By Sophie Newsome,
12 October 2017.
Superbugs and storytelling: how do we get the message across about antimicrobial resistance?
It’s a media buzzword relating to one of the world’s critical health issues: antimicrobial resistance. But despite a worldwide response headed by the World Health Organization and a spate of newspaper headlines, current efforts aren’t making a large enough dent in a problem that is projected to kill 10 million people per year by 2050. Research indicates that most people don’t really understand what antimicrobial resistance is or why its progress needs to be halted. In fact, misunderstandings and myths are considerable roadblocks to progress in mitigating resistance.
So what exactly is antimicrobial resistance? Antimicrobials are a category of drugs used to kill infective microbes, such as bacteria, viruses, and fungi. Antibiotics, perhaps a more familiar term, specifically target bacteria. Overuse of antimicrobial drugs, in part driven by the use of antibiotics in inappropriate situations (e.g. for viral infections), has accelerated the rate at which these microbes make clever adaptations allowing them to survive treatment. With added resistance, common infections will become much harder to treat, result in more severe illness, and cause more deaths. The loss of antibiotics as an effective treatment for infections could soon jeopardise important medical interventions such as chemotherapy and organ transplants.
However, antimicrobial resistance is not just a story of evolving microbes. It is also a story of the attitudes towards antibiotics that have developed in our society over nearly a century. When Penicillin was introduced in the 1940s, antibiotics were conceptualised as miracle drugs. Even now, antibiotics are often regarded as a magic bullet for colds and flu, even when the infection is of viral origin and antibiotics would therefore be useless. Receiving a prescription for antibiotics at the end of a consultation imparts a sense of validation (‘The doctor gave me antibiotics so I really must be sick’) while the tangible outcome provides evidence that the consultation was ‘worth it’, especially if the patient is not being bulk billed. It has been suggested that the widespread presence of these attitudes and misunderstandings places pressure on GPs to prescribe antibiotics, and has contributed to Australia’s high rates of inappropriate prescription.
In Australia, increasing consumer awareness of antimicrobial resistance is part of our National Antimicrobial Resistance Strategy. Messages about antimicrobial resistance have primarily been delivered by NPS MedicineWise in an annual campaign, encompassing TV and newspaper advertisements, and more recently, social media infographics and a film contest. But with persistently high rates of antibiotic overuse, it seems that simply raising awareness of the problem can only go so far. To make a real difference, consumers need to be transformed into engaged and active participants, who understand how the issue will affect them personally and how they can play a role in addressing it.
A recent suggestion is that the language used to communicate information about antimicrobial resistance needs to be revamped to better resonate with the community. Currently, the interchangeable use of technical terms by doctors and scientists such as conservation/stewardship, and antibiotic/antimicrobial, is an obstacle to understanding. Furthermore, the alarmist rhetoric surrounding antimicrobial resistance in the media can alienate people, making them feel powerless in the face of such a large and seemingly inexorable problem. This large-scale picture also makes it easy to shift the weight of responsibility onto big players like government and the pharmaceutical and agricultural sectors, and away from individuals in society.
Successful Australian health campaigns, notably the anti-smoking campaign, were effective because they provided incentive for change by highlighting personal impacts. Confronting TV advertisements showing the harmful effects of smoking (think diseased lungs and gangrened toes) were difficult to ignore. Moreover, the campaign appealed to people through messages about the effects of smoking on loved ones. Campaigns asked parents how their children would cope without them if they died from smoking-related disease. Communication about antimicrobial resistance could use a similar line of thinking. Indeed, this storytelling approach has already been embraced by organisations such as the Infectious Diseases Society of America, which has compiled the personal accounts of individuals who have suffered from the effects of resistant infections. The widely underappreciated side effects of antibiotics and links with poor gut health and childhood obesity could also be communicated via a narrative that frames the health benefits of reduced antibiotic use.
Storytelling has been valued as a powerful tool for education since ancient times, and is being increasingly explored as a mechanism to reach communities with health messages. People tend naturally towards narrative formats of communication. Stories stir up empathy and connection. In the age of social media, these stories would make for compelling content to be shared across online platforms, with the hoped-for outcome of people viewing antimicrobial resistance not as a distant epidemiological issue but as one that could significantly affect them within their lifetime.
The approach to antimicrobial resistance needs to be multipronged, and will involve research and regulation across the breadth of the human and animal health sectors. But with such a strong cultural aspect to antibiotic use, consumer engagement is a link that cannot be overlooked. Communication is key, and to be effective we know it must be both clear and personal. One solution may indeed be an ancient one: telling stories that hit home and resonate with people.