We’ll publish articles on a different topic every month throughout 2021, before bringing them together at the end of the year in the form of a report with recommendations.

In this first article, Dr Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and, most recently, a member of President-elect Joe Biden’s Transition COVID-19 Advisory Board, describes how we can all become advocates for a new and better future, in spite of the increasingly complex threat of antimicrobial resistance…

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I’m stating the obvious when I say that 2020 has been a year like no other, a year in which we’ve learned so much about how we’re connected to each and every person’s health, livelihood, and future. Throughout this process, we have become more aware of our vulnerability to forces outside of our control. As frightening as that has been, I believe that in that vulnerability lies the blueprint for our empowered future.

For many years, we have been losing the ability to treat bacterial, parasitic, and fungal infections. Our lifesaving antibiotics have been used inappropriately, access to medicines and medical testing is inequitable across the globe, investment in new antimicrobial drugs is not profitable, and, yes, we often have difficulty seeing the actions and health of all beings on this planet as deeply interconnected.

Until now. We now see what happens when systems fail and when structural problems weave their damage into the lives of individuals. We struggle with what the past year has meant as we recover and become advocates for a new and better future, a future in which scientists predict that antimicrobial resistance will cause 10 million deaths by 2050. However, a prediction is not certainty unless we do nothing to prevent it. What do we want to see happen in the next 30 years? What groundwork do we want to lay at all levels to prevent future suffering?

The power of advocacy in times of public health crisis can’t be overstated, and it’s a power that can be used for good or for bad. We can easily become overwhelmed by the enormity of the problem of antimicrobial resistance and choose to ignore it. Another approach is to use advocacy to promote a certain outcome with the belief that we know the perfect solution or the hope that a crisis can’t possibly be as bad as others say it is. In these cases, our advocacy puts pressure on others to turn our beliefs into policy and practice, even if the evidence does not support our desired conclusions.

Scientists also aren’t immune to advocating for what we want to believe is true! In epidemiology, we liken this practice to shooting at a wall and then drawing a bullseye around the bullet hole. We all want to be right on the mark, and we all want to live in a world where nothing bad happens to the ones we love. In this way, advocacy that ignores the science in favor of the need to be right becomes one more symptom of a failing system.

Alternatively, advocacy, when linked to tools of accountability and empowerment, can build the foundation for systems that respect the preciousness of human lives in the context of all the beautiful and terrifying things that connect us. And nowhere is advocacy more necessary right now than in preventing drug-resistant infections, a problem sometimes called a “slow-moving pandemic.” “Slow-moving” means we don’t see the devastation caused by antimicrobial resistance as clearly as we do with COVID-19, but it also means that we—every single person on this planet—have a chance right now to use our unique skills and experiences to prevent astonishing harm. That knowledge is an extraordinary gift, but how do we turn it into empowered advocacy and real, lasting change?

One of the first steps toward advocacy is to become a witness to the reality around us. I’ve been called Dr. Doom more times than I can count in my career. Once you’ve witnessed a child lose their life in a way that could have been prevented or seen someone you love on life support, it changes absolutely everything you do and why you do it. In some way, we’re all advocates because of what we’ve seen and experienced, and, in many cases, our suffering and the suffering we’ve witnessed in the world gives us a vocation.

Once we acknowledge our roles as witnesses, we can then begin to address how we can grow into our vocation as effective advocates for a future free of difficult-to-treat infections. A few ideas come to mind:

• Build accountability between governance, science, and those who are affected by policies. During the COVID-19 pandemic, we all have seen and felt the demands made of us as governments and healthcare workers have tried to stop the spread of the virus. But, in many cases, the general public has had very few tools with which to hold planners accountable for how effectively they spent the time they gained, and this led to anger, blame, despair, and disempowerment. It’s time to start thinking about what we want the tools of mutual accountability to look like.
• Learn about how antimicrobial resistance affects all parts of our daily lives and global health security, recognizing that no one is unaffected by this problem. By learning about how antimicrobial resistance touches all aspects of our lives and how it is intimately connected to health security and access around the world, we will find ourselves embarking on 30 years of dedication to save as many lives as possible.
• Think about what you bring from your experience and knowledge that might make you an advocate for activities that prevent antimicrobial resistance. Whether you’re working on access to medicine, anti-racism, microbiology, or art, you have a voice and a vocation when it comes to building a better future.

It’s up to us to listen to the scientists who tell us what they are seeing, to acknowledge the lived experiences of others that are different from our own, and to follow our own individual calling to make this a healthier and safer world. We have a short but promising window of time to use the power and vocation of our own personal advocacy to make that difference.

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Initial response from BSAC

We fully support Dr Osterholm’s main message: that we all have a responsibility to work with elected representatives, opinionmakers, policymakers, and lawmakers, on the issue of antimicrobial resistance.

Following Dr Osterholm’s comments, BSAC will commit to creating a web page that will pull together some of the best available resources for those who are keen to advocate, but don’t know where to start.

For this, we will draw on some of the guidance, advice, and tools, that were highlighted in ‘Informing & Influencing: Stewardship, Politicians, and the Media’, a chapter in our our eBook on Antimicrobial Stewardship: From Principle to Practice.

But first, we want to hear your thoughts on Dr Osterholm’s article. What you say could inform the recommendations we make in the Vanguard Report itself, which will be published at the end of the year.

You can join the conversation by emailing mcorley@bsac.org.uk or tweeting our @BSACandJAC account.