Compounding the cure: How our overzealous efforts to zap infections could be making animals — and humans — sicker

Experts are calling antimicrobial resistance the silent pandemic: Each year, AMR is responsible for more than a million deaths around the world. It’s a threat to our health that’s been exacerbated by the very medications used to treat it. This problem has been growing for decades, and healthcare practitioners have responded by developing new antibiotics. “And then,” says Dr. Scott Weese, a global expert in antimicrobial resistance, “we started running out of antibiotics.” To address the rise of drug-resistent pathogens, we need to examine how we use these medications to treat disease in both humans and animals, says Weese. The question is, how can we safeguard the life-saving drugs we have — while also protecting the health of all creatures on this planet?

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Narration: There’s a lot of serendipity in science. In the fall of 1928, a Scottish scientist named Alexander Fleming walked into his lab after a two-week vacation and happened upon something … well, kind of gross. To be fair, it was a bacteriology lab, so icky things weren’t unexpected. But there, in the middle of a petri dish, was a big glob of mould. What Fleming realized was that the mould was actually wiping out the bacteria that surrounded it. His discovery led to the development of penicillin — and laid the foundation for the antibiotics we still use today.

Experts say penicillin has saved at least 200 million lives, and that’s just counting humans. But as bacteria evolve, the tools we use to wipe them out are no longer as effective.

Scott Weese: The spectre of having an individual that has an infection that we can’t treat because it’s resistant to all the antibiotics, that does happen. And the concern is you get back into the pre-antibiotic era where you have a routine infection, and you die from it.

Narration: My guest today is Scott Weese, an infectious disease expert based in Guelph, where he heads up the Centre for Public Health and Zoonoses at the Ontario Veterinary College. So yes — he’s a vet — but he also happens to be the right person to talk about one of the biggest challenges threatening our existence as humans: antimicrobial resistance, or AMR.

Scott Weese: AMR has been building up since the first use of antibiotics. And we know it’s been a problem and we had some decades where, “OK, it’s not a big deal. We’ll just make a new antibiotic.” And then we started running out of antibiotics.

Narration: Scott has been recognized by the UN as a global leader on this subject. On any given day, you’ll find him consulting on the toughest cases of animals sick from resistant pathogens. Sadly, by the time he’s face-to-face with that dog, horse or cow, they’re usually in critical condition — and that has repercussions beyond the barnyard.

I’m Manjula Selvarajah, and this is Solve For X: Innovations to Change the World, a series where we explore the latest ideas in tech and science.

To fully grasp how and why AMR has become such an urgent problem, we need to zero in on what’s causing it in the first place. On its own, antimicrobial resistance is a natural process, but in our overzealous efforts to zap infections, we’re actually speeding up this process. It’s how we wind up with superbugs. And while this is very much a human health issue, as Scott knows, all creatures are connected. That means decisions we make about treatment in one area might backfire elsewhere in ways we don’t anticipate.

Manjula Selvarajah: Now, one of the things that we’re kind of talking about here, or we’re getting to talking about here, is this idea of drug-resistant pathogens. And the fear that, or perhaps it already happens now, drug-resistant pathogens getting out of control. Give me a sense of what that looks like on the ground to you and other vets.

Scott Weese: It’s already happening and the spectre of having an individual that has an infection that we can’t treat because it’s resistant to all the antibiotics, that does happen. And the concern is you get back into the pre-antibiotic era where you have a routine infection, and you die from it. Pre-antibiotics, mortality rates around women giving birth were quite high. Young children, death rates were really high. Even little things like you get a wound. Like if we didn’t have antibiotics, we wouldn’t have healthcare the way we have it, right?

Manjula Selvarajah: It’s one of the miracles of the modern world, for sure.

Scott Weese: Yeah. As we lose the effectiveness of them, you know, we’re, people talk about the post-antibiotic era and that’s not realistic, we’re hopefully never going to get near that. We do get in situations where infections aren’t treatable or are treatable, but with very toxic, difficult-to-use, expensive, whatever you want to describe them, problematic drugs. And all these things layer on additional health challenges and additional cost.

Manjula Selvarajah: What does that drug-resistant pathogen look like in a person? How does it manifest itself?

Scott Weese: In general, if we look at a resistant bacterium, resistance is usually caused by genes that they pick up or genes that change that make the antibiotic ineffective, not able to work. And that doesn’t change the bacterium, apart from making it resistant to the antibiotic. So the bacterium does what it would normally do. The problem is we can’t treat it.

Manjula Selvarajah: So this person comes into the hospital and suddenly whatever you have in that institution doesn’t cut it.

Scott Weese: And normally that antibiotic would work, and the person would normally get better. But if they come in and they have a resistant infection, and we don’t know that at the start, and the drug that we pick doesn’t work, it’s not because the bacteria are inherently more virulent or more able to cause severe disease, it’s the fact that we’re not able to treat them like we could have in the past.

Manjula Selvarajah: Because they’ve adapted.

Scott Weese: Yeah.

Manjula Selvarajah: This problem has been called the silent pandemic. Is that an accurate way to describe it?

Scott Weese: Well, it’s probably very accurate because it fits all the definitions of a pandemic. It’s causing a huge amount of damage. We look at the number of lives that are lost. We look at the billions to trillions of dollars in economic costs associated with disease. But it’s something that we don’t pay a lot of attention to because it’s not as dramatic and it’s been sneaking up on us.

Manjula Selvarajah: You said that we are losing lives now. Can you give us a sense of that? Are there numbers to back that up?

Scott Weese: It’s hard to say because this is a global problem and a lot of the damage is being done in low- and middle-income countries where there’s not as much surveillance, and in young children because that’s where a lot of the infections are. On the conservative side, a million plus people a year die because of antibiotic resistance.

Manjula Selvarajah: That’s high.

Scott Weese: And when you start putting that together with other diseases that we pay a lot of attention to, it becomes obvious that this is a huge problem that we just don’t really have that recognition of. As long as we keep having people that are sick. And we keep using antibiotics, and the same thing on the animal side, we continue this cascade to more and more resistance.

Manjula Selvarajah: I want to talk about this quote from the director general of the World Health Organization that caught my eye. I want to read it out to you. He says…

Tedros Adhanom Ghebreyesus: “The irony of AMR…”

Manjula Selvarajah: “The irony of AMR is that it’s driven by the inappropriate use of antimicrobials. And yet a large number of people also die because they can’t access these medicines at all.” What goes through your mind when you hear that?

Scott Weese: One of the things I would say is it’s not even just inappropriate use, it’s just use. Like whenever we use an antibiotic, we create some degree of resistance. So it also highlights what one of the big things that we need to do to address antibiotic resistance is to address health. Because if I don’t get a bacterial infection, I don’t need an antibiotic. Doesn’t matter if it’s here, available in my country, or whether I have access to a physician. If I don’t have an infection, none of that matters. So we focus on antibiotic use. We focus on appropriateness of use, which is really important, obviously. But that’s trying to address it too late. In one way, we actually need to have more antibiotic use across the world. And that’s hard for people to understand. And in some ways we need less. So in some countries you need better access to antibiotics, you need access to high-quality drugs, but you need access to healthcare providers as opposed to just going to the pharmacy saying, “I’ve got this problem, what do you have in here that might work? I can afford two days, so I’m going to get two days of drug.” And that’s a reality in some areas.

Manjula Selvarajah: There’s something interesting that you said that I want to bring up. It’s this idea that we actually need to focus on health and prevention before, before you get to the point where you require a prescription of some sort. Is that concept of preventative health, is that applicable to how we treat animals as well?

Scott Weese: Oh, absolutely. And even more so, probably.

Manjula Selvarajah: How, what would that look like?

Scott Weese: One of the biggest things we could do internationally to reduce antibiotic use in animals, in food animals, would be to build better barns, make sure that all farmers everywhere have access to a veterinarian one way or the other, improve education, improve access to vaccines. We’re much better off spending our money and our effort on prevention so that we have to spend less on treatment because there are fewer individuals that need to be treated. So it’s exactly the same basic concept between humans and animals. It’s just applied a little bit differently between food animals and companion animals and humans. There are different nuances in those areas.

Narration: How could building better barns help? For the most part, we raise livestock in such tight quarters that one sick animal can lead to an outbreak. To avoid that risk, farmers will often treat animals even if they aren’t sick. This is becoming a bigger and bigger problem, as we eat more meat and we raise more animals in less space to meet that demand. Annual global meat consumption has jumped nearly 10 percent over the last decade. So I asked Scott, “just how common is the preventative use of antibiotics in animals?”

Scott Weese: Depends on the country, depends on the species. It’s quite widespread and we know there’s a lot of overuse of it. But a lot of time antibiotics get used because, you know, “That’s what I do, because that’s what Dad did, because that’s what Grandpa did,” right? And we’re worried about bad things happening directly in front of us. So if I’m a farmer or if I’m a vet and I’ve got an animal in front of me, “I’m worried about that animal in front of me. You know, I kind of worry about resistance. But that doesn’t impact me putting food on my table.” So it’s hard to get people to change because they’re worried that if they change, something’s going to go wrong.

Manjula Selvarajah: And to begin with, farming is also a tough business, right? So you want to make sure that you protect your flock or whatever the case may be. I wonder though, this idea of talking to people or getting farmers and people in agriculture to change their views on the preventative use of antibiotics. Is that realistic when we’re talking about animals meant for food, and people need to feel safe about what ends up on their dinner plate?

Scott Weese: Yeah. And that’s where you get into the complexity and get into the situation where we kind of need to use more antibiotics in some areas. In most countries, we would want to decrease the amount of antibiotics that get used, and we certainly know that use in animals can drive resistance. We certainly know that we have to use it, and it’s that general line, “Use as little as possible, but use enough.” And we have to find that sweet spot and that sweet spot’s tough to do because it really varies with species and farm and a lot of other things. But it’s tough to get people convinced to make changes and things when, especially I think things are going well, right? “I’m doing OK. I’m surviving. I’m making money. My animals seem fine. Leave me alone.”

Manjula Selvarajah: Now you’re showing up with this idea.

Scott Weese: Yeah. You can make guidelines, you can make regulations, and those can all play a role, but ultimately we have to change what individuals do, both with antibiotics and how we raise animals.

Manjula Selvarajah: And I think this is part of what makes this really complicated. How do you imagine getting buy-in? Because the people that you’re advocating to, you know, they could be anything from a pediatrician to a bird doctor.

Scott Weese: Yeah, and that’s a challenge, right? Because, you know, if I’m dealing with a case, that animal in front of me, like, that’s a big thing. The owners that are there with that animal, it’s their farm, and they’re worried about their livelihood, or it’s their dog, which is a family member, and they’re worried that it’s sick, that’s why we default to being more aggressive with antibiotics. And you understand why, right? Because ultimately, we talk about this as a population problem, but the people that are dealing with it are dealing with that individual.

Manjula Selvarajah: What you’re talking about, then, is trying to get involved in that relationship, a vet that meets with a farmer or a doctor that is, you know, seeing the parents of a kid with that ear infection, you know, making sure that they understand the impact of this. Do you think you can move the dial with medical professionals?

Scott Weese: Yeah. And we know we are, it’s a slow process and you have to think about how we deliver it. You can’t just come in and say, “Do this.” So we have to kind of address what drives decisions. Is it risk aversion? Is it fear? Is it lack of understanding? Is it lack of confidence? And we can address these in different areas, but we can’t just say, “You know, you should use less,” and targeting an amount of antibiotic reduction is a challenge and that’s been a big barrier internationally saying, “OK, we should drop antibiotic use in animals by 30 to 50 percent.” Which maybe makes sense to some degree in some situations, but population is growing, populations are getting wealthier in some countries, there’s more demand for food, there’s more demand for meat, you know, is increasing antibiotics a little bit, If we’re doing it better, a bad thing? And maybe not. So looking at appropriateness of use. So when we use an antibiotic, are we using it right?

Narration: Scott’s talking about changing human behaviour on a global scale. That’s a monumental task under any circumstances. And it’s made even more challenging here because of the paradoxes inherent in AMR. It’s a threat to our health that’s been exacerbated by the very medications we use to treat it. It’s an issue of over-prescription that has disproportionately harmed individuals who lack adequate access. As Scott says, there’s no blanket solution, no cut-and-dry recommendation. So how do we fix this? How do we encourage appropriate use? Could tech play a role here?

Scott Weese: One of the things that we don’t do very well is monitor interventions. So we can bring in a guideline or bring in a change, but if we don’t actually know whether it worked, you know, how useful is it? Or if we don’t know how to optimize it. So tech can be useful in having a better understanding of what’s going on. You have a dog, cat, cow, child that comes in and they’re sick. If I can instantly and with high confidence say “Yes, you have a viral infection, you don’t need antibiotics,” that’s going to have a big impact. So, patient side, diagnostic testing is a big focus as opposed to, “I’m gonna do this test but the result’s going to come back in two or three days, so I’m gonna put you on the antibiotic right now just in case.” Because we use a lot of “just in case” antibiotics. And then trying to integrate the whole pathway of how we use antibiotics and the outcome. So looking at our prescribing data, our resistance data, all our culture data, to figure out what’s driving resistance, and if we change something, what does that do, good or bad?

Manjula Selvarajah: Is there a particular technology that you’ve seen, used, experienced in this space that gives you hope?

Scott Weese: Well, I think a lot of it’s actually just low-level tech, it’s that supporting thing. So we’re not looking at something that’s come in and fixed the problem. We’re looking at all of these little nudges. So in humans, they have a system called AWaRe. And it stands for Access, Watch and Reserve. So which antibiotics should everyone have access to? And these are the ones that we’re going to use. First line versus which drugs are more for some select situations and which of the drugs we really want to save. And this works at the local level, but also works at the global level because you can look at countries and say, “OK, here are the access drugs we should have for all these different species.” So we’ve got ways to look at what’s been done in one species and reflect that in the other and guidelines, categorizations are one way we can do that.

Manjula Selvarajah: What’s at risk if we keep working in silos when it comes to animal and human health?

Scott Weese: We miss opportunities. And we miss opportunities to intervene when things cross those silos, when infections cross those silos or resistance crosses silos. And we also miss the opportunity to learn from what was done on the other side. How much resistance in humans is coming from animals? We have no idea. It’s probably a very small percentage. But it’s a small percentage of a huge problem, so it’s still a big issue. But if we have a better understanding of, “OK, I do this in an animal, or this happens with this type of food, how’s that reflected in disease in people?” I can figure out where I’m better off spending my time and money and energy.

Manjula Selvarajah: It’s interesting, and I hope this isn’t the case, that it is disease spillovers from animals to humans that generate that recognition. I hope that’s not the case.

Scott Weese: Well, that’s some of it. And I think as we see more zoonotic diseases, COVID, influenza, it kind of keeps reinforcing that concept that things move both directions. It really focuses on animals to humans, and that’s where the main concern is, but it does go both directions. So everything that increases awareness of One Health probably helps. Then, how do we get motivation to do things that maybe aren’t as directly identifiable as fixing the problem, right? You say, “I want to fix an antimicrobial resistance problem. Let’s build better barns.” It’s hard for some people to make that link, or “I want to fix, you know, I want to fix antibiotic resistance in humans. Let’s build more wells in Africa.” That would be a huge thing.

If we had better roads and better wells in Sub-Saharan Africa, it would tremendously improve health, it would reduce the need for antibiotics, it would reduce antibiotic resistance. It would be a big thing, but we’re often focused on flashier things. So putting money into basics to improve health, to improve infrastructure, it’s sometimes harder to get money for that than it is for this new tech or new toy. We think about changing things through progress, and progress is often something new or technology, and progress isn’t, “Wash your hands, drink clean water, raise your animals better, have better ventilation.” And it’s sometimes hard to get motivation for those basic things. We want to throw a lot of money at new drugs, which are important. But on the animal side, I actually don’t want new drugs. I want to make sure I don’t need new drugs. So that any new antibiotic that gets made can be dedicated to people. I want to be able to conserve what we have right now. Because basically everything we use in animals is the same drugs as are used in humans. And we want to make sure we don’t start pilfering some of those other drugs that are really important.

Manjula Selvarajah: This is such an important point that, to a certain degree, it’s some of those old ways of doing things that actually prevent you getting to the point where you need to be prescribing or taking antibiotics. That’s actually fascinating. OK, can I have a couple of minutes of your time to do a rapid fire with you? I will make it fun. I promise.

Scott Weese: Go for it.

Manjula Selvarajah: OK. Here we go. If you could go back in time and change one thing to prevent AMR, what would it be?

Scott Weese: Oh, good question. I have no idea. I could look back and look at things that I taught even not too long ago, that where I would teach differently now, because we know more now and we have more confidence now, and we have more motivation because we know the issues. What I think we maybe could have pushed for more aggressive approaches to antibiotic stewardship. I could have done that earlier in my career, but it really wasn’t on the radar, and I don’t think we had the kind of backing to be able to say we should do these things, but I think that would be one.

Manjula Selvarajah: Which animal makes for the worst patient?

Scott Weese: So you can grade that at so many different levels. There are certain species of dogs that are notoriously good at going at your face. Um, you know,

Manjula Selvarajah: Like which ones?

Scott Weese: Oh, some of the small dogs, Spitz dogs in particular tend to really like their owner and really not like a lot of other people and really, really don’t like vets. Some of them are sweet dogs. You know, some species just don’t do what you want them to do. I’ve worked with everything from small reptiles that weigh, you know, grams to elephants. And if the elephant doesn’t want to do anything, the elephant’s not doing something. So it’s…

Manjula Selvarajah: I don’t think I would want an elephant, like a bad elephant patient. I feel like size matters here.

Scott Weese: Oh yes.

Manjula Selvarajah: Is it the end of the antibiotic era?

Scott Weese: No, I don’t think we’re near that. I don’t think we’ll get there. For individuals, they will have the end of the antibiotic era because there are still people, lesser degree animals, who will get an infection that’s not treatable with antibiotics. Globally, are we going to be at the point where we can’t use antibiotics because none of them work? That’s a long, long way away. And, you know, we’re not making new drugs very effectively, but we can make some, so…

Manjula Selvarajah: So the short answer is…

Scott Weese: So the short answer is no, I don’t think we have the post-antibiotic era, but we definitely are beyond the time of Fleming when, you know, he recognized there were problems when he discovered penicillin, but we didn’t recognize the scope.

Manjula Selvarajah: Are vets the bellwethers for the future of global public health? Do you think you guys are the ones who are going to identify the next major pandemic?

Scott Weese: I think we’re a big part of it. And everyone, it’s one of these things, everyone has to play a role because it might be the veterinarian that sees that first individual in an animal or might be the veterinarian stems the problem through improving health. It might be the farmer who first sees sick animals, because most of the next threats are going to be moving from wildlife into people directly, or wildlife into domestic animals. And animals, and people in contact with them, are the early warning and that’s kind of worth paying attention to with H5N1 influenza. So I don’t think we can say anyone is the key player in pandemic preparedness, and more important than that, is the early action and communication, because if a farmer or a vet or a physician identifies a problem, but then we can’t act on it quickly enough, it doesn’t matter. Veterinarians, animal owners, companion or food animal are going to play really important roles in this.

Manjula Selvarajah: They’re part of the bigger solution. Scott, you’ve been so kind with your time. Thank you so much. And such a fascinating chat.

Scott Weese: Thanks.

Narration: Solve for X is brought to you by MaRS. This episode was produced by Ellen Payne Smith and written by Sarah Liss. Lara Torvi and Sana Maqbool are the associate producers. Kathryn Hayward is the executive producer. Mack Swain composed the theme song and the music in this episode. Gab Harpelle is our mix engineer. This episode features a clip from Dr. Tedros Adhanom Ghebreyesus at the November 2024 AMR conference in Jeddah, Saudi Arabia. I’m your host Manjula Selvarajah, and we want to hear from you. If you have a burning question or an idea that you’re curious about, email us at media@marsdd.com.

Solve for X is brought to you by MaRS, North America’s largest urban innovation hub and a registered charity. MaRS supports startups and accelerates the adoption of high-impact solutions to some of the world’s biggest challenges. For more information, visit marsdd.com.

Photo illustration by Kelvin Li and Workhouse