Here's what typhoid looks like. Put it under a kaleidoscope to see a superbug. via Flickr.
There are all kinds of potentially world-ending disasters that stain our collective unconscious these days: super storms, nuclear war, or a violent alien invasion—but perhaps the most downright terrifying possibility is the proliferation of a bacterial superbug that’s resistant to antibiotics. Part of that terror is because the likelihood of something like this happening is far from impossible, and the Canadian government isn’t doing anything to prepare us, just in case.
For decades, scientists the world over have been warning about what will happen to us when antibiotics stop working and bacteria that is resilient to our medications starts to spread. We should have listened. Now all the talk is that we are already in a “post-antibiotic era,” which according to Dr. Margaret Chan, the Director General of the World Health Organization, means that we’re facing: “…an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
Since the forties, doctors have been able to slice us open and fix us up with antibiotics. Health issues like organ transplants, chemotherapy, gonorrhea, skin infections, tuberculosis, childbirth, and even tattoos will soon (if not already) become life threatening unless we fight off these killer bacteria that threaten our use of antibiotics. Nowadays, we throw antibiotics at anything and everything from the tiny paper cut you put Polysporin on, to the generic antibiotic you’re given while you wait for your blood tests to come back. This cure-all approach to antibiotics is great for the longevity of bacteria, and terrible for the longevity of, well, us.
According to the Chief Public Health Officer’s 2013 Report on the State of Public Health in Canada, which was released earlier this month, more than 200,000 people get infected every year while receiving healthcare, and at least 8,000 people die—making it a leading cause of death in Canada. Some hospital-acquired infections (HAI) come from viruses or fungi, but a growing number of cases are attributed to superbugs that can’t be cured by any antibiotics. One of those pesky superbugs is the deadly clostridium difficile (aka “c. difficile”), which can cause a gruesome amount of diaherea that has resulted in fatal colon inflammation in past cases. Instances of c difficile have increased threefold in Canada since 1997, according to the Chief Public Health Officer’s report.
A World Health Organization 2011 report on high-income countries says Canada has the second highest rate of HAIs at 11.6 per cent—second only to New Zealand at 12.0 per cent. Meanwhile, Germany has the lowest at 3.6 per cent. To put things into perspective, being in the same ballpark as New Zealand is not at all comforting, given that a kiwi gentleman died from a superbug resistant to every antibiotic just last week. Super!
If we want to put up a fight against this imminent threat, our government needs to do a better job at getting accurate information out there. Currently, Canada’s only surveillance program for in-hospital infections is called the Canadian Integrated Program Antimicrobial Resistance Surveillance (CIPARS). That organization receives information from provincial healthcare bodies and the Canadian Nosocomial Infection Surveillance Program (CNISP), which collects data from 54 hospitals nation-wide. They reported, for example, that there were just 154 cases of the “nightmare bacteria” called carbapenem-resistant Enterobacteriaceae (CRE) between 2010-2012 in this country. That’s positive information in comparison with the US who had 9,300 infections leading to 600 deaths, according to the Centers for Disease Control and Prevention (CDC).
But when you think about it, 54 hospitals is hardly an accurate assessment of our huge country—and not every hospital provides information to the province. According to Bruce Gamage, President of the not-for-profit Community and Hospital Infection Control Association Canada (CHICA), that’s a funding issue. He told me that although accurate data collecting on a federal scale is not in place, new programs are being launched.
Why is it taking so long? Gamage says: “Well, you live in Canada, I live in Canada, we know that things take a long time to move forward. The organizations that have an interest in this need to make sure that the government is hearing them and the public needs to be aware of these issues to let the government know.” Canada may be a slow-moving machine, but I surely don’t want my cause of death to be “bureaucratic” once the superbug apocalypse hits. There’s no need to add “lack of monitoring” to our list of superbug-related problems.
Doctors and patients need to know if what they’re prescribing can actually help eradicate a bug, or if it’s just increasing our exposure and reducing the general effectiveness of antibiotics. For instance, according to Gamage, 30-50 percent of people in the community are prescribed antibiotics for viral infections, and we know that antibiotics don’t work for viruses. In total, 50 percent of antibiotics are prescribed unnecessarily and the number is even higher when preschool children get prescriptions according to the Canadian Committee on Antibiotic Resistance (CCAR).
In a PostMedia News article last week, Dr. Mark Joffe, President of the Association of Medical Microbiology and Infectious Disease Control (AMMI), took on Public Health and CIPARS with complaints that they are not providing information quickly enough for doctors to prescribe the right antibiotics. A quick peruse of the federal website shows that the latest “annual report” from CIPARS was released back in 2009, and you even have to contact them to get your hands on it. After calling CIPARS, I was able to obtain a more recent report from 2011 which we've uploaded here. Unfortunately, Canada trails behind Europe and the US for health information transparency, as Dr. Lynora Saxinger, chair of AMMI explained in the PostMedia story: “I can get better access to data from tiny European countries like Estonia on their resistance than I can on trends in Canada.” Saxinger blames the Harper government’s “muzzling” and “gagging” of federal researchers for the snail-like data release.
A spokesperson for Public Health told me that it takes a while to “validate, analyze and interpret the data” and although the information is not on the PHAC website he sent me a shortened copy. He couldn’t tell me why the data is not on the website, but Gamage from CHICA thinks it is because of a 2010 court-mandate to make all Federal website data accessible to all Canadians—including visually impaired ones. The switch was supposed to take a maximum of 15 months to implement, but it has yet to be completed. Oh, bureaucracy.
Even worse than doctors overprescribing antibiotics without knowing if they work are the copious amounts of antibiotics we find in our meat. Of the up to 200,000 tons of antibiotics manufactured annually, up to 80 percent are fed or injected into livestock, according to a generally cited 2010 report from the US Food and Drug Administration, that although disputed, was proven correct by Politifact. Fattening up our meat gives bacteria a fighting chance to kill antibiotics, and has been linked to childhood obesity and inflammatory illnesses like heart disease, type II diabetes, and cancer.
The European Union was wise to eliminate the use of antibiotics for non-medical use back in 2006, and the US has at least issued a “guidance for industry,” which asks really super nicely if farmers could maybe possibly consider not using antibiotics in livestock—but Canada is far behind. Here, there is a “loophole” that allows farmers to buy antibiotics for their animals without having to file a prescription. Organizations like CHICA and the Ontario Medical Association have been pushing for legislation to mandate farmers to go to the veterinarian for prescriptions to no avail. Public Health couldn’t comment on what’s taking our government officials so long to tighten that loophole up.
One way to crack down on the overuse of antibiotics and raise money for surveillance could be a sort of carbon tax, or a “Pigouvian tax,” which could tax all use of antibiotics worldwide. But that wouldn’t be good for the consumer as Gamage explained: “I think that would be difficult to be putting the cost on the users because you are actually affecting the most vulnerable people when they need these drugs.”
But keep your head up, because it might not be all doom and gloom. New research out of Ontario’s McMaster University has offered a glimmer of hope with a new study on compounds that could attack the bacteria’s ability to produce the vitamins and amino acids it needs to survive. But, new drugs take funding, which is hard to come by when drug companies are hesitant to dish out the billions of dollars it costs to research and develop new antibiotics. They know by now there isn’t much money in a drug that you only use for five to seven days, compared with something that can be used long term for chronic illnesses like diabetes or heart disease.
If that doesn’t work, another approach scientists have suggested would be a return to some medicine of years’ past, such as serums and bacteriophages. But if you ask me, you can save your leeches and snake oils. Just kill me now before the superbug apocalypse destroys us all.
Follow Joel on Twitter: @JoelBalsam