How China Can Prevent the Apocalypse
Last week scientists announced they’d discovered a gene spreading among bacteria in China that renders them resistant to some of the world’s most powerful, “last resort” antibiotics. If such invulnerable bugs spread, doctors may soon lack the tools needed to combat infections, whether contracted through chemotherapy, surgery or even simple cuts. Indeed, the post-antibiotic “apocalypse,” as this scenario has been known for a decade, may already be upon us: There’s evidence that the resistant genes have made their way to Laos and Malaysia.
Antibiotic resistance isn’t new. Alexander Fleming, who discovered penicillin, presciently warned in his 1945 Nobel Prize address that casual overuse of his miracle drug could promote resistance. In recent years, the U.S. has suffered several cases of foodborne illnesses that didn't respond to existing drugs. But the real threat lies in China, where a large, dense population and close interactions between people and livestock have long made the country a breeding ground for new infectious diseases. To control the problem, the world has to control it in China first.
That won’t be easy. China's millions of farmers are notorious for pumping their livestock full of antibiotics -- roughly three times more, pound for pound, than counterparts in the U.S.; agriculture accounts for perhaps half of antibiotic use in China. The practice, pioneered in the 1940s in the U.S., increases yields for farmers, but also creates an ideal environment for bacteria to develop resistance. Bigger herds offer bigger evolutionary opportunities and China -- with the world’s largest pig and poultry industries -- is particularly susceptible. The drug-resistant gene that scientists reported last week is believed to have evolved in Chinese pigs.
Human patients also contribute to the problem. China's health-care system is designed to push drugs unnecessarily. Chinese hospitals receive limited government support, and face price caps on fees and doctor salaries. They thus rely on pharmaceuticals for about 50 percent of their income and most of their profits. Antibiotics account for about 25 percent of drug sales.
Patients have grown used to demanding antibiotics even when they're unneeded or ineffective. According to a World Health Organization survey released last week, more than 60 percent of Chinese believe antibiotics can cure colds and flu. (They can't: Those illnesses are viral.) Worse, nearly half of respondents mistakenly thought they should stop taking antibiotics even after feeling better -- a textbook method for breeding drug-resistant bacteria. Some 57 percent of Chinese had taken antibiotics in the last six months. A separate December 2014 survey found that 78 percent of colds in China were “treated” with antibiotics. Nearly 40 percent of all antibiotics were prescribed incorrectly.
Reforming China's health-care system -- which encompasses around 300,000 hospitals and clinics -- is a daunting task. But it's not impossible. As part of a 2011 reform effort, China’s Ministry of Health set antibiotic-prescription benchmarks and worked with key hospitals in a pilot program to meet them. Penalties included demotions, dismissals, revoked accreditations and even public shaming. The effort succeeded in reducing prescriptions and deserves to be extended nationally.
Meanwhile, the government could make better use of its propaganda apparatus to educate Chinese about the basics of antibiotics. Such a campaign would face a potentially receptive audience: According to last week’s WHO survey, 83 percent of Chinese believe that farmers should give fewer antibiotics to livestock. They can surely be convinced of the dangers of overprescribing for humans as well.
Changing farmers' minds may be most difficult. To start, the government needs to impose an immediate ban on the agricultural use of “last resort” antibiotics. Though unlikely to be totally effective (China has millions of small farmers), meaningful penalties and high-profile prosecutions would go a long way to reducing usage.
At the same time, the government should promote the market for antibiotic-free meat as part of its food-safety campaigns. In the U.S., McDonald’s has promised to phase out the use of antibiotics in chicken by 2017. It and other companies that use large volumes of Chinese livestock should be encouraged to do the same in China. With consumer concerns over antibiotics running high (in 2012, KFC’s China business was badly damaged by news that its chickens exceeded China’s lax antibiotic standards), such an effort would receive broad public support. At a minimum, China might succeed in putting off the apocalypse long enough for researchers to come up with some badly needed new drugs.
(Corrects description of poll response given by nearly half of respondents in the fifth paragraph of article published Nov. 22. They mistakenly believed they should stop taking antibiotics when after feeling better.)
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