Investigators' Blog

Did you miss our InfectedNZ campaign with Figure.NZ? Don’t worry – we’ve put together a collection of resources and Twitter Q+A to help answer your burning questions.

Resources

• InfectedNZ blogs
• Science Media Centre – Antimicrobial resistance – expert Q+A
• Science Learning Hub – teacher and student-orientated information about fighting infections, the immune system, and the work of some researchers.
• NZ Herald online“The big read: is the world on the brink of an antibiotic apocalypse?”
• The Spinoff “In the fight against the superbug apocalypse, don’t fall for the idea that infectious diseases only happen somewhere else.”
• Newshub. “Online campaign highlights dangers of infectious diseases.”
• Newshub. “Antibiotics will soon stop working, scientists warn.”
• NewstalkZB “Antibiotic resistance a growing threat to world health.”
• The Spinoff “Calling a vagina a vagina: why cutesy code words are terrible for our sexual health.”
• Waikato Times “Urgent action needed to combat killer infections.”

Twitter Q+A

I am an ardent defender of people being free to choose what they do with their own life, even when I would not make the same decision. Partly this is because studying economics gave me an appreciation of how individual decision making is surprisingly effective at producing good outcomes, and partly it is me following the golden rule: I don’t like people telling me what to do so I try to refrain from telling others what to do.

I make an exception when it comes to antibiotic use.

The difference being that most health choices that people make primarily affects themselves. However, when people misuse antibiotics this presents a direct threat to my health. Misuse increases the risk of bacterial resistance to antibiotics which compromises the effectiveness of treatments I may need in the future. In economics, we call this an externality – when the choice an individual makes has a direct flow on effect to a third party. When externalities are present the result of individual decision making is not likely to be the best possible outcome.

When it comes to antibiotics there are a number of ways in which individual decision making is clearly causing bad outcomes. When people demand antibiotics to treat illnesses that do not require it, they are not considering the contribution their unnecessary use will make to future resistance. One more person taking antibiotics won’t make much of a difference, right? And if it helps this pesky cold go away then so be it!

Thankfully, in New Zealand we do have safeguards in place to mitigate overuse. Antibiotics are only available by prescription from a medical professional. This is a major step in combatting overuse that could occur if patients were able to self-medicate. Sadly, many countries do not have these responsible safeguards in place and overuse is rampant.

Doctors who are too willing to prescribe antibiotics to placate patients are part of the problem. The Center for Disease Control and Prevention estimates that one in three prescriptions for antibiotics in the US are unnecessary. Monitoring prescribing behaviour by doctors is important to ensure responsible prescription behaviour is taking place.

Incorrect usage after prescription is another issue. For example, people who stop taking antibiotics before finishing the prescription increase the risk of bacteria developing resistance to antibiotics. It is not easy to prevent this from happening but the government can take an active role in education campaigns to inform and persuade the public to use antibiotics correctly.

Agricultural usage is also a major concern. Antibiotics can play an important role in reducing bacterial disease in farm animals, especially important for animals living in cramped conditions which are particularly susceptible to outbreaks. However, the use of antibiotics at the farm contributes to growing resistance. Regulation to monitor agricultural usage is critical. So too is regulation to ensure farm conditions are suitable to limit the risk of disease. Consumers can also help here by choosing to purchase free-range eggs and meat, or reducing their consumption of animal products.

Antibiotic resistance is a looming threat that could have far-reaching and deadly consequences. A world where we cannot rely on antibiotics to treat infections is a very scary thought but a very real possibility if we do not take action. We take antibiotics for granted at our peril.

There are many things that both the public and the government can do to combat antibiotic resistance, but the first step is to raise awareness. Campaigns like Antibiotic Awareness Week and InfectedNZ are crucial to addressing this growing problem.

So when it comes to most health choices individuals make, I’m happy to live and let live, even when the choices may not seem like a good idea to me. But when it comes to antibiotics, I want a firm regulatory hand of government to ensure responsible use. My future health may depend on it.

About

Dr Rachel Webb is a research fellow at the New Zealand Initiative. She has a PhD in economics from the University of Canterbury, specialising in the area of health economics.

What is InfectedNZ?

Hey, Aotearoa. It’s time we had a chat about infectious diseases and what we’re going to do about the looming antimicrobial armageddon. That’s why we’ve asked leading health, social and economic researchers, and people with personal stories, to help us get real about our vulnerability and discuss solutions. Follow their blogs right here at tepunahamatatini.ac.nz and watch the conversation spread across social media with #infectedNZ.

Backing it all up, wherever possible, is data from the good folk at Figure.NZ. Their super duper charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.

Two years ago, to commemorate the 300th anniversary of the original Longitude Prize, the UK government offered a ten million pound prize for the solution of a significant global problem. The original Longitude prize was set up in the eighteenth century by the British Admiralty to tackle the difficult problem that mariners faced of determining their longitude at sea. Three centuries later, it was decided that the challenge addressed by new prize would be chosen by the British public by popular vote.

Voters were asked to chose between challenges such as “How can we fly without damaging the environment?” and “How can we ensure everyone has nutritious sustainable food?”. In the end, the public chose to fight the rise of antibiotic resistance in bacteria: the first team “to create a cost-effective, accurate, rapid, and easy-to-use test for bacterial infections that will allow health professionals worldwide to administer the right antibiotics at the right time” will win the prize, provided this occurs before a cut-off date of 2019.

In New Zealand we held the Great New Zealand Science Project (don’t bother googling it, as the site will now try to sell you the services of a personal trainer “Effective Personal Workouts? That’s not Rocket Science !!?!”). The 2012 campaign encouraged the New Zealand public to vote for a range of science challenges and, like the people of the UK, the public voted for a project for “Fighting Disease”. I’ve always found it remarkable that of the ten National Science Challenges that were chosen by the government, not one tackles infectious disease.

In the end there were four challenges that involved the health sciences: “A Better Start”, “Healthier Lives”, “Aging Well”, and “High-Value Nutrition”. The Healthier Lives Challenge, which at first glance seem best placed to tackle infectious disease, addresses what it calls four of New Zealand’s main non-communicable diseases: “Cancer, Cardiovascular disease, Diabetes and Obesity”. The Better Start Challenge grapples with obesity, learning, and mental health problems in children and teenagers. Aging Well concerns “brain and body health”, as well as ways “to reduce disability and moderate the impact of age-related illness such as dementia, stroke, depression and frailty.”

So despite a mandate from the public, the National Science Challenges shied away from taking on infectious disease. The report of the panel that selected the Challenges noted that research into infectious disease did not meet their threshold for additionality (that is, what would a science challenge add to the health science sector) or for current scientific capacity in New Zealand. To appraise these comments, we need to look at what else is going on in the health science system.

With that in mind, the other major source of health science funding in New Zealand is the Health Research Centre (HRC). They fund a very wide range of projects, and those awarded since 2016 are listed here. To what extent does the HRC fund research into infectious disease?

It’s actually quite hard to tell. I pulled down two years of data from the HRC website concerning projects that were awarded funded in 2006 and 2014. Running through the list project-by-project, my estimate is that only 3% of the HRC funding in those years was allocated to researchers to study infectious disease. For the most part, HRC funding in these years mirrors the “Healthier Lives” Challenge (cancer, cardiovascular disease, diabetes and obesity) with nods to a “A Better Start” and “Aging Well”.

This week’s #InfectedNZ discussion has highlighted some of the challenges New Zealand faces from infectious disease. There is clearly concern amongst the public and amongst the scientific community about this, particularly the potential threat from antibiotic resistant bacteria. There are also significant costs to our healthcare system: as the figure below shows, we have nearly 100,000 hospital admissions per year due to infectious disease.

It is hard to argue that a National Science Challenge in infectious disease would not have provided additionality: it would evidently have provided much needed resource in an area to which we devote less than 3% of our health research funding. If the panel that selected the National Science Challenge was correct, then it would seem we don’t have the scientific capacity in New Zealand to address infectious disease. This should be a serious concern in light of the conversation this week. Perhaps it is time to do something about it.

About

Shaun Hendy is the Director of Te Pūnaha Matatini. Shaun is an advocate for multi-disciplinary research and teaching, and lectures in the University of Auckland’s Department of Physics and the University’s Centre for Innovation and Entrepreneurship.

What is InfectedNZ?

Hey, Aotearoa. It’s time we had a chat about infectious diseases and what we’re going to do about the looming antimicrobial armageddon. That’s why we’ve asked leading health, social and economic researchers, and people with personal stories, to help us get real about our vulnerability and discuss solutions. Follow their blogs right here at tepunhahamatatini.ac.nz and watch the conversation spread across social media with #infectedNZ.

Backing it all up, wherever possible, is data from the good folk at Figure.NZ. Their super duper charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.