Scientists last week announced that they had discovered a gene spreading among bacteria in China that renders them resistant to some of the world’s most powerful “last resort” antibiotics. If such invulnerable bugs spread, doctors might soon lack the tools needed to combat infections, whether contracted through chemotherapy, surgery or even simple cuts.
Indeed, the post-antibiotic “apocalypse” — as this scenario has been known for a decade — might already be upon us: There is evidence that the resistant genes have made their way to Laos and Malaysia.
Antibiotic resistance is not new. Alexander Fleming, who discovered penicillin, in his 1945 Nobel Prize address presciently warned that casual overuse of his miracle drug could promote resistance. In recent years, the US has suffered several cases of foodborne illnesses that did not respond to existing drugs.
However, the real threat lies in China, where a large, dense population and close interactions between people and livestock have long made the nation a breeding ground for new infectious diseases. To control the problem, the world has to control it in China first.
That is unlikely to be easy. China’s millions of farmers are notorious for pumping their livestock full of antibiotics — roughly three times more, pound for pound, than counterparts in the US; agriculture accounts for perhaps half of antibiotic use in China.
The practice, pioneered in the 1940s in the US, increases yields for farmers, but also creates an ideal environment for bacteria to develop resistance. Bigger herds offer bigger evolutionary opportunities and China — with the world’s largest pig and poultry industries — is particularly susceptible. The drug-resistant gene that scientists reported is believed to have evolved in Chinese pigs.
Human patients also contribute to the problem. China’s healthcare system is designed to push drugs unnecessarily. Chinese hospitals receive limited government support and face price caps on fees and doctor salaries. They thus rely on pharmaceuticals for about 50 percent of their income and most of their profits. Antibiotics account for about 25 percent of drug sales.
Patients have grown used to demanding antibiotics even when they are unneeded or ineffective. According to a WHO survey released last week, more than 60 percent of Chinese believe antibiotics can cure colds and flu — they cannot: those illnesses are viral. Worse, nearly half of respondents thought they should keep taking antibiotics even after feeling better — a textbook method for breeding drug-resistant bacteria. About 57 percent of Chinese had taken antibiotics in the past six months.
A separate survey, conducted in December last year, found that 78 percent of colds in China were “treated” with antibiotics. Nearly 40 percent of all antibiotics were prescribed incorrectly.
Reforming China’s healthcare system — which encompasses about 300,000 hospitals and clinics — is a daunting task. However, it is not impossible. As part of a 2011 reform effort, China’s Ministry of Health set antibiotic-prescription benchmarks and worked with key hospitals in a pilot program to meet them. Penalties included demotions, dismissals, revoked accreditations and even public shaming. The effort succeeded in reducing prescriptions and deserves to be extended nationally.
Meanwhile, the government could make better use of its propaganda apparatus to educate Chinese about the basics of antibiotics. Such a campaign would face a potentially receptive audience: According to the WHO survey, 83 percent of Chinese believe that farmers should give fewer antibiotics to livestock. They can surely be convinced of the dangers of over-prescribing for humans as well.
Changing farmers’ minds might be most difficult. To start, the government needs to impose an immediate ban on the agricultural use of “last resort” antibiotics. Though unlikely to be totally effective — China has millions of small farmers — meaningful penalties and high-profile prosecutions would go a long way to reducing usage.
At the same time, the government should promote the market for antibiotic-free meat as part of its food-safety campaigns.
In the US, McDonald’s has promised to phase out the use of antibiotics in chicken by 2017. It and other companies that use large volumes of Chinese livestock should be encouraged to do the same in China.
With consumer concerns over antibiotics running high — in 2012, KFC’s China business was badly damaged by news that its chickens exceeded China’s lax antibiotic standards — such an effort would receive broad public support.
At a minimum, China might succeed in putting off the apocalypse long enough for researchers to come up with some badly needed new drugs.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
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