This clearly written effort from Suhaina Yasmin of Tanjong Katong Girls’ School netted her the second prize in our Post-Antibiotic World Essay Competition. One of our judges was deeply impressed and persuaded the other two to revise their scores!

The War Between Man and Mutant

Along with other crises of the world like terrorism and global warming looms a more silent threat – antibiotic resistance and the rise of the superbugs. In 1928, Alexander Fleming discovered penicillin, a bacteria-killing mould which was soon known as a miracle drug because it saved countless lives. However, he raised the alarm on antibiotic overuse barely two decades later because he observed that people had begun to rely heavily on his antibiotic. Alexander had warned “the public will demand [the drug and] …then will begin an era…of abuses.” (Calderone, 2015). His words ring true today as more antibiotics are rendered ineffective against the bacteria they could once kill (, 2014).

One of the main reasons for increasing levels of antibacterial resistance is due to the widespread abuse of antibiotics. As innocuous as the act of not completing the entire course of the antibiotic may be, this may cause non-resistant bacteria to be killed off, but result in resistant strains multiplying due to Darwin’s theory of natural selection. Horizontal gene transfer may allow resistant genes to be transferred not just between related species of bacteria but also between completely different species of bacteria with the aid of plasmids (Rogers, 2011). A case in point was when the “superbug”, Klebsiella pneumonia killed a woman in Nevada in August 2016, after testing showed that it was resistant to 26 different antibiotics, one being the “last-resort” antibiotic colistin. All 26 of the antibiotics used were potent ones but had no effect on the superbug. (Zhang, 2017). The invisible invaders we are dealing with, by nature of their rapid rate of reproduction and mutation, seem to have gotten a head-start.

It also seems that almost half of all Americans do not know what antibiotic resistance is (Fox News, 2015), but neither do three-quarters of my classmates. A straw poll conducted with 30 classmates revealed that 27 out of them had no idea as to what meaning and significance the words “antibiotic resistance” carried. It does seem that both Americans and my classmates here in Singapore do not understand the dire straits of the situation and how just widespread a phenomenon this is becoming.

During the Dark Ages, fear and inability to treat those down with infections had led to plague-ridden corpses being catapulted over city walls to protect the healthy population within. Only the uninfected were allowed to remain in the city; while weakened or infected people were shut outside the city walls and only allowed back inside once their symptoms had subsided. With the start of post-antibiotics era, it has been hypothesized that we may be forced to do the same in the near future – ostracizing the stricken – to prevent the spread of disease (Wheelis, 2002). Time has been ticking for mankind – with the advancement of microbe invasion, how will human beings as a whole respond this time around?

The prevalence of antibiotic abuse is staggering. From homes to clinics to multi- national corporations, antibiotics are being misused. If the family breadwinner does not make much money, the cost of antibiotics when family members fall ill may seem insurmountable. Thus, antibiotics left over from previous visits to the doctor’s may be shared with other family members. This would eventually lead to the bacteria becoming resistant to the antibiotic administered; and the drug would henceforth have no effect on the bacteria. This behavior is mostly found in developing countries, where there might be a supply and demand problem, or where the belief prevails that self-medication is cheaper and more cost-effective than going to a doctor (Okeke,1999).

In commercial usage, corporations introduce antibiotics into crops and livestock to make products resistant to bacterial attacks since bacteria can wipe out sizeable quantities of their produce. Adding antibiotics supports the profit-driven industry of mixed farming so that farmers and corporations alike do not suffer losses due to the death of their crops or livestock. USA Centers for Disease Control and Prevention (CDC) estimates that of all the antibiotics purchased per year in the United States, 80% is used for livestock and crop cultivation (Romm, 2014). This may also cause antibiotic resistance where the livestock and crops may not be able to use their natural antibodies to fight off invading bacteria.

Another reason for the increased rate of antibiotic resistance is the fact that fewer new antibiotics are being developed currently. Scientists have shifted their focus to improving current medication because of economic and regulation changes. The slower rate of development and improvement of existing medication compared to the speed of bacterial mutations is another contributing factor. By the time researchers establish how to further develop the current antibiotics, mutations in bacteria could render the “new and improved” antibiotics ineffective. Most recently, the CDC estimates that superbugs cause 2 million infections and 23,000 deaths per year and this number is projected to increase due to the slowed rate of development of new drugs (Sisson, 2016). This paints a very real picture on how delicate human health is linked to more or better forms of antibiotics.

A third reason for growing antibiotic resistance is over-prescriptions by doctors and demands of patients. While some antibiotics are prescribed seemingly liberally, it may also be patients’ insistence that doctors prescribe them. Sometimes, patients themselves may pressurize doctors into thinking that they need to have antibiotics, even for trivial ailments like the common cold, which is caused by viruses like coronaviruses and rhinoviruses, and that cannot be cured by a dosage of antibiotics. Some patients then proceed to consume the antibiotics until their bodies show early signs of fighting the illness, but then they do not finish the prescribed dosage thinking that they have been cured. Patients may assume that they no longer have an infection but in actuality, the bacteria are now what have become resistant to the antibiotic.

Some scientists believe that recombinant DNA technology, commonly stylized as gene splicing, may be an effective solution to antibiotic resistance. They believe that the separation and recombination of certain genes may prevent antibiotic resistance. This has already been proven to be possible by the creation of genetically modified foods. A notable case is the case of Antifreeze Strawberries, where the gene from the Arctic Flounder Fish was transplanted into strawberries so they could survive sub-zero temperatures. However, a debate has risen whether or not it is morally and ethically correcting to experiment using the gene-changing CRISPR or Clustered Regularly Interspaced Short Palindromic Repeats on humans, despite the knowledge that this method works, having tested it on a one-year old with leukaemia (the Guardian, 2015). Industry experts who attended an international summit also discussed the possibility of genetically modifying human embryos to create “designer babies”. From dabbling in genetically engineering microbes, are we now moving on to human beings? Another debate involves the success rate of the procedure, with many worrying about side- effects from the procedure if it were to be carried out. Scientists have yet to find out and classify all the parts of the human genome, making it risky to carry out. While CRISPR technology is cheap and easy to manipulate, it may pose a problem to those living in less-developed or third-world countries because of the difficulty of getting hold of the technology and administering it correctly.

Antibiotic resistance; while being an Achilles Heel for mankind, could be harnessed as a strength by countries willing to manipulate it to their advantage. One of the ways that antibiotic resistance could be misused would be through the use of bacteria as biological weapons. Using the high mortality rate or the pervasive spread of certain bacteria as an advantage, countries could resort to threatening each other using highly resistant bacteria to contaminate enemy territory, thus leading to a widespread outbreak of disease. Notable examples of biological warfare include the 2001 Anthrax attacks, and the previously-mentioned bubonic and pneumonic plagues. Other sinister bacteria like smallpox, Ebola and tularemia may be developed as potential biological weapons (Lamb, 2013). This would spell disaster for the world as the majority of medical and army personnel are vaccinated against the above-mentioned diseases, but not the rest of the world.

To prevent such a catastrophic event like biological warfare from occurring in the future, there are some precautions we can take. Education would be one of the most effective ways to spread awareness about the issue of antibiotic resistance as many people would learn about it and make a change immediately, if the message is stressed sufficiently. A revamp of the education system may be considered to include topics such as viruses, bacteria and germs being different organisms. We should also try to involve students and have them play the part of youth advocates so that they can spread awareness about antibiotic resistance by explaining the severity of the situation to their parents and their friends. After all, misconceptions about antibiotics are what led to misuse, and nipping the problem in the bud may prove to have good results in the future.

Some other ways of delaying the onset of antibiotic resistance include asking for targeted drugs that kill a specific species of bacteria instead of settling for the broad- spectrum drug that unnecessarily kills more types of bacteria; avoiding products marked as “antibacterial” and staying up to date on vaccines. This can prevent situations like bacteria not responding to tried-and-tested methods, therefore imposing additional costs onto patients and the healthcare system in general, so that we need to keep finding new medicines and ways to administer them.

Sufficient publicity of the issue and spreading awareness through educational material to the general public is a long shot, but it may help us to escape our doom at the hands of these microorganisms. I hope that someday, more people (Americans and my classmates) finally pay attention to the ever-evolving situation and work to prevent such an event from materializing.

While the war between mankind and his ever-mutating enemy seems daunting, we as the human race should recognize that while microbes are invisible, they still continue to co-exist with us. With that understanding, within our own sphere of influence, we ought to be make responsible decisions on medications and the state of our healthcare. Through collective efforts, humans may be able to slow down or turn the odds in our favour for winning the war.

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