What if the drugs don’t work? Solutions start with communities

In this World changers episode, Vice-Chancellor Simone Buitendijk speaks to Dr Jessica Mitchell.

Infections that would have quickly killed us a hundred years ago are rarely a cause for concern nowadays. Antimicrobials protect us from infections caused by microbes such as bacteria, fungi and viruses.

But the speed at which microbes are becoming resistant to these drugs is accelerating rapidly. What will happen if the drugs stop working?

Dr Jessica Mitchell is exploring effective ways for our communities – global, national, and local – to come together and respond.

Research that changes lives.

Four simple words, inspiring researchers at the University

of Leeds to reshape the world.

I am Professor Simone Buitendijk, since arriving at the University

in 2020 as Vice-Chancellor.

I've been amazed by the passion, creativity and ingenuity of the

research community to make a difference.

Having the opportunity to exercise choice is really key to palliative care

and that individualised care that supports the person in the last few months of life.

We need to learn from the mistakes that we've made and we

need to learn from the instances where prevention atrocities work.

I think the COVID-19 pandemic actually forced us to become a

little bit more digitally literate.

Although I do think we still have some room to kind of, continue growing.

One of my priorities has been to learn more about the sheer

range of research carried out by early career researchers at Leeds.

They are the new generation of world changers people working tirelessly

with communities and academics around the world on finding solutions to

seemingly intractable problems.

Over the course of this podcast series, I will be in conversation

with those researchers.

Join me as our World Changers described new discoveries and

approaches that will make the world a better and more equitable place

to live.

It's about research that changes lives.

Welcome to this latest edition of the World Changers podcast.

Our topic is anti-microbial resistance, which in just three decades could

cause up to 10 million deaths a year, unless the world acts to stop it.

Anti microbial resistance happens naturally as microorganisms evolve

and become resistant to drugs that we use to try and kill them.

With widespread inappropriate use of anti-microbial compounds has

accelerated the speed at which micro organisms develop resistance.

Joining me to discuss the issue is Dr.

Jess Mitchell, a postdoctoral research fellow at Leeds.

Who's trying to find solutions to a large global problem.

Jess, thank you for being on the podcast.

Thank you for having me.

Great.

Most of us have heard at some point somewhere antibiotic resistance,

but can you talk a little bit more about what what's anti-microbial

resistance or AMR actually means and why it's such a big problem?

Yeah, definitely.

when we talk about antibiotic resistance, that's maybe a bit more

familiar because a lot of people will be familiar with taking antibiotic

medicines if they're sick, or if they're pets or livestock are unwell.

and antibiotic resistance is simply where the bacteria that

we're treating with those drugs no longer respond to the drugs.

So the bacteria have become resistant to the medicines and

the medicines don't work anymore.

But there's lots of other different microbes that cause illnesses.

So it's not just bacteria, there's viruses, parasites, funghi and there's

lots of other different medicines that we can use to treat those infections.

So anti-microbial resistance simply refers to the changes that happen to all

sorts of different microbes that mean they're able to fight off the medicines

that we would use to treat them with.

It's a very big

problem, not just for people, although a lot of the conversations around AMR

are around people and human health, but for animal health as well, because if we

suddenly have infections or microbes that can resist certain types of drugs they're

likely to spread between different types of animals between animals and people.

They could even move through our water sources and through our natural

environments to infect the populations.

So AMR is really a global problem and what we call a one health problem,

because it infects and affects people, animals, and our wider environment.

Thank you, that's really clear and I hadn't realised the difference between

antibiotic and anti-microbial resistance.

So thank you for explaining that and before we go further into the detail,

then can you tell me how you got involved in studying this particular area.

Yeah, I guess it's a bit of an unusual story.

So my background is actually as a Zoologist and I spent a lot of

years studying social animals.

So animals that live in big groups, things like meercats, and mongooses, and

So animals that live in big groups, things like meercats, and mongooses, and

So animals that live in big groups, things like meercats, and mongooses, and

while was working on that field site,

it was in a national park, it was quite remote, I became very engaged with

the local community around the field site and worked on a lot of projects

to mediate human wildlife conflict.

So particularly managing human elephant conflict.

I worked in schools, I engaged with other health promotion

interventions in the area.

So I became quite engaged, not just with the animals, but

the people around the site.

And it sort of got me thinking about, what I wanted to do with my career and

how I really want it to be tackling problems that had meaning at both

human animal and environmental level.

And so it was several years after that project, I actually got

into anti-microbial resistance.

That's really fascinating.

And also the relationship between humans and animals and how this

particular problem clearly plays itself out in all populations.

So what is the scale of the problem of anti-microbial resistance mean globally?

I guess this is quite a scary answer, but I know we're going to talk

about a bit more of the positive sides of the work that we're doing at Leeds

and how we can have more positive impacts on the problem, but at the

moment, AMR is, is a huge global concern.

A report published actually from a UK scientist who estimated

that anti-microbial resistance could cause as many as 10 million

global human deaths per year.

If we don't do anything about it in the next couple of decades.

And that report really catalyzed a lot of action on AMR and a lot of people

saying, okay, this is a huge problem.

What can we do about it?

More recently, a paper has come out.

That's absolutely looked at real-time data rather than just making predictions.

And it's shown us that in 2019, about 1.3 million human deaths could be

directly linked to antibiotic resistance.

These two publications only look at the human death toll.

What they're not doing is telling us how big a problem.

Resistant infections and AMR is in the animal sector.

So for example, if we have poultry or pigs or cows contracting resistant

infections, we could see huge damage to our food supply and food chains globally.

And whilst in certain countries, we have lots of choice over

what we eat in other countries

there is much more limited choice.

So if a certain type of poultry

goes down with a resistant infection and we can't treat that and it spreads people

could become severely compromised in terms of the nutrition that's available to them.

And we also can very clearly say that the use of anti-microbial medicines or

rather the misuse of those medicines is what's driving the problem at this global level.

So Jess could you explain to me what types of human behavior

actually exacerbate the problem of anti-microbial resistance?

Yeah, so I think that's a really important question because as we've discussed,

anti-microbial resistance is, is a natural process microbes change naturally.

And by chance, that will mean that some of them evolve a way to fight off medicines.

You know, that's always happened.

Even Alexander Fleming, who first invented penicillin, one of our first

anti-microbial medicines, he warned us that resistance would happen.

It would develop.

And we've seen that happen over the last sort of 80 years since we'd been

using anti-microbials very frequently.

But what we've also seen is that certain things we do speed up that process.

So if we use an anti-microbial on the wrong type of bug

the wrong type of infection.

It won't kill that microbe.

It won't kill the infection, but what it might do is challenge that

infection to find a way to get stronger so that, that infects and then

becomes resistant to other medicines.

What we also see happens.

if people take anti-microbials, say they have an infection and they're

feeling really poorly and they take the first couple of days of anti-microbial

medicines and then they feel better.

They think, "oh, well I'm better now.

So I'll stop taking those medicines".

But actually they won't have killed the entire infection.

That's making them feel poorly, so they might feel better, but there'll still

be some microbes left in their system.

And because there's microbes have been exposed to the medicine, the

anti-microbial treatment, they will start to find ways to survive it.

And that could allow anti-microbial resistance to develop.

So there's lots of things that we do that allow resistance to

develop and happen a lot faster than it would by chance.

And remember, because this is happening at the level of the microbe, it's the

same, whether you're a human taking the medicines yourself, or whether you're

giving the medicine to a sick animal, sick livestock animal, or a sick domestic

animal, the same process is happening.

If the medicine isn't used properly, if it isn't used for the right amount of

time or in the right dosage, the microbe is going to find a way to survive it and

build up resistance to that medicine.

So that next time you get an infection, the medicine may not work as effectively.

And that's when we say that AMR has developed.

So behavior really drives a lot of the problems that we're

seeing with AMR at the moment.

Yeah, and is that, that behavior element, is that why your research focuses so much

on community and community engagement.

Yeah, absolutely.

My training as a zoologist, I always focused on animal behavior.

You know, what decisions animals are making and why they're making them

and I think that's just really spread into humans while I've been studying

and working on AMR to understand.

What behaviors are driving AMR, but more importantly, why they're happening.

So we know that, um, for example, in agricultural health, often

So we know that for example, in agricultural health, often

anti-microbial medicines can be bought in bulk or bought in really big packs.

So in that situation, somebody giving medicines to their sick animals

isn't getting a small prescription, isn't getting a lot of guidance about

how to dispense those medicines.

So it seems very logical that they would only want to use the medicine

while an animal is showing symptoms of an illness and then want to

save the rest to use again later.

And they may also then sell or share that medicine with

other people in that community.

Because again, it seems very sensible that if your neighbor has

a sick animal and you have medical, course you would want to help them.

And it's things like that, those behaviours that go under the radar

that we don't see, um, you know, noticed, they don't get recorded.

that we don't see, you know, noticed, they don't get recorded.

Those are the behaviors we really need to understand.

And we can only understand that by talking to people at community

level and having them share their story, share their knowledge with us.

And that's what community engagement is really about for myself

and the team I work with, we're looking up exchanging knowledge.

So I might be going to a community and telling them about AMR, but

I don't have any expectation of what I'm going to change.

And what I'm looking for is for them to tell me about their experience of AMR.

And then together, we can come to a mid- point while we might think, okay, so

where we both recognize this problem is happening, but actually in this situation,

this XYZ might be the best solution, not the solution that I had in my head

when I was sat in my office at Leeds.

That's really great.

And is that also the hallmark of your project in Nepal this approach?

Yeah, definitely the project and Nepal has been going for a little

while and it was actually started by a team that I still work with at Leeds,

they worked in Nepal to make short films about anti-microbial resistance.

It was a similar approach people in the community were talked to about

AMR they were given some basic facts, but then they were also trained on how

to use a camera and editing software.

And they went out and made films about their experience of AMR.

So they were telling us exactly what was happening in their situation.

There's a lot of impacts from that small project, but one of the really big

impacts that I've developed a lot of my research on was the feedback that you

should be doing this with younger people.

It shouldn't just be us as adults, that, of making these films

and having these conversations.

So a lot of my work has been centered around developing that project, but

with young people, so school, age students, and we've worked in a couple

of schools in the same area of Nepal.

So the Katmandu region, and we've worked to, co-develop a whole

suite of educational resource around anti-microbial resistance.

But again, using that same approach that we would run a short session where

we talk about AMR and the community.

So the teachers, the pupils, the, some of the school support staff would then

have time to think about that and come back to us and say, "well, you know,

this is how we see AMR in our lives.

This is where we get our medicines from.

This is how we treat sick animals.

These are the kinds of hygiene practices we'd use in certain seasons,

depending on the weather and so on".

And so we've built all that information into the teaching pack and the education

pack, because now that's completely appropriate for use in those schools.

It's not an instruction manual.

It's not a basic biology lesson.

It's a contextually appropriate resource that's co-created by the community.

So it's meaningful in that setting.

Yeah, that sounds wonderful.

I can see what you mean and it does fill me with optimism immediately.

And can I ask you a little bit more about what you were just saying?

It's also the healthcare providers the, I'm assuming veterinarians and human

doctors who are prescribing drugs.

How does that work?

Because I could imagine that sometimes the people in the communities actually

are being led by what the vet of their animals tells them to do or what their

doctor tells them to give that child.

So it's probably beyond just individual patients thinking about

how to properly take the drugs.

How does that work?

Is that part of your research as well?

Working with a wider network of academics at the University of Leeds.

We are looking at the context in which behaviors.

And we're very keen in those dialogues to explore what normal in inverted

commas looks like for you and where you're sourcing the, your medicines from

and who who's giving you the advice?

Because that might help us to identify other communities

that we need to engage with.

And in the wider AMR research landscape, there is a lot of work underway,

engaging with health care professionals.

So, not just medical practitioners, but also vets also dentists who

are another group of prescribers.

And these studies tend to look at the reasons why healthcare professionals might

prescribe an anti-microbial and what they do before that, do they look at symptoms?

Do they look at symptoms and do a test to try and find out

what's causing the infection?

And those kinds of questions are really important because it can show

us where people might be prescribing anti-microbials very carefully or

where they might be thinking, okay, I just need to make this person better.

For example, often with very young children or elderly or very weak

individuals, health care professionals may move to prescribe quickly rather

than conducting a diagnostic test.

That takes a few days to comeback and by which time the patient may have got sicker

and the same happens in the veterinary and agricultural care sector as well.

There can be different decisions around different prescribing practices.

And I think again, taking the ethos of community engagement, it's important not

to be critical of those practices until we really understand why they're happening.

And also whether it's possible to question those practices and implement

another measure, in a lot of the countries that I work in diagnostic

tests are not routinely available.

So it could be very dangerous to suggest to a vet or a dentist or a nurse that

they try and find a diagnostic test for a patient that's clearly suffering

very severe respiratory problems.

So it is about context as well.

Thank you for listening to this World Changers

podcast from the University of Leeds.

I am Professor Simone Buitendijk and I am in conversation with Dr.

Jess Mitchell to hear about her research into anti-microbial resistance.

And then what do you think we could learn in the

UK from your project in Nepal?

I think one of the most interesting things is how we can draw parallels

with AMR from climate crisis education and engagement with the climate crisis.

So, you know, 20 years ago, the language around the climate crisis was about as

new and scary as the language about AMR.

And it was reserved for certain groups of people who had a certain background

and who could understand that language.

And I think that's where we're at with AMR, even in Western countries,

even in the UK, it's not something that's talked about generally,

it's seen as quite complicated.

I liked the idea of using community level research and trying to unpick the

language of the challenge and make it a lot more accessible because really AMR

is quite similar to the climate crisis.

There's lots of very small behavioral actions that any individual can take.

And then depending on your profession, there may be more you could do, or that

could be more, you could put pressure on to do, but getting buy-in and getting

engagement right at community level is a fantastic way to put pressure on health

sectors, veterinary sectors, policymakers, politicians, and actually drive

change at the top level of the system.

And so I think that for me is one of the most exciting things that I see

coming from my research is that parallel with the climate crisis and using

community level action to drive change.

And that's absolutely not to say that other forms of action

should not be happening, you know, they absolutely should be.

And we need to be looking at

how to develop new anti-microbial drugs.

We need to look at strengthening prescribing practices.

We do need to look at those kinds of big problems, but that doesn't

mean that community action can't be a really key part of the puzzle.

So let me ask you then towards the end of this interview, you're one of the

University of Leeds World Changers.

And as a World Changer, do you think that over the next decade, you and colleagues

And as a World Changer, do you think that over the next decade, you and colleagues

at the University of Leeds clearly with many others will be able to make in roads

into slowing anti microbial resistance?

How optimistic are you?

I do feel optimistic and I know that, that might seem misguided

considering some of the figures we talked about earlier on, but I feel

especially at Leeds and a number of other, universities anti-microbial

resistance is really shooting up the agenda and definitely within the community

I work in, in Leeds, there are people working on so many different aspects

of the problem, that, that gives me hope that we can join up our thinking.

And tackle the problem from multiple points of entry.

I would say, from my particular angle of research, the sharing of

knowledge and exchanging knowledge with communities is a really important

step in that process because there are still so many unknowns with AMR.

And if we're just having these conversations in a university, we're

probably not going to find the answers because we're all quite well-educated,

we all understand our areas in a lot of detail, we need to be asking other people.

And a lot of the time it is people at community level who are going

to be able to give us insight into those questions, especially with

behaviour, you know, explaining why an optimal behaviour doesn't happen.

We need communities to tell us that, and that helps us to understand , why

tools like having simple behavioural objectives, why are they not working?

Well it's because the context doesn't allow that behaviour to work.

So I feel very optimistic from the whole research landscape on AMR, but

I do feel particularly optimistic that I feel AMR is really harnessing

the value of community knowledge and focusing on talking to people across

all different types of networks.

All different countries, lots of different stakeholders are

involved in the problem of AMR.

And so that gives me hope that we really can work towards finding meaningful

solutions and hopefully not seeing those terrifying predictions come true because

I think yeah, 10 million global deaths per year is, is really, really frightening.

And we're seeing, from the data in the more recent paper that we're

moving towards that figure.

And I think we have a chance now, especially coming out of the COVID

pandemic where we've seen just how much behavior and communication can

help, support a health challenge.

I, you know, I think we have a lot of evidence and a lot of enthusiasm

to protect ourselves and our environment from other global threats.

That's wonderful.

Thank you so much Jess for this interview.

And of course, mostly for all the good work and the brilliant research your doing.

Thanks alot

Thanks very much Simone.

Thank you for listening to this podcast from the University of Leeds, to find out

more about the work of our early career researchers and to read essays written by

World Changer researchers, please go to the World Changers page on the University

website, details can be found in the information that accompanies this podcast.