Q&A with Maryn McKenna
Last month’s G7 Summit produced headlines covering subjects from political scandal to trade policy. But one critical outcome you may have missed is the G7’s commitment to holistically fighting antibiotic resistance, as outlined in the summit’s full communique. We caught up with Maryn McKenna between book tours, scientific meetings and reporting assignments to get a handle on the importance of this commitment by world leaders and the progress it could represent.
Maryn is a journalist and author who specializes in public health, global health and food policy. She is a senior fellow at the Shuster Institute for Investigative Journalism at Brandeis University and the author of the 2017 bestseller Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats. Her 2015 TED Talk has been viewed more than 1.5 million times and translated into 33 languages.
In 2010, Maryn had already published her second book, Superbug, when she decided to do some personal genealogy research. She discovered a great-uncle who had died from a severe infection just three years before the invention of penicillin. Reading about his plight – a prolonged, difficult battle with an infection caused by a simple injury – painted a vivid picture of a world without antibiotics. If we lose these important medications to antibiotic resistance, Maryn realized, her great-uncle’s fate in 1938 could become commonplace once more.
Nano: Maryn, you have written about health issues from virtually all places and angles – from avian flu in the Midwest to polio in India. But your last two books and many recent articles have focused on antibiotic resistance. What drew you to this topic?
Maryn: As a journalist, your goal is always to find a story that’s untold or underreported. Antibiotic resistance is an incredibly important, worldwide health problem. It’s something that the former secretary of the United Nations called, “the greatest and most urgent global risk.” And yet, I just didn’t feel as though people were paying adequate attention to it. It felt like a topic on which I could make a real difference.
Nano: While it represents a small portion of a broad statement, the G7 obviously felt that it was important to include antibiotic resistance in its recent communique. Do you think this represents real progress toward combatting the issue?
Maryn: I do. In 2016, both the G7 and the G20 groups of nations made some degree of commitment to combatting antibiotic resistance in their final communiques. In 2016, there was a high-level, all-day meeting during the United Nations general assembly that tackled antibiotic resistance, which is the first time the topic had ever been publicized at that body.
What’s really important about what happened this week is that the G7 said specifically that they commit to working on antibiotic resistance with a “one health” approach. What that means is that medicine, agriculture and the environment will all be considered as a single ecosystem, contributing equally to antibiotic resistance. That’s really important because some of the most pressing risks within the big topic of antibiotic resistance are superbugs that cross from one “realm” to another.
For instance, NDM, which is a resistance factor that was identified about 10 years ago, began as a medical problem, but since has been discovered to be widely distributed throughout the environment in India. Similarly, MCR, another profoundly important resistance factor identified in 2015, was found simultaneously in human hospital patients and in livestock in China. The emergence of these microbes and their movement across the world is telling us that we can’t tackle medicine, agriculture and the environment apart from each other. Therefore, for these nations to commit to working on resistance in medicine, agriculture and the environment all at the same time is critical and new.
Nano: Most people have heard to antibiotic misuse or overuse and agriculture antibiotics contributing to antibiotic resistance – but how does the environment come into play?
Maryn: When any of us take an antibiotic or when we give an antibiotic to an animal, a fair amount of that antibiotic passes through us unmetabolized. That means it’s fully active as it enters sewage systems or washes off farmland. This means that the whole microbial world that surrounds us is getting loaded with compounds that either could directly affect our health or could affect the further evolution of bacteria toward resistance. The environment as a player an antibiotic resistance isn’t something that has been thought about until recently.
Nano: Your most recent book, Big Chicken, specifically explores the overuse of antibiotics in agriculture. What portion of this big problem is caused by agriculture?
Maryn: The reason it’s hard to answer this question with precision is because we don’t have good data. Gathering data on farm use and the resistant bacteria that emerge from that use is a government task, but governments around the world have fulfilled it to different degrees; some do an excellent thorough job, while others neglect the responsibility entirely. And there is no overarching organization, similar to the Intergovernmental Panel on Climate Change, that would press governments to keep track.
What data has been gathered does seem to show that globally, the amount of antibiotics, just the sheer tonnage being used in animals (mostly not for the purpose of curing infections) literally outweighs the amount of antibiotics being used in people. To me, it is reasonable to assume that that use of antibiotics is more influential than the amount of antibiotics that is used in medicine. Some people might say that because the antibiotics that are used in medicine are used in higher doses, they are more influential in guiding the evolution of superbugs. But it’s hard to argue that agriculture doesn’t at least account for the greatest amount of antibiotics.
Nano: When you say that antibiotics aren’t always being used to cure infection in agriculture, what do you mean? What are they being used for?
Maryn: When we use antibiotics in medicine, it is almost always to cure an infection. There are rare cases where people are given antibiotics prophylactically to prevent an infection if they’re having a surgical procedure, but that’s done on an individual basis. But in agriculture, antibiotic are given to entire populations of animals for reasons other than curing infections. Only a small percentage of the antibiotics that are given to animals are administered because the animals are sick. Instead they are given to encourage growth (banned in Western Europe and the United States but still practiced elsewhere) or to defend against any potential infections.
In human medicine, we accept that we are only to use antibiotics when people are sick. But in agriculture, for most of the past 70 years, antibiotic use has not conformed to what we would consider appropriate use in humans.
Nano: From your perspective, what will it take to drive real change in the fight against superbugs?
Maryn: The development of resistance is an inevitable biological process. Long before humans came along, bacteria competed with each other for living space or nutrition by making compounds that would kill other bacteria. We took those compounds into the lab, refined them and synthesized them, and sent them back out into the bacterial world. It was a little naïve of us not to expect that bacteria would learn to defend themselves against our compounds the way they had always defended themselves against each other’s compounds.
To slow that inevitable process as much as possible, we need to dial back our use of antibiotics as much as we can. That means finding non-antibiotic treatments for diseases, and ceasing using antibiotics unnecessarily in agriculture. We also need much better data and surveillance. As an example, through the World Health Organization, we have a worldwide network of reference laboratories that alerts us every year when new influenza strains emerge. We don’t have anything like that for antimicrobial resistance; we don’t have a robust early warning system. We also need a profound commitment from political leaders. We started to get there with the G7, G20 and UN commitments in 2016, but progress is moving very slowly.