The importance of public engagement on antibiotic resistance

Antibiotic resistance is on the rise. A recent report has anticipated that if we don’t change the way we’re using antibiotics, drug-resistant infections will cause 10 million deaths per year by 2050. Over 90 per cent of the UK public have heard of antibiotic resistance. But only about 50 per cent say they have a good understanding of what the term actually means.

A big focus of our work at the Centre for Genomic Pathogen Surveillance is tracking the emergence and spread of antibiotic resistance globally. With World Antibiotic Resistance Awareness Week coming up, we decided to run a public engagement activity to help people understand antibiotic resistance.

We didn’t want to take an activity off the shelf, we wanted it to be specific to our work. So we decided to get people to using real software, on real data, to track antibiotic resistance around the globe.

Common misconceptions about antibiotic resistance

There are many misconceptions around how antibiotics should be used. According to a recent global survey:

• 64 per cent of people believe that antibiotics can be used to treat colds and flu
• 76 per cent believe antibiotic resistance occurs when our bodies become resistant to antibiotic
• 57 per cent said they believed there was nothing they could do to prevent the spread of antibiotic resistance

What is antibiotic resistance?

Antibiotic resistance occurs when bacteria gain the ability to survive treatment by antibiotics that would usually kill them. Bacteria mutate quickly, and can change in a way that makes them able to survive a range of challenges. Once resistant, they’re often referred to as ‘superbugs’, and can be very difficult to treat. This can then lead to higher medical costs, longer stays in hospitals, and more deaths.

Tracking the spread of antibiotic resistance

We opted to run an activity at one of the Open Saturday events here on campus. Open Saturdays are a monthly event at the Wellcome Genome Campus where anyone can come along to discover more about the work that happens here.

We knew a
range of age groups were likely to attend, so we needed activities that would
cater to everyone. Our aims were:

• Encourage general awareness of antibiotic resistance
• Talk to people about their understanding of antibiotic resistance and address any misconceptions
• Specifically target some known misconceptions:
  • Bacteria, not humans, become resistant to antibiotics
  • Viral infections cannot be treated with antibiotics
• Show people what we do and give the younger audience an opportunity to see what it's like to work in science.

We chose
three activities. We designed them to appeal to different age groups and give
people some options for what to do.

The first was a simple colouring activity, as we knew this tended to be popular, particularly with young children. The second was a game for older kids, that challenged them to separate out cuddly microbes into ones that could become resistant to antibiotics and ones that couldn’t. The cuddly microbes activity achieved exactly what we’d hoped — the kids were excited to play with the microbes and learn about the bugs in order to complete the activity.

Showcasing scientific software

Our third activity was the main event for the session. We showcased Microreact, one of the tools we use for research. We put together a real example to illustrate the global spread of antibiotic resistance due to the spread of a resistant strain of bacteria. We began the session with a short talk on antibiotic resistance, then introduced the bug we’d be investigating and the Microreact tool using a live demonstration.

For the investigation, we used the example of a family of bacteria called Klebsiella ST258. Klebsiella are a type of bacteria that many of us carry harmlessly on our skin, in our noses and in our guts. However, sometimes these bugs can cause dangerous infections, including urinary tract infections, wound infections and pneumonia. While anyone can suffer one of these infections, they are a particularly big problem for the very young, the very old and the very vulnerable. As a result, infections tend to predominantly occur in hospital settings.
In our investigation, we traced the initial appearance of ST258 in the United States, and its subsequent spread around the world. Most of the strains we studied carried a particular gene which causes these bacteria to be resistant to many antibiotics that we would normally use to treat infections. We designed some key questions for the participants, so they could see what we look for when studying one of these bugs:

1. In which country did this strain of Klebsiella first appear?
2. Is this Klebsiella strain more commonly acquired in hospitals or elsewhere?
3. In which year did this Klebsiella strain first appear in Israel?
4. Belgium has an outbreak of this strain spanning two hospitals — which country did it spread from?
5. How might this Klebsiella strain be spreading from country to country?

To have alook for yourself, click here

Tracking antibiotic resistance across the globe

120 people signed up for the session, giving us a great turnout with an audience interested to find out more .

The Microreact activity was well-received. People quickly picked up how to use the tool and got to work answering the questions. One thing that impressed us was the number of people who came in, started reading the questions and using the software to answer them without us explaining how it worked. We were thrilled to see that people got most, if not all of the questions right by working together in small teams.

Overall, we found that people were really engaged with the activities. We got great feedback, particularly around the ability to experience outbreak investigations first-hand. We had some great questions from the well-informed audience. One very ambitious young girl wanted to know if she could get into science policy through working at the Sanger Institute! (yes you can)

Through interacting with the public during these activities, we learned a lot about their understanding of resistance, and how they feel about scientists engaging with the public.

The public’s understanding of antibiotic resistance

Real scientists and real examples make a difference. We found a major benefit of public engagement was talking about our work antibiotic resistance face-to-face. The interactive tracking of a resistant bacterium spreading around the world really drove home the point that antibiotic resistance emerges in bacteria, not humans. It also showcased how quickly these bugs can move from country to country, given the opportunity.

Some people believe humans become resistant to antibiotics. We found that, consistent with broader surveys of the public, some people in our sessions believed that people have different levels of intrinsic resistance to antibiotics. They thought that this resistance was caused by our genetics. This seemed to be linked with recent press coverage of genetic testing for prescribing other drugs.

Advice needs to be explained. There was a sense of frustration that the public are often told what to do without a clear explanation of why. This left them unconvinced about whether it’s worth the effort. One person asked why it was important to take a full course of antibiotics if you already feel better. They said this often doesn’t get explained by doctors. Differences in prescribing practices (a large dose over a short time vs a small dose over a long time) seem to add more confusion, suggesting that doctors can’t agree on what’s right. A good discussion of the issues can be found here.

What we learned about public engagement

People want to know more about real science. An overwhelming majority of the UK public think it’s useful for people to have an understanding of science in their daily lives. 63 per cent of people surveyed have expressed interest in hearing about science directly from the scientists who do it. People at our event were keen to ask questions about things they’d heard in the news or seen on TV. They wanted to learn more and see whether they should take it seriously.

People like a challenge. We hoped to get our participants doing something close to what we do on a daily basis. We wanted to show people what being a scientist really looks like, and let the kids decide whether this is a career they’d like to pursue. We were surprised at the ease with which people took to the task and answered the kinds of questions we answer when performing an investigation. We found that people didn’t want a simplified version of the science, they wanted something as close to the real thing as possible.

It’s important to show what science really looks like. A group of school girls joined us for one of our sessions. One of the teachers was pleased to see female scientists, as well as a mix of classically trained scientists and software/web developers. It’s a chance to shape how students view science as a profession and who fits into it. We heard from a few children who really hated science but loved design. The activity we ran showed them how effective design can really make a difference to research and communicating findings.

Our take-homes

We went into this unsure of what we’d get out. We found that people are motivated to become better informed about the science that affects their daily lives. They will ask insightful and interesting questions, and the conversations are enjoyable. We were able help people understand antibiotic resistance. Importantly, people were interested enough by what they’d learned to tell others about it.

Speaking to younger people who wanted to know what life as a scientist could involve and whether it could be a job that was interesting and fulfilling made the experience worthwhile.

We’re definitely keen to do this again!