April 13, 2018, by Brigitte Nerlich
Antimicrobial resistance and climate change: Communication, governance and responsibility
Last week I was reading some tweets from an international science communication conference held at Dunedin, New Zealand. As I have blogged and written about hype, I was particularly interested in tweets about a fascinating Roundtable convened by Tara Roberson entitled: “Can hype be a force for good? – Debating the benefits and drawbacks of science hype”. Various topics were discussed, amongst them antimicrobial resistance or AMR. But, of course, I wasn’t there; so I am not sure what exactly people said.
But reading about this set me thinking about potential differences between hyping an issue and alerting people to an issue or between hyping an issue and alarming people about an issue, and, related to this, which forms of communication might lead to better understanding of an issue, such as AMR. I also began to think about whether those researching such matters around AMR could learn something from well-established research into hype and alarmism in the context of global warming and climate change. So, I began to muse….
Climate change and AMR
As long ago as the 1970s scientists and politicians warned about the consequences of unchecked human-induced climate change, namely global warming and climate chaos. Some, including scientists, saw this as hype and scaremongering. This changed in 1988 when climate change aka global warming began to be taken seriously. As long ago as 1945 scientists warned about the consequences of unchecked (human-induced) overuse of antibiotics, namely antibiotic resistance or AMR. In 1988 Joshua Lederberg warned that, “[i]n that natural evolutionary competition [between bacteria and us], there is no guarantee that we will find ourselves the survivor” (Lederberg, 1988).
A decade later, 1997, the Kyoto protocol came into force in the hope that governments would act on scientists’ warnings and start mitigating the impacts of climate change. And that hope continued for a while. Around the same time, in 1998 scientists observed that “there is an incoming tide of concern about the problems of antimicrobial resistance“ and compared the rise of antibiotic resistance to climate change – a comparison that some might call hype. Indeed a forthcoming lecture at Addenbrook’s hospital Cambridge is entitled: ‘Antibiotic resistance: a crisis on the scale of climate change or over-hyped?’ I wonder how the speaker, Nick Brown, will answer these questions, but the lecture is only in September!
Another decade alter, 2007/08, warnings about climate change were increasingly dismissed as alarmist hype – a dismissal that had started in quite a concerted fashion in the 1990s, was intended to create doubts about the warnings issued by climate scientists, and has been quite successful. In 2007 Richard James, a University of Nottingham expert on AMR, who had created the term ‘post-antibiotic apocalypse’ in order to make policy makers sit up and listen, “was accused of being a ‘sensationalist and scaremonger’ by the UK Department of Health’s chief nursing officer”. This is no longer the case and the UK government has recently issued its own dire warnings about AMR. However, debates are ongoing about whether or not we are facing an ‘apocalypse’ and/or whether or not it’s a good idea to use such terms.
In some countries public concerns about climate change decreased over time, especially after 2007, while scientific confidence and consensus with regard to climate change increased (this is a dynamic issue and things are changing). But what about AMR? Is there any research monitoring the ups and downs of public concerns about antibiotic resistance? Is there research about levels of public awareness and, even more so, understanding of antibiotic resistance? Have awareness and understanding increased or decreased over time, as warnings have increased and scientific confidence and consensus have consolidated? Have warnings about AMR been perceived or framed as hype? And if so when and where?
These are all questions that social scientists interested in AMR might want to address – and probably did at the roundtable in Dunedin. (For some information on AMR/science communication, see this blog post by Rony Armon) (A symposium showcasing social science research on AMR will ‘take place’ in September in London)
Hype and alarm in climate change communication
In the context of climate change, warnings about its impacts have been issued for a long time and some scientists and advocates might indeed have engaged in what I once called ‘honest hype’, that is, they tried to create and sustain a sense of urgency about an issue they were and are sincerely worried about.
What is interesting in this context is that although alerting people to danger and even sounding the alarm about danger is generally not hype, climate change scientists and advocates have been accused of hype – and not just any hype, but alarmist hype.
This had the effect of sowing doubt about these warnings, polarising opinion about climate change in the United States, and paralysing global efforts to dealing with issues related to climate change. ‘Alarmism’ as a derogatory label has indeed a special status in climate change communication and especially in climate change misinformation.
Hype and alarm in AMR communication
What about AMR? What type of hype are we dealing with? I think we are dealing with something a bit different here. Warnings about the effects of the overuse of antibiotics have been issued for decades, but only quite recently have they become louder and more persistent.
Some scientists, policy makers, communicators and some media have used alarming linguistic, numerical and visual portrayals of an apocalyptic future in order to raise awareness of issues surrounding AMR – and some, like Richard James, have, initially, been accused of scaremongering.
There are some concerns, which had also been expressed by some experts in climate change communication, that inducing fear amongst people through the use or alarming messages might not be a good strategy both in terms of raising awareness and understanding of AMR and in terms of inducing behaviour change.
However, as far as I can see, AMR scientists and policy makers have not yet been accused of alarmist hype in order to manufacture doubts about rising levels of antibiotic resistance and thus to paralyse efforts to deal with this problem. But I might, of course, be wrong.
There have also been concerns about a certain type of hype that seems unique to AMR communication. In a recent article for the British Medical Journal McDonnell and Woodford point out that “researchers often tout early stage successes in antibiotic development to the media as being potential game changers in preventing resistant infections. These statements are often misguided. Furthermore, they may undermine wider policy efforts to improve the research and development system for antibiotics because they create the impression that our current research system is adequate.” It is however rather difficult not to write such statements when trying to attract funding. Again, I would argue, that this is a case of (relatively) ‘honest hype’ not ‘alarmist hype’.
What does this mean for communication, awareness and understanding of AMR? It’s not that easy to tell. At the moment (according to a US report) “research on public awareness, knowledge, and attitudes about antibiotic resistance is limited, as is research on communication and engagement strategies” (Nisbet and Markowitz, 2016, p. 56). However, there are some interesting reports (and there are probably many more than I can quote below).
Awareness and understanding of antibiotic resistance
According to a recent (2016) Eurobarometer report on AMR, public awareness and understanding vary substantially between countries. It seems that the more pro-active governments are regarding AMR (e.g. Finland, The Netherlands), the more awareness increases and behaviour changes. This is important! Governments need to create the political context in which behaviour change can happen (this includes investment in health care and investment in information and education). Without such a context it doesn’t, however much we communicate and inform.
Surprisingly, knowledge of antibiotics has remained constant in Europe since 2013 – more or less across the board. I wonder why that is. This echoes a 2015 report by the World Health Organisation from 2015 based on a multi-country survey which “shows people are confused about this major threat to public health [AMR] and do not understand how to prevent it from growing”.
Another 2015 report, this time by the Economic and Social Research Council in the UK, found that “[a]wareness of and engagement in the issues surrounding AMR is relatively low in the UK compared to other global issues, such as climate change. Public awareness internationally represents a major challenge.”
So a lot still needs to be done – but what?
Its essential that governments, nationally and internationally, take the lead and provide the political and social context that enables individuals to perform actions and behaviours that mitigate the problems posed by climate change and AMR. Governments have to change their behaviour before calling on climate change or AMR communicators to induce behaviour change in their citizens (and corporations). Information and education play an important role here but are not sufficient by themselves to change behaviour and avert the threats posed by AMR or climate change.
This means that communication efforts, hyped or not, are never enough to tackle global problems like AMR and climate change. Nevertheless, one has to keep a close eye on who communicates what and for what purpose.
In short: Governments and policy makers have a responsibility to alert citizens to the global dangers posed by problems such as climate change and AMR, even to sound the alarm about them. However, their main responsibility lies in enacting policies that make it easy for people to act responsibly on these issues in their local environments. Citizens need to be able to assume agency.
Image: Flickr (labelled for reuse on Google images), author: Martin Brandt