You wake up with a sore throat.
Nothing too bad, you think to yourself. A simple cup of tea or a cough drop can alleviate the pain. But as you go about your day, the sore throat develops into something more serious: extreme throat pain, a fever and chills.
The doctor diagnoses you with strep throat, which is a common illness that can be cured quickly and easily with antibiotics. After a course of antibiotics, however, your painful symptoms are not alleviated.
Another round of antibiotics is necessary, but again, these drugs fail to cure your strep throat. Eventually, you discover there is no treatment that will cure your strep throat.
Luckily, this situation is not a reality. Yet.
Slowly, right under our noses, bacteria are becoming resistant to the medical defenses we’ve developed. Bacteria are persistent creatures, constantly searching for new ways to survive. Rapid evolution has allowed bacteria to acquire antibiotic-resistant genes, and through a mechanism called horizontal gene transfer, bacteria are able to spread resistant genes rapidly without discrimination. Penicillin, for example, the first line of defense for strep throat, was released for use in 1943, and by 1976, two bacterial strains were found to be resistant to it. The Centers for Disease Control and Prevention reports that there are now more than 2.8 million antibiotic-resistant infections annually and 35,000 deaths among those infected.
It’s easy to blame this situation on the overprescription of antibiotics. While human consumption of antibiotics plays an important role, a key culprit to consider is antibiotic use in livestock. According to the Food and Drug Administration, in 2010, antibiotic use in livestock accounted for about 80% of the United States’ yearly consumption.
This blatant overuse causes animal intestinal bacteria to develop a resistance to antibiotics, which is then transferred externally via animal excretions. What is animal dung typically recycled for? Agriculture! Manure carries resistant bacteria and easily pollutes agricultural settings. A study conducted at pig farms in China reported alarmingly high levels of antibiotics and distinctive resistant genes in manure and soil.
Manure runoff from rain also drains into nearby bodies of water, and widespread pollution of antibiotics places pressure on bacteria to evolve more quickly. An environmental scientist from the University of York collected samples at various rivers, and a majority contained antibiotics at levels much higher than deemed safe. The antibiotics found in the rivers are crucial for the treatment of serious diseases, such as respiratory and skin infections, so if bacteria develop a resistance to these drugs, the consequences will be drastic and worldwide.
Pharmaceutical factories are another critical source of antibiotic contamination in the environment. Seeing that there is a significant lack of oversight on pharmaceutical industries, it comes as no surprise that in India, 45 kilograms of antibiotics are released into the environment every day from factory discharge. For context, Sweden’s total daily consumption is just nine kilograms.
This shocking discrepancy not only has toxic effects on life in the environment but also drives the evolution of unique antibiotic-resistant genes. There is a serious lack of transparency when it comes to where pharmaceutical waste goes and whether it is truly removed in an eco-friendly and safe manner. A case study in India showed that 95% of samples collected from environments around drug-manufacturing sites contained drug-resistant bacteria and fungi. About 60,000 newborns in India die annually from antibiotic-resistant infections. This staggering statistic is, therefore, seemingly linked to the fact that India is home to one of the world’s largest drug-manufacturing industries.
In February, India published a draft bill to regulate antibiotic pollution from pharmaceutical factories. This is an amazing step toward limiting the progress of antibiotics, and other countries must follow India’s lead. Without appropriate regulations, antibiotics will continue to be overused for monetary, short-term gains, with no consideration for the future of the health care landscape. We need specific limitations on pharmaceutical waste and measures to monitor effluents from factories and animal husbandry farms.
I urge policymakers to consider the long-term effects of antibiotic pollution and take action before an uncontrolled drug-resistant bacteria sweeps the world, akin to the current COVID-19 crisis. Pharmaceutical companies must publicly release data on effluent concentrations, which should be directly measured rather than estimated from internal data. Lawmakers must then determine the appropriate methods of effluent waste removal, ensuring antibiotic-resistant genes remain out of the environment and/or neutralized.
Further research is required on how to appropriately manage antibiotics in waste. In addition, there needs to be a ban on the use of antibiotics as growth promoters. This also requires increased transparency on the part of livestock farmers. Banning growth promoters in Denmark resulted in either no increase or a very little increase in production costs without any spike in infectious diseases.
Finally, a worldwide agreement on the use of antibiotics can be an important step to set international standards for and draw attention to this critical matter. We are in the twilight of infectious diseases, and we must take preventative measures to avoid even more devastation and mayhem than we are seeing today.
Meera Nagpal is a senior at UC Berkeley studying molecular and cell biology.