Antibiotic resistance in the Anthropocene

This week is World Antimicrobial Awareness Week (WAAW 2020). We, therefore, organized the webinar “Antibiotic Resistance in the Anthropocene: solutions to a multi-faceted problem in a rapidly changing world” together with Axfoundation. The webinar gathered leading exerts within healthcare, veterinary medicine, systems ecology, and innovation as well as representatives from both the business and the policy sector, to think creatively about novel solutions to this existential threat.

Antibiotic resistance is a prime example of a wicked problem. These super complex challenges are characteristic of the Anthropocene. They have multiple roots of origin. Antibiotic resistance is related to over-prescription and misuse among humans, to the way we produce animal protein on land and at sea, and to how we produce drugs today without any thought of the environmental effects, to mention a few of these. The consequences of antibiotic resistance give rise to cascading effects across different regions of the world and across sectors, and any solution to this problem will be partial at best. 

Today 700.000 people die every year as a consequence of antibiotics resistance, but this number will rise exponentially in the years to come.

Predictions point that, by 2050, 10 million people will die every year if no decisive action to halt this development is taken immediately. This is because antibiotic resistance threatens modern healthcare as we know it. It will make common infections difficult to cure, it will threaten standard surgical procedures, and it will make many of our current cancer treatments ineffective.

Our usual way of working is not enough to tackle the wicked problems of the Anthropocene, like antibiotic resistance or climate change for that matter. Creative thinking and innovation are necessary. However, to ensure that our efforts go in the right direction, it is crucial to frame the problem in a meaningful way. And this requires systems thinking.

Over the past years we have focused our efforts on the tip of the iceberg, so to speak, reacting to the spread of resistance by trying to develop new antibiotics. But that is like adding water to a leaking bucket. While it buys us some more time it doesn’t solve the problem, as new resistance develops all the time. So in addition, we also need to look deeper down at the iceberg, to the root causes of the problem, asking ourselves why we get all this resistance and why is that such a big problem for us? What are the drivers, structures, and feedbacks that put us in this position? And we must try to address those underlying issues to a much higher degree. Innovations that target preventive care is one example, but also innovations that shift the way we produce food, or what we want to eat for that matter.  

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By moving down the iceberg we also reconceptualize the issue of antibiotic resistance, seeing it as a much broader human problem instead of a scientific or a technical one only. This change in perspective also opens up for more collaborative responses, because it becomes clear that only authoritarian approaches, such as policy responses, or only competitive approaches, such as racing to create a new drug, will not be able to address the multitude of underlying drivers of this problem and create change at a scale that matters. What we need to do is to rewire the system, and that requires collaboration. 

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