Stop talking about the ‘antibiotic apocalypse’, report warns

Presenting drug-resistant infections – or antimicrobial resistance – as an ‘apocalypse’ or a return to the ‘dark ages’ fails to create a sense of urgency on the issue and makes people feel defeatist, finds a new Wellcome report.

 

Global action to address drug-resistant infections is not happening at the scale and urgency needed. Through testing messaging in the UK, US, Germany, Japan, India, Thailand and Kenya, the study of over 12,000 people looks at whether the way we talk about drug-resistant infections is helping or hindering progress. 

Headlines that focus on the numbers of deaths and catastrophic future projections were perceived as “overly sensationalist” and did not inspire people to take immediate action. As one person noted: “It may happen in the future, but I don’t see it as an issue that will be affecting me anytime soon.” 

People are much more likely to engage with the issue when communications focus on the current impact on individuals and the issue is presented as solvable, the report finds. 

Tim Jinks, Head of Drug Resistant Infections Programme at Wellcome, said: “The language we use when talking about drug-resistant infections plays a crucial role for raising public awareness. People need to understand what drug-resistant infections are, that they are not limited to one illness or country, and that they are affecting people today. This problem can affect anyone and undermines a cornerstone in healthcare. Our communications must be evidence-based and compelling if we are to increase public understanding and see pressure for political action.”

The report reveals that current communications around drug-resistant infections are causing widespread confusion, with low awareness in all countries. And because people don’t understand the issue they are neither aware of who may be at risk, nor inspired to apply the public pressure needed to press for political action.

The most readily understood and compelling way to talk about drug-resistant infections is as ‘undermining modern medicine’, the report says, - where common infections and routine surgery could once again prove fatal. Using this messaging alongside tailored examples of the most common procedures and illnesses in a country likely to be affected by rising drug resistance helps the public to understand that drug-resistant infections are bigger than one disease.
  
Using multiple terms and scientific jargon causes significant confusion. The report recommends avoiding the terms ‘antimicrobial resistance’ and ‘AMR’ outside of a scientific dialogue, as they are not understood by the majority of the public. The term ‘drug-resistant infection’ was best understood in all countries and should be used wherever possible. 

The report also finds that the majority of respondents did not see antimicrobial resistance as an issue that would affect them. It recommends explaining that the bacteria develop resistance, rather than people, to show that everyone is at risk. 

How Wellcome recommends communicating about drug-resistant infections:

  • Explain that they undermine modern medicine, making routine procedures and common infections untreatable. 
  • When talking about the science, use simple, non-technical language – like ‘drug-resistant infections’. Be clear that it is bacteria that develop the resistance, not individuals.
  • Focus on the current, human impact of the issue, drawing on personal stories and case studies as much as possible. 
  • Encourage immediate action, with a specific call to action, framing it as solvable.

Read the report, Reframing Resistance.

Quotes

Professor Dame Sally Davies, UK Special Envoy on antimicrobial resistance

“Every time we communicate about antimicrobial resistance we have the potential to inspire allies or drive apathy through the language and messages we use. By basing our communications in evidence – as we would be required to do for any other intervention we develop – we can better unlock the huge potential we have as advocates to more effectively galvanise support for the antimicrobial resistance cause and stimulate action. Guidance on best practice has been sorely needed for some time, and I applaud Wellcome’s investment in this vital area of research.”

Dr. Hanan Balkhy, Assistant Director-General, Antimicrobial resistance, World Health Organization

“Antimicrobial resistance is a profoundly complex issue and how we talk about it can be the difference between inertia and action. As a global community, it is our responsibility to use informed approaches in language and context to communicate more effectively on antibiotic resistance and this report provides evidence to bridge the gap between what we say, why we say it, and how we say it.” 

Dr Juan Lubroth, FAO Coordinator on AMR & Chief Veterinary Officer, Food and Agriculture Organization of the United Nations 

“How we talk about antimicrobial resistance matters, not just when presenting scientific findings, but equally when communicating about vaccination, biosecurity and other food production practices that reduce AMR risks. Research on framing is one of many sources of evidence that may make our conversations more effective in gaining public understanding and support for best practices – in the medical arts, in food production and beyond.  FAO looks forward to seeing how Wellcome’s research may contribute to our ongoing efforts to apply evidence-based insights to AMR communication for a safer, healthier planet.”

Dr Matthew Stone, Deputy Director General, World Organisation for Animal Health (OIE)

“The prudent and responsible use of antimicrobials requires change in the behaviour of veterinarians, aquatic animal health professionals, farmers, farm workers, in fact, all actors in the food value chain, including retailers and consumers. Information on what these groups know about antimicrobial resistance, what they believe, and what it would take to drive infection prevention, biosecurity and responsible antimicrobial use throughout the food system is invaluable. It sounds intuitive, but framing research is fundamental to communicating using appropriate language.”  

Dr Padmini Srikantiah, Antimicrobial Resistance Strategy Lead, the Bill & Melinda Gates Foundation

“Our goal is to prevent unnecessary death and suffering from AMR, especially among the most vulnerable—newborn babies in low-resource settings. Using research to inform communications around AMR to achieve the greatest impact is no different than formulating a vaccine to be as effective as possible."

Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases & HIV Medicine, Groote Schuur Hospital, University of Cape Town, South Africa; President of the International Society for Infectious Diseases 

“Behaviour and social change start with understanding and lie at the heart of mitigating drug-resistant infections. Our ability to communicate in language and imagery that is understandable and non-threatening to all, is critical to achieving this shared goal. Only by undertaking contextually-appropriate communication research, can we harness the true power of language, to meet our goals.”

Dr Kamini Walia, Senior Scientist, Epidemiology & Communicable Diseases Division, Indian Council of Medical Research, India

“Effective evidence-based communication is as important as scientific evidence itself. We need more research to understand how to communicate in a way that generates support for antimicrobial resistance. We have seen the impact effective communication can make in HIV/AIDS and polio campaigns; both the programs benefited tremendously from the right messaging.”

Dr Direk Limmathurotsakul, Head of Microbiology at Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Thailand

“The current language used around antimicrobial resistance is full of complexity and jargon. We need more evidence on how to communicate effectively about antimicrobial resistance, especially when working across different countries and languages.”

Mirfin Mpundu, Head of ReAct Africa; Executive Director Ecumenical Pharmaceutical Network

“Communicating on the topic of antimicrobial resistance presents a number of challenges. The complexity of the issue can make it difficult to help people understand how it affects them and what they can do to support positive changes - l see this challenge when talking to people in African communities from all walks of life and professions. If we have an evidence-based foundation for communicating cohesively and collectively as a community, then we have the power to create new advocates and help policy makers to invest in programs and interventions that are sustainable.”