, which repeated (but modestly) warned of the risks of AMR, they seem to have made sod-all difference either.

This year alone I have spoken about AMR to a cumulative total of around 4,000 GCSE and A-level students in various UK cities, and have delivered similar messages in open days for hundreds of prospective undergraduate students and in the classroom of modules that I teach. It’s not a scientific study by any means, but I can tell from the feedback that I receive – emails, tweets, people flocking up afterwards to chat, students who’ve told me they went into biology because of the passionate urgency of my message – that my approach might be working at least to some extent.

This is when I started digging through the Wellcome study to look for their methodological details. It’s not in the main report, but you have to scour the appendices to work out what sort of “people” they surveyed. The answer is adults (aged 22 and over).

So I wonder whether kids respond differently to the doomsday scenarios than do grown-ups. It kind of makes sense. Think about the success of the “Horrible Histories” franchise, or kids’ fascination with disgusting stuff like poo or ghoulish eyeballs at Halloween. I am utterly repulsed by that pot of green play slime that so enchants my son. Perhaps younger people are wired to respond better to scary things – maybe that’s how they cope with a big scary world.

And think of the success of Greta Thunberg in mobilising an entire generation of teenagers to wake up to climate change. Her language pulls no punches either.

If my hypothesis bears out, it would not be unexpected at all that adults and students need a different messaging style. And I would argue that targeting children and students is just as important as targeting adults in the current AMR crisis – maybe even more so. We need to change behaviour, and adults are set in their ways. Will genteel communications really stop that worried mum badgering her GP for antibiotics for her coughing child? Or is it better to instil the ethos of antibiotic stewardship into that child, and hope that they do better once they’re grown?

Dr Jenny Rohn is a practising cell biologist at University College London. She is also a writer, broadcaster and novelist. She has written three novels, the latest being Cat Zero, released in mid 2018. She was a regular contributor to the Occam’s Corner blog at The Guardian and was a co-founder of the Science is Vital group. She is on Twitter at @JennyRohn.

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