If antibiotic resistance continues to spread, then the drugs we take for granted now will become ineffective within the next few decades. The UK’s Chief Medical Officer, Dame Sally Davies, wasn’t exaggerating when she said it could herald the end of modern medicine, because without antibiotics, everything from transplant surgery to cancer treatment becomes unviable due to the risk of infection.
The advice for the public is straightforward: be really, really careful about how you use antibiotics and we’ll probably be able to keep our existing ones effective for longer. You would therefore think that people who know most about the threat of antibiotic resistance would also be most likely to follow this advice to the letter.
Strangely, a survey by the Office for National Statistics (ONS) has found that it’s the people who know most about antibiotics and the threat of resistance who are most likely to do two dangerous things experts advise against: they are more likely to take antibiotics without prescription, and more likely to give them to someone else. It turns out that knowledge alone isn’t enough to solve the problem.
Worse, we have known about this effect since 2003. Has that knowledge influenced public health campaigns? With the stakes so high, are policymakers doing enough to incorporate public opinion and behaviour into their plans? In other words, are we using research about what the public think and do to inform evidence-based policy?
The lesson from the ONS findings isn’t that we should stop educating people about antimicrobial resistance – the public clearly need to be aware of this public health risk. What the evidence should do is make us more aware of the complex relationship between what we know and how we act.
Participants in the 2003 study were asked whether they agreed with a series of factual statements about antibiotics and antimicrobial resistance. People with higher scores were indeed more likely to follow a crucial rule in antibiotic use – completing the full course of antibiotics, helping to kill off bugs that might have a weak resistance to the drug in question.
However, these knowledgeable people were also two and a half times as likely to take antibiotics themselves without a prescription in order to avoid going to the doctor, and more likely to give the drugs to someone else, such as a family member. This may be a classic case of people weighing up the long-term public good (protecting antibiotics) versus the short-term private good (not having to go to the GP, making life easier for a family member) – but we simply don’t know.
We clearly need to understand how the public think and act, rather than just whether they understand the science. Without that, our behaviour-change policies and guidelines won’t be as effective.
Sadly, public opportunities for discussing antimicrobial resistance are few and far between. Aside from a single public dialogue and a handful of surveys, there’s precious little data on what people think and what they do about it.
The British Science Association has been looking at these findings as part of our efforts to bring public views into policymaking through our partnership with Sciencewise. Our recently published report also shows that public opinion on antimicrobial resistance hasn’t changed much over the past 10 years, despite the fact that resistant infections now kill as many people across the European Union as car accidents.
We’re at a critical moment in the fight against antibiotic resistance. Politicians are paying attention, economists are on the case, and the public recently voted the issue the top challenge for the new Longitude Prize to address. If we’re going to make the most of this momentum, we have to explore the relationship between science and the public a bit more closely – otherwise we might all pay the price.
Imran Khan is chief executive of the British Science Association
