May 23, 2016, by Brigitte Nerlich
AMR, alarm and awareness
On 19 May the much awaited report on antimicrobial resistance (AMR), chaired by Jim O’Neill, was published under the title “Tackling drug-resistant infections globally: Final report and recommendations”.
In the UK this report was announced by the newspapers under (not very snappy) headlines, such as “Warning: Rise of SUPERBUGS resistant to antibiotics poses ‘bigger risk than CANCER’” (Express); “Experts call for $1bn rewards for solution to antibiotic crisis” (Daily Telegraph); “No antibiotics without a test, says report on rising antimicrobial resistance; Report by economist Jim O’Neill says global cost of problem could be loss of 10 million lives a year by 2050 and $100tn a year” (Guardian); “England’s chief medical officer warns of ‘antibiotic apocalypse’; Efficiency of antibiotics falling as deaths in EU and US hit around 50,000 annually from infections drugs can no longer treat” (Guardian); “Act now to defeat superbug catastrophe; Major report spells out dire consequences of antibiotic resistance” Independent); “’Antibiotics apocalypse’: 10 million people a YEAR to die due as drugs lose their effectiveness; Routine ops such as hip replacements and caesareans may be threatened by superbugs as a result – and chemotherapy could be hit” (Mirror); “’10m a year to die due to antibiotics resistance’; Routine ops such as hip replacements and caesareans may be threatened by superbugs as a result” (Mirror), and so on.
Alarming numbers, words and visuals
The figure of 10 million deaths* by 2050 (pages 12 and 19 of the report), as well as another one according to which superbugs may kill every three seconds (ibid.), were reported widely, together with words like ‘catastrophe’ (p. 19 of the report) and ‘apocalypse’ (not used in the report). As The Atlantic put it: “The report’s language is sober but its numbers are apocalyptic“. Although not used within the report itself, the words ‘apocalypse’ and ‘post-antibiotic apocalypse’ have surrounded this report for a while and the word apocalypse also turned up in the headlines listed above.
In some instances, such alarming words and numbers were accompanied not only by images of real bacteria or pills, but by frightening visualisations of their power or loss of power. The BBC, for example, displayed an image of a ‘superbug’ with a skull face. The Economist, meanwhile used pills to paint a shocking portrait of death.
Does alarm work?
These alarming linguistic, numerical and visual portrayals of an apocalyptic future or, indeed a post-antibiotic apocalypse, in which antibiotics are scarce and no longer work, reminded me of an article published by Tom Fowler, David Walker and Sally C. Davies (Chief Medical Officer for England) published two years ago. It was entitled “The risk/benefit of predicting a post-antibiotic era: Is the alarm working?” (£)
After asking this question, the authors go on to argue that “the main potential criticism of predicting a post-antibiotic era can be answered thus: (1) there is a need for such predictions to help inform the response to the issue, particularly if we are going to require societal as well as healthcare responses; (2) there is a need for such predictions to provide an appropriate evidence base for the need for resources to address the issue; (3) it is reasonable to make such predictions as a worst-case scenario if action is not taken.” (p. 5)
I am wondering what the social scientific evidence is that underpins point (1) in particular. Can one really say that such predictions are needed because they can contribute to eliciting appropriate societal responses?
Questions about the effectiveness of alarmism have been asked in the context of climate change communication and also in the context of the communication of epidemics, such as avian flu and swine flu, where health professionals have worried about ‘swine flu fatigue’ – similar to climate change fatigue. Risk communication is a complex problem, where it is difficult to find the right balance between what some have called ‘complacency mongering’ and ‘scare mongering’. Research into crisis communication in the context of the Ebola outbreak seems to show that “Over-reassurance erodes public trust far more than alarmism”. The question is: Is the AMR crisis like Ebola or like climate change or something else altogether?
These are things to think about when launching, as the report recommends, “a massive global public awareness campaign” (pages 4 and 19 of the report), with a yearly budget of $40 to 100 million. At the moment (according to a recent 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). The new ESRC research initiative devoted to AMR would be a good place to start filling these gaps.
*Added 1 December 2016: A critical report discussing these numbers has just been published here.
Image: Dr Graham Beards at en.wikipedia: Antibiotic resistance tests; the bacteria in the culture on the left are sensitive to the antibiotics contained in the white paper discs. The bacteria on the right are resistant to most of the antibiotics.