We are heading for a post-antibiotic dystopia that will result in slow productivity, make simple medical procedures unviable, and reduce human life expectancy for the first time in generations.
Australia's rates of antibiotic use per capita are higher than many other OECD countries. We are addicted to antibiotics, the magical cure.
We can reduce the emergence of multi-resistant superbugs by reducing the antimicrobial load in the environment. Put simply, we need to lower our usage of antibiotics.
But things are getting worse. Globally, there has been a 40 per cent increase in the use of a major class of last-resort antimicrobials (carbapenems) over the past 10 years.
This addiction is often treated as a medical or public health problem. Research led by UNSW reveals that, in fact, it is a distinctly social problem, driven by our modern fears of bacteria, our expectations for swift intervention, vested interests and unconscious behaviour.
Collaborating with hospitals and health professionals across NSW and Queensland, we conducted 260 interviews with health professionals to discover what drives antibiotic over-use in the health sector.
What became clear is that we have a modern fetish. We are not talking about anything kinky here. This is a fetish with antibiotics; the seduction of easy fixes that blinds us to long-term planning.
Let's take chest infections. In most scenarios, antibiotics aren't needed at all; or the infection is viral rather than bacterial, so antibiotics are useless.
Why would Australian doctors continue to use antibiotics excessively when they are clearly not required?
The answer is that doctors desperately want to avoid any chance of infection, to not miss an existing infection, to avoid subsequent litigation, to reduce reputational costs, to appease hospitals and consumers, and avoid all perceptions of not doing everything possible.
As a result, much antibiotic use is virtually useless and contributes to resistant superbugs, while perpetuating the fetish through heightening the fear of resistant superbugs. It's a vicious cycle.
By imagining antibiotics to have almost magical qualities beyond what they actually have, we diminish their actual efficaciousness and, ultimately, their value to us long term.
But it's not the doctors we should blame. As patients and consumers we drive this trend. We treat antibiotics as security and are comforted by the "armour of antibiotics", regardless of what they actually do to lower our risks of ill health.
Taking antibiotics has become a modern ritual – they have become common sense, unquestionable and invisible. We think there is something wrong if we don't get them. Our doctors feel they are at reputational or even economic risk if they don't provide them.
Nurses, we found, see their role as brokering doctors' decisions, often regardless of their validity, including when using antibiotics. Pharmacists were reluctant, if not fearful of, questioning medical decisions, even if they felt they were inappropriate. Our institutions, and their managers, fear litigation and political blowback if they don't offer anything to avoid infections. Rebates from private insurers to private hospitals are now linked to antibiotic cover, and our work shows that in private hospitals, pressures to over-prescribe may be even greater than in the public health system.
Our work also shows that impact of politics, fixated on the short-term healthcare-related KPIs usable within a given political cycle, and the subsequent incapacity for us as a society to respond to longer-term crises such as antimicrobial resistance.
Sometimes it seems the entire system is gauged towards the perpetuation of superbugs.
If we are to reverse this trend we must combine drug development with swift and broad social and behavioural change to protect those antibiotics that still work. This means understanding the social, economic and political pressures that shape how our ultimately well-meaning health professionals act, and ensuring we provide an environment conducive to people protecting this precious resource. Otherwise, the new drugs we will hopefully develop will also quickly develop resistance.
Alex Broom is Professor of Sociology at UNSW.
This opinion piece was first published in the Sydney Morning Herald.