Communication of research findings to the general public is increasingly recognized as a responsibility of scientists. While research communication might help the public to make informed decisions, communication about complex issues such as antibiotic resistance is challenging. Here we acknowledge 4 complications in science communication.
1. The general public’s understanding about antibiotic resistance is limited
Preserving the efficacy of antibiotics and reducing antibiotic resistance is critical to our ability to treat infections and maintain our current quality of life. However, the media often delivers exaggerated messages about antibiotic resistance that include “Superbugs”, death, and the end of modern medicine. These explosive headlines may effectively grab readers attention, but we cannot be sure if they help educate the general public in anyway about antibiotic stewardship, antibiotic resistance and its development, and how this problem can be solved.
A number of surveys have revealed that a majority of people have very limited understanding of the importance of antibiotics, their proper use, antibiotic resistance, or what can be done to reduce resistance. A 2015 World Health Organization survey of 12 countries found that many people have a correct understanding about some issues regarding antibiotic use: 72% correctly stated that antibiotics are used to treat urinary tract infections or wound infections, and 87% agree that they should take antibiotics only when prescribed by a physician.
However, the same survey identified many points of confusion about antibiotic use and resistance. 76% of those surveyed believe that the person’s body becomes resistant to antibiotics, but in reality, it is bacteria that become resistant to antibiotics. Even more alarming, 64% thought that the flu could be treated with antibiotics, but in reality, the flu is caused by a virus and will not be affected by antibiotics. As many as 32% believed that they can stop taking their antibiotic prescription when they feel better, but in reality, this behavior may lead to increased antibiotic resistance.
The mechanisms and possibilities of antibiotic resistance transmission is even still under investigation by scientists and consequently only 44% thought that resistant bacteria can be spread from person to person. Also, 44% thought that antibiotic resistance is only a problem for people who regularly use antibiotics, but in reality, antibiotic resistance can be a problem for anyone who contracts a bacterial infection. While 72% correctly thought that many infections are becoming more resistant to antibiotics and 63% of people think that antibiotic resistance is one of the biggest problems the world faces, a majority (57% of respondents) thought that there is not much they could do to stop antibiotic resistance and 64% thought that medical experts will solve the antibiotic resistance problem before it becomes too serious.
These responses show that individuals are relying on others to solve this problem and do not understand the role they can play in the solution.
2. Antibiotics are not the problem, resistance is
It seems that the public has received the message that antibiotic resistance is causing a problem, but they do not know what this means and what they can do to reduce the problem. This lack of understanding by the general public reveals that scientists and government agencies likely need to improve their communication strategy towards the public.
We assume that the most common message delivered to the public is that “antibiotic overuse is threatening the future of humankind”. This oversimplified message about unfavorable outcomes of antibiotic use, while very important (according to CDC, 80 million unnecessary antibiotic courses were prescribed in the US in 2015) may lead to misunderstanding by the general public. The public might misinterpret this message and might decide that we should avoid all uses of antibiotics, as if antibiotics are inherently the problem.
However, it is antibiotic resistance genes which are the hazard. We believe that antibiotics, a precious tool to cure infectious diseases, can be used responsibly with limited impacts on antibiotic resistance genes. Thus, responsible use of antibiotics is not a problem, but the uncontrolled spread of antibiotic resistance genes is the problem.
3. Antibiotic resistance is a complex issue to communicate
A simple message is easier to deliver than a complicated one. Unfortunately, antibiotic resistance is not a simple message, but a complicated biological phenomenon with many interconnecting parts that is only beginning to be characterized in real-world settings. Only a very small portion of society will have the interest or patience to understand this topic.
Antibiotic resistance is obtained by bacteria when they gain a gene or a mutation that renders the antibiotic less effective to kill them. Some people may understand ecological processes like evolution and natural selection, but antibiotic resistance adds a layer of complexity even to these principles in that antibiotic resistance can either be directly selected (tetracycline selecting for tetracycline resistance genes), or indirectly selected by other compounds (tetracycline selecting for aminoglycoside resistance genes) and are rarely negatively selected against.
Even non-antibiotic compounds, such as metals and disinfectants, can select antibiotic resistance genes and contribute their dissemination. Add to this, antibiotic resistance genes can be transferred to the bacterial neighbors of resistant bacteria. To explain this process requires the explanation of complex molecular mechanisms like horizontal gene transfer, recombination, mobile genetic elements, bacterial conjugation, transduction and the mind-dizzying complexity of thousands of species in microbial communities.
Like the two layers of complexity wouldn’t already been enough, there are hundreds of different antibiotics and even more resistance genes. Also at the same time, antibiotic resistance is occurring in human environments (homes, hospitals, schools, churches, etc.), animal environments (production animals, farms, veterinary clinics, pets, manure, etc.) and the natural environment (soils, wastewater, surface waters, sediments, irrigation water, etc.). Bacteria are well evolved to survive transport from one of these sectors to another, so approaches to reduce resistance will be most effective if all environments are addressed simultaneously. Even more confusing, antibiotic use is not the only driver for antibiotic resistance.
A recent study published in Lancet Planetary Health found that lack of sanitation, poorer governance and warmer climates contributed more on antibiotic resistance indices than antibiotic consumption. This means that tackling antibiotic resistance may not be possible only by decreasing the use of antibiotics. The environmental dimension of antibiotic resistance was just recently acknowledged, and we still have a limited knowledge about its role in the global emergence, however, sanitation, water quality, water recycling and management of biological wastes seem to be contributing to the problem, which means that the environment should also be addressed in action plans.
4. Also the terminology used in communication is complex
Communication on multidimensional problems is challenging and professionals should be persistent that the used language is clear and understandable, but the words we use in communicating about antibiotic resistance are often imprecise and even experts use terms incorrectly. Knowing when to use the terms antimicrobial (against microbes), antibiotic (of bacterial origin against microbes), antibacterial (against bacteria), antiviral (against viruses), or antiparasitic (against parasites) can be very confusing. In addition, there are several other terms in use for example in agricultural sciences and if a group of biologists conducts research on farm environments, the possibility that confusing terminology will be communicated increases.
We feel that with all this complexity and confusing terminology, using a combination of oversimplified message and headlines that raise hopelessness is not working in communication to the general public. The terminology confusion is recognized even among scientists and likely also arises from the complexity of antibiotic resistance. We want to emphasize that multidisciplinary collaboration between scientist and societies is fundamental in tackling antibiotic resistance, however, substantial effort is needed in advancing the communication between experts as well.
+ We need an intergovernmental panel on antimicrobial resistance
Similarly as with the climate change, it is the actions of all individuals and nations that contribute to the global antimicrobial resistance. Experts in these two fields could find synergy on how to design education and action plans.
Currently, the United Nations, Food and Agriculture Organization, World Health Organization and many other national and international organizations have stated that embracing One Health approach that recognizes the interconnection between humans, animals and their shared environment, is essential in tackling antibiotic resistance. Despite these statements, most of the actions these organizations pursue are still designed in segments of the One-Health approach, such as food safety, animal health and in some cases, integrated surveillances from hospital patients and production animals. We agree with a policy comment in Nature and think that the global challenge of antibiotic resistance could benefit from establishing an intergovernmental panel such as IPCC for assessing the related science.
This panel would use a One-Health approach to provide a scientific basis for governments and organizations to develop policies for tackling antibiotic resistance. Recent advances in sequencing and laboratory technologies have allowed the researchers to make new scientific breakthroughs and their importance in the battle against antibiotic resistance is yet to be understood.
An international panel of the most distinguished scientists would be able to evaluate these intriguing results, allowing them to find their place in the complex problem. As the outgrowth of the work of this panel, the communicated scientific message on antibiotic resistance would most likely be more educative, more uniform and more motivating to action.
We have witnessed that a rational educative message sent to public about climate change has enhanced the knowledge of individuals what they can do for the problem. The public’s education on climate change has involved both targeted simple campaigns and more in-depth education and messages on greenhouse effect, carbon footprint, and carbon offsets have introduced these ideas into general conversation.
Regarding antibiotic resistance, in addition to avoid unnecessary use of antibiotics, promoting hygiene for preventing infections could gather more attention, as well as avoiding the use of disinfectants in regular cleaning. Eventually individuals formulate groups of people, and groups become larger groups, thus for big changes, we need to start from individuals.
Educating the general public with more consistent message would also benefit the scientific community eventually, since members of the public include also decision makers and journalists and what is their knowledge on the issue might affect for example on research funding. Advancing the communication between scientists and research funding agencies could enable funding opportunities to address also those issues that are currently understudied because they are too interdisciplinary for current funding systems.
Johanna Muurinen is a postdoctoral researcher at the Animal Microbiome Laboratory, Purdue University, with a postdoc research grant from the Nessling Foundation for studying antibiotic resistance in agroecosystems.
Tim Johnson is the PI of the Animal Microbiome Laboratory with a special research interest towards antimicrobial resistance in agroecosystems and alternatives to antibiotics in animal agriculture.
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