This essay by Mstr Aaron Chua from Raffles Institution was awarded one of the two Merit Awards by our judges.

“Post-Antibiotic World”

I was born in 2007, the decade before antibiotics failed us. Living in a HDB apartment, going to the pre-school at my void deck, and then attending a primary school in my neighbourhood, I was very much the quintessential Singaporean kid. School was an amalgamation of hard work and play, where I stayed back often with friends. When it rained, we practiced the art of multitasking, alternating between our homework and discussions on the most trivial of things. When it shined, we were to be found playing soccer in the school’s muddy open fields, the concerns of the adult world the last things on our minds. I fondly recall too, my canteen’s mouth-watering wanton mee: At just two and a half dollars, it was a frequent indulgence of mine. Back at home, I would help my mother in the kitchen, or game on my father’s computer, while church, hawker centres, relatives’ houses and the shopping mall were my family’s weekend haunts.

I thought my childhood was by all accounts a typical one, but I was to learn, painfully, that it was a privilege only those living in the developed world during the epoch of antibiotics—1943 to 2019—were fortunate to enjoy.

The first superbug pandemics happened in 2019. There have been so many since then that I can no longer recall from where it originated. Then, was when the world truly began to remember what life was like in a pre-antibiotic world, and started to appreciate antibiotics for the miracle that it was. But it would be too late.

My father was a healthcare worker then. Involved in treating a businessman who had returned from the infected region, he was one of those on the medical team that the bacteria transmitted to. Some of them were lucky to survive, but my father was not. I never guessed that the hug we shared before I left for school that fine morning would be our last interaction. I was twelve then. What affected me as much as his death was its cause: not an unavoidable stroke of misfortune, but an entirely preventable cumulation of irresponsible lifestyles; the collective mistake of a few generations ignorant of how antibiotics should be used.

My father’s story would not be unique. Superbug pandemics, like the infamous Black Death in the fourteenth century, are notoriously devastating, and spreads incredibly fast in a globalized world. Taken rudely aback by this first pandemic, countries were quick to develop emergency response systems and protocols.

I am in secondary four now, but feel woefully inadequate for the impending ‘O’ levels. The latest pandemic has suspended school for a week, and already, a third of the entire curriculum has had to be taught through e-learning. It is anyone’s guess as to how long it would take for the alert level to return to safe. I communicate with friends online nowadays, but it is just not the same. We do not hang out much anymore: our parents do not allow us. It is much too easy to get infected. I see less of our relatives too, and my mother is reluctant to go to public places.

Across the globe, infected people are quarantined and left to die. There is little that can be done for them, much like the state of affairs in the pre-antibiotic world.

Yet, the disruption and danger of pandemics is just the tip of the iceberg of what the post-antibiotic world is like.

My daily routine has changed drastically. Going outdoors unsupervised during school hours was prohibited three years ago, after a student died from an infection he got when scratched while climbing a tree during recess. Soccer, with all its associated risk of injury—and now, death—terrifies my mother, so I have since stopped playing it. I do not want to burden her with the prospect of losing yet another loved one. I am no longer allowed to help her cook either, after I inadvertently cut my finger while dicing carrots. We shop online now, like everyone else, to minimise our time outside.

An overwhelming sense of anxiety pervades society. People take multiples baths a day. Classrooms are sprayed with disinfectants whenever there is a change of class. No one uses the railings. Public transport moves slowly, because people refuse to hold on to the handlebars. Political issues revolve around government expenditure for novel vaccinations and antibiotics, but they have a tremendously long and costly development process.

Life is mundane. It is not just social activities that have lost popularity: thrilling activities that bring excitement to life, like traveling or extreme sports, are avoided—ironically—like the plague, because even the most minor of accidents are life threatening. No one gets tattoos anymore. People have become more much cautious outdoors, driving slowly or not at all, and paying neurotic levels of attention to their surroundings. All this because countless medical procedures run a high risk of infection, and without antibiotics, it is dangerous to undertake them.

The prices of food have skyrocketed. My primary school’s wanton mee now sells at a hefty three and a half dollars. To prevent pandemics among livestock and agriculture, farmers could no longer rely on antibiotics like they used to, and have since passed on the costs of improving hitherto squalid farming conditions to disgruntled consumers.

My mother works as an accountant. She tells me white-collar workers are fortunate because their jobs have remained, but many others are struggling to survive. The small boutique shop she owned went bust as shopping malls—just years before the epitome of vibrancy—turned deserted. Communications and transactions went online, and businesses and employees alike had to adapt or become obsolete. My mother had remained in contact with her salesgirl. Jobless for months, she eventually ended up working for CleanGo, a widely-used service where items are delivered in a sterilized box by drone, and one of the few businesses that are thriving. The wages in some industries involving physical work, like engineering, have swelled along with their risks. But I have heard that, especially overseas, the wages in the manufacturing and construction industries have not been much affected. People are clamouring desperately for jobs: even one where the smallest incident spells a death sentence is better than none.

My eldest uncle passed away from heart disease a month ago, at age 65. Bacterial infections remain the biggest threat, but the mortality rate of non-infectious diseases have also escalated since 2019. Antibiotics had been a vital part of the process in treating them. The transplant of organs and treatment of cancer relies on suppressing the immune system, and antibiotics were needed to step in to fulfil the role of destroying bacteria. Similarly, any treatment dependent on a permanent port into the bloodstream, such as kidney dialysis and major open-cavity surgery, is no longer viable. Neither is surgery on parts of the body that harbour populations of bacteria: the guts, the bladder, the genitals, nor the implantation of devices like new hips and knees, for they are open invitations to large numbers of bacteria the immune system cannot deal with alone. But I find my uncle fortunate, because it seems not many of us will get to live long enough to ever develop such diseases.

Then there has been the public uproar over many of the ultra-rich, recently exposed by the media to have had privately funded and successfully developed an exclusive antibiotic solely for themselves. They do not share it with the rest of the humanity, for fear of the pace that bacteria might develop resistance to it too. In a world driven by profit and where ethics takes a backseat, I guessed it should have come as no surprise that those with the capital would decline to produce antibiotics for the public good.

I learn about history in school. In many ways, I am grateful that our lives are still far better than our forebears in the pre-antibiotic world. We have vaccinations and disinfectants to fight off bacteria, well-maintained public utilities, and sophisticated technologies to cope with pathogenic disasters. But for a species that has already grown accustomed to having the upper hand over bacteria for more than seventy years, adjusting has been difficult. What I think we have lost most is not the quantity of our years—life expectancy remains much higher than in the pre-1940s—but their quality: No longer can we live in the same confident, carefree way of the past. There are no more toddlers running ecstatically about at the playground downstairs, nor social gatherings where I can relish in the excited chorus of voices. And with increasing civil unrest, I am anxious about the economic and political upheavals to come. I have wondered whether I will live long enough to have kids. But I also wonder: Will my children ever have the same childhood as I did? Could they cope with the possibility that one day, their father too might suddenly disappear?

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