Antibiotic resistance is a threat to humanity, yet we have no idea exactly how big the

Antibiotic resistance is a threat to humanity, yet we have no idea exactly how big the problem is in Australia

A selection of pharmacists across NSW have been licensed this year to prescribe antibiotics to women suffering suspected urinary tract infections, or UTIs. The trial program mirrors similar schemes being rolled out in other states.

One in two Australian women will contract a UTI in their lifetime and antibiotics are a common treatment. Although GPs have complained about the quality of care women might receive under the program, the idea is obvious: If pharmacists can take over prescribing antibiotics, so less the burden on an overwhelmed health sector.

In our hyper-connected world, however, nothing is so simple. While the pharmacy model might make perfect sense for an individual patient, and potentially for her dedicated, enterprising pharmacist, it might not for the rest of us.

If these schemes contribute to the wider use of antibiotics, they risk exacerbating so grave a threat to humanity it is often compared with climate change: antimicrobial resistance, or AMR.

AMR is the ability of microbes and bacteria to acquire resistance to antibiotics and become what is often dubbed a "superbug".

This phenomenon is corroding one of the core pillars of modern pharmaceuticals, and it is rampant. Already, AMR is narrowing the range of medicines available to treat tuberculosis, HIV, leprosy, gonorrhoea, typhoid and malaria. Multi-drug resistance contributed to almost 5 million deaths in 2019, according to the WHO, and directly killed another 1.29 million people.

In 2020, Australia launched a 20-year National Antimicrobial Resistance Strategy "to protect the health of humans, animals and the environment" from AMR. It's an ambitious new plan to ensure antibiotics can continue to be effective in this country into the future, and encompasses food and the environment and a series of medium-term goals to "achieve the vision".

Long-term observers of AMR policy will be watching its progress with some caution, however.

It is another of the very many wicked, over-the-horizon quandaries which confound our system of government. A civil service struggling with AMR’s complexity, politicians who see little electoral up-side in the issue, and vested interests careful to protect their bottom line.

The resulting inertia has put a stop to the most fundamental of policy responses: gathering the data. We still do not know how many AMR incidents are occurring across Australia, and we do not know how many antibiotics are in circulation.

What happened to JETACAR?
In 1999, a Commonwealth quango — the Joint Expert Advisory Committee on Antibiotic Resistance, or JETACAR — recommended a multi-pronged approach to tackle AMR. At its heart would need to be "an internationally acceptable and scientifically defensible … continuous surveillance program" of both drug-resistant infections and antibiotic use.

Rather than action, the government commissioned an examination of such a program's "feasibility".

In 2004, we were told a new "strategy" was "being finalised". It took another two years for this document to be handed over to another government committee. From there, it sank without trace.

Another seven years floated by. Finally, the Senate at last asked the obvious question: what had happened to JETACAR? The answers made for depressing reading.

One expert told the Senate that "barely any of the 22 JETACAR recommendations have been implemented", including the surveillance program. The Senate Inquiry identified a conga-line of committees — CIJIG, EAGER, EPHA, AMRAC — which briefly flamed to life before being snuffed out. Committees "rarely met and did nothing", according to one of the original JETACAR authors, while the Department of Health was "totally unresponsive and disinterested".

The crisis was growing
Meanwhile, the crisis had grown only more acute.

It was now a "common event" that children "with resistant Staphylococcus aureus infections of the skin, bones and soft tissues, and resistant Escherichia coli infections of the urinary tract, gall bladder and bowel" were forced onto "intravenous therapy as there are now no effective oral antibiotics available".

Antibiotics report
"The issue of untreatable infections is no longer an abstract notion; it is now a reality."

The Senate recommendations were, by now, all too familiar, including the establishment of a surveillance system and mandatory reporting of the sales of antibiotics across the country.

Finally, in 2014, the AURA (Antimicrobial Use and Resistance in Australia) Surveillance System creaked into life. It collects data from hospitals, aged care homes and laboratories, and builds on a patchwork of other, isolated AMR initiatives.

Be under no misapprehension, however. It is not anything like the national surveillance program envisaged 24 years ago. Critically, it does not measure all incidences of AMR, the true volume of antibiotics in use, nor the impact on patients.

Swathes of Australia's medical community have declined to hand off their data to the engine that drives AURA (known by another acronym, APAS, or Australian Passive AMR Surveillance), including private health giant Healius, and some of Sonic Health Care's pathology companies. Even the Northern Territory's pathology department has declined to plug in its data.

The agricultural sector has escaped scrutiny
But these are mere teething problems. The real scandal is the failure of the government to force the agricultural sector to participate.

There has long been compelling evidence of a causal link between the use of antibiotics in the farming sector and the rise of superbugs. Australian health officials have known of it since 1969.