The Battle of Bacteria: Antibiotic Resistance and its Consequences

By Telyse Masaoay

Global attention seems centered on subjects like the conflicts in the Middle East, the politics behind the Iran nuclear deal, the economic threats of China’s financial stability, and even the 2016 United States’ presidential election. As a result, other critical topics appear to be sidelined, such as antibiotic resistance, an issue that “is now a major threat to public health” according to the World Health Organization.  No longer an impending concern, antibiotic resistance is an important problem communities are currently facing.

        Antibiotics were first introduced quite primitively through the practice of using molds of microorganisms to fight microbial infections in ancient societies in India, China, Greece, and Egypt. In 1928, Alexander Fleming, a Scottish biologist, discovered penicillin through his work with the fungus Penicillium notatum. Mass production of penicillin in 1945 and the discovery of a host of other antibacterial drugs led to a revolution in medicine in the 20th century. The Allied Forces in World War II used penicillin to treat soldiers with gangrene, which reduced the likelihood of limb amputation, fought off infections, and increased the probability of survival for many injured combatants. Following the war, antibiotics flooded the medical market and as the National Center for Biotechnology Information explained, “A surge of discovery of several such antibacterial and antifungal antibiotics accompanied with a new generation of semi-synthetic drugs initially led to euphoria that any infectious disease could be successfully controlled using antibiotics.”

        Today, antibiotics are prescribed and used at unprecedented levels around the world; many countries even provide over-the-counter access to some treatments.  Additionally, using antibiotics to supplement livestock feeding is a common practice globally.  This leads overuse of antibiotics in medicine and agriculture, which becomes problematic when considering the dangerous effects of antibiotic resistance, or, the ability of microbes to grow in the presence of a chemical (drug) that would normally kill them or limit their growth. The explanation of antibiotic resistance at the biological level is complex, but the sum of it all is that at their simplest level, bacteria are able to mutate and adapt to antibiotics. Over time experts have shown that increased consumption of antibacterial drugs has a positive correlation with increased resistance.

This phenomenon was most recently outlined in the first global report of antibiotic resistance. Conducted by the World Health Organization (WHO), it gathered data from 114 countries. Experts have warned for years that increased dependency on antibiotics would have disastrous effects on the ability of entire populations to combat infections that we have not viewed as major threats for decades; these predictions are coming to fruition with a few examples outlined by the WHO’s study. For example, in countries such as the U.K., Canada, Australia, France, Japan, Norway, South Africa, Slovenia and Sweden, Gonorrhea is being treated primarily with antibiotics that were once considered last-resorts. Simultaneously, these last-resort antibacterial methods have been increasingly linked to the appearance of aggressive, drug-resistant strains of the sexually-transmitted disease, which make the aforementioned antibacterial approaches less effective. The WHO’s report also mentions that similar issues have been recorded with influenza, HIV, malaria, and tuberculosis treatments on a global scale.

Even developing countries, which are not using antibiotics at the same level as developed nations, are still being touched by the drug-resistance. As Susan Brink  of NPR notes “MRSA, a dangerous staph infection often contracted in hospitals that does not respond to many antibiotics, is found at high rates in the United States, Romania, Portugal, Vietnam and India — rich, middle-income and poor countries alike.”

Due to its clear global presence, it is important to examine the extent to which antibiotic resistance can and will cause problems. Dr. Keiji Fukuda, WHO’s Assistant Director-General for Health Security, explains why antibiotic resistance is so consequential, “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.” We are entering a time period in which modern medicine could be setback, ironically, because of the use of modern medicine. Those who have contracted infections are now at risk of being sick for longer interludes with an increased risk of death because of the developed drug-resistance of microbes. This issue has the potential to increase hospital stays and medicinal costs—putting the ill out of work for longer periods and affecting the health of whole groups exposed to these evolving strains.

Fortunately, there are steps that can be taken by individuals, healthcare providers, and public officials to address antibiotic resistance. At the most basic level of deterrence, people can avoid using antibiotics unless they are prescribed them, refuse to share medicine with others, and follow all prescription instructions laid out by their doctors.  The solution with respect to healthcare providers and policymakers lies in the regulation of antibiotic prescription and dosage.  It is essential to decrease the use of antibacterial drugs for simple infections and invest in new methods for disease control and prevention. Dr. Ramanan Laxminarayan, director for the Center for Disease Dynamics reminds the public “In the absence of antibiotics, resistant bacteria more easily die out… In many cases, if we stop overusing antibiotics, resistance will go substantially down.” It is time to alter the mindset that antibiotics are miracle medicines; if not used appropriately they can be as harmful to global health as they are helpful.

The United State’s Responsibility to Fight Climate Change

By Dustin Cai

Amidst the more visible problems currently going on in the world, the relative invisibility of climate change is no excuse to ignore the ever-looming problem. In fact, the world has already seen its effects: The UN’s former secretary general Kofi Annan released the world’s first comprehensive study on global warming and found that 300,000 people die each year as a result of climate change with an extra 300 million people negatively impacted.[1] Even small increases in global mean temperature of 2°C can negatively influence the market sector in developing countries, increase the frequency of heat waves, increase the transmission of infectious diseases like malaria and dengue fever, and destroy agricultural production and increase the amount of malnourished people in the world by 10%.[2] Elon Musk, Tesla’s chief executive and a world leader in technology development recently gave a speech in Berlin citing the world’s climate change as the direct cause of the mass refugee problem that we will see in the future that will dwarf the Syrian crisis we see today.[3] Musk explains that climate change will only exacerbate the current problems of water shortages,[4] food insecurity,[5] and the displacement of people due to rising sea levels.[6]

In the face of such crisis, it becomes a moral imperative for the most developed countries, namely the United States and others in Europe, to mitigate these effects in an attempt to prevent the greatest crisis of the century. If, in a relay race, I were to run a terrible segment, the blame of our team’s atrocious time would certainly not be on the guy I passed the baton onto; similarly, the blame of the world’s climate problem should not be put on the countries currently in the develop cycle. Rather, countries that have historically owned the largest shares greenhouse gas (GHG) emissions – to the tune of 75% from 1705-2005[7] – should carry this weight.

Thus, in terms of a moral responsibility, it falls upon the rich and developed nations to ensure a stable future for global development. Because these developed nations in the industrial North created the majority of the problem in GHG emissions and climate change, they therefore bear the same proportional responsibility in cleaning up after themselves.[8] It would be a great injustice to those who are most affected by climate change in the Global South to also bear the responsibility of mitigating its effects. It is already a moral imperative to act on climate change in the face of its devastating effects with the responsibility falling on the shoulders of the industrial North. Now, the question deals with feasibility and timing.

Some people like Nicholas Stern argue that countries like China and India are the ones that need to step up to the plate as a result of their current state of GHG emissions, which now are responsible for the bulk of global emissions.[9] However, developing countries, most notably China, have already taken pacts to act on climate change, but their promises are only in the future. China has pledged to reduce their carbon emissions by 65% in 2030.[10]

With all this in mind, what can the US do to ensure the globe acts now? Lead by example. A cap and trade policy, which sets limit on carbon emissions for companies while also allowing companies to trade their unused portions of their limits to other companies, has shown promising effects: The EPA reports that a Clean Air Interstate Rule, a cap and trade system in 27 American states, has reduced GHG emissions by 70% in seven years.[11] The Center for Environmental Journalism analyzes the effects of a cap and trade policy like this one if implemented by the entire United States and finds that it translates into the entire world avoiding 1.75°C of warming by 2100.[12]

But change from one country alone won’t offset or stabilize the current condition of global climate change. While developing countries have pledged to take action in the future, it comes upon the Global North to take action now. Ethically, the industrialized nations can no longer afford to remain ignorant to the problem of climate change that we face now and potentially will face in the future; rather, it becomes a moral obligation to stabilize Earth’s condition while developing nations are given their equal right to develop in the same ways that developed nations did decades ago.

[1] http://www.theguardian.com/environment/2009/may/29/1

[2] http://www.grida.no/climate/ipcc_tar/wg2/pdf/wg2tarchap19.pdf

[3] http://www.huffingtonpost.com/entry/elon-musk-in-berlin_560484dee4b08820d91c5f5f

[4] http://water.worldbank.org/topics/water-resources-management/water-and-climate-change

[5] http://www.fao.org/forestry/15538-079b31d45081fe9c3dbc6ff34de4807e4.pdf

[6] http://www.climate.org/topics/sea-level/

[7] http://paristext2015.com/2015/08/should-emerging-economies-be-expected-to-bear-the-burden-of-climate-change-equally-with-western-developed-countries/

[8] http://spot.colorado.edu/~vanders/pubs/JPR_responsibility.pdf

[9]http://www.theguardian.com/environment/2012/dec/04/lord-stern-developing-countries-deeper-emissions-cuts

[10] http://foreignpolicy.com/2015/07/11/china-climate-change-greenhouse-united-states-policy/

[11] http://www3.epa.gov/ttncatc1/dir1/fnoxdoc.pdf

[12] http://www.cejournal.net/?p=1880

The Forgotten Crisis in Yemen

By Gabrielle Timm

Recently, the world’s attention on the Middle East has been focused on Syria due to its long running civil war and the resulting refugee crisis in Europe. Largely overlooked however, is the violent conflict that consumes the Middle East’s poorest country, Yemen. Already troubled, this current conflict is making living situations worse and displacing many people, some of whom have fled into Djibouti and Somalia. With the seemingly endless conflict and existing internal threats from Al Qaeda increasing, the war in Yemen has the potential to become just as devastating as the conflict in Syria, with profound negative implications for the international community.

Since September of 2014, the political situation in Yemen has been tumultuous. Houthis, a militant Shi’a group, has long been fighting against Yemen’s government and finally seized control of Sana’a, Yemen’s capital that month. Following the takeover of the capital, the Yemeni government still retained nominal control over the country, though Houthis did exert great influence over it. This changed in January 2015, when Houthis forced President Abd Rabbuh Mansur Hadi, among others, to resign following disagreements over a proposed new constitution. Following these resignations, the Houthis placed Hadi under house arrest. Officials in Aden and other cities across southern Yemen stated they would refuse to accept orders from a new government in Sana’a, and there were rumors that they would seek an independent South. (Yemen had formerly been separated into a northern and southern country, until unification in 1990, with Aden being the capital of South Yemen, and Sana’a the capital of North Yemen.)

In February of 2015, Hadi escaped from house arrest, fleeing to Aden. With Houthi forces rapidly advancing in the South and surrounding Aden, Hadi fled the country in late March and called on foreign powers to intervene and restore its legitimate government. The Arab League agreed, initiating the start of the broader conflict that engulfs Yemen today. The Saudi-led coalition acted promptly, initiating airstrikes against the Houthi insurgency and instituting a naval blockade around all Yemeni ports. In April 2015, the United States announced it would be providing logistical and intelligence aid to the coalition.  Other Western powers, notably Great Britain, have also supported the coalition.

The coalition has been making some progress against Houthi forces in the South, though Houthis still occupy Sana’a and heavily populated regions in northern and western Yemen. Saudi Arabia and the coalition continue to conduct airstrikes on northern territories, and now have a troop presence on the ground.

This war has dangerous implications for the entire region, as it has the potential to exacerbate regional tensions between Iran and Saudi Arabia. Iran has been accused of aiding Houthi forces, as both are Shi’a. While Iran has denied this, intelligence indicates that Iran has supported the group for years, and, more recently, the Arab coalition seized an Iranian fishing boat loaded with weapons meant for Houthi forces. Saudi Arabia has long viewed itself as a defender of Sunni Islam, in contrast to Iran’s defense of Shi’a Islam, which has made the two countries hostile on religious grounds. Moreover, Iran considers Saudi Arabia a wealthy, ambitious proxy of the United States, and Saudi Arabia views Iran as a major source of instability in the region. Thus, with Saudis backing Hadi, there is a very real danger of Yemen turning into a proxy war between the two regional giants.

Additionally, Yemen’s strategic location could have a negative impact on international trade, particularly on the oil industry.  The Bab el-Mandeb, a narrow chokepoint with Eritrea and Djibouti on the west and Yemen on the east, connects the Red Sea and the Gulf of Aden. It is located on a vital sea-lane between Europe and Asia, and trade that goes through the Suez Canal must pass through this area. The US Energy Information Administration estimates that 3.8 million barrels of oil and refined petroleum products pass through the Bab el-Mandeb each day en route to European, Asian, and American markets. This makes it the world’s fourth busiest chokepoint, so even the thought of a potential shutdown could have huge consequences on the oil market. While Houthis did gain control of this area in March, it was recently recaptured with the help of the Saudi-led coalition.

Al Qaeda in the Arabian Peninsula (AQAP) also stands to benefit from the war. US intelligence considers AQAP to be one of the world’s most dangerous terrorist groups, and the most threatening branch of Al Qaeda.  AQAP was already a very strong force in Yemen, particularly in the eastern province of Hadramawt (Osama bin Laden’s father’s homeland), and it currently controls some territory within Yemen. The group could exploit the current conflict to increase its power; this has precedent in Libya, where al Qaeda-affiliated extremists have made major advances following the overthrow of Gadhafi, as infighting plagues moderate forces. Success in weakening Houthi forces could strengthen AQAP, since Houthis have been an effective fighting force against AQAP. This is one reason why some in the US intelligence community are against the idea of the US helping the Saudi led coalition, in addition to their overriding belief that the coalition is doomed to failure.

AQAP currently operates (somewhat) as a Sunni ally of Saudi Arabia in Yemen, both fighting against the Shi’a Houthis.  AQAP consists of about 5% Yemenis working with Saudi Arabia, with the rest split evenly between southern Yemen secessionists, former government troops loyal to Hadi and pro-Saudi and ultraconservative Salafi Islamists. However, AQAP also hates the al-Sauds, the royal family of Saudi Arabia, since they believe that many of their actions are un-Islamic. Given all the serpentine and sometimes conflicting interrelationships, it is more likely that AQAP and the Saudi-led coalition are cooperating with an informal and somewhat shaky nonaggression pact, which is unlikely to continue indefinitely. Strategically, Houthi forces and Iran are using this as propaganda, saying the Saudis are allied with AQAP; many Yemenis are against AQAP, and are already upset with Saudi Arabia and its allies due to the large civilian death toll caused by coalition airstrikes.

The United Nations estimates that 5,400 people have been killed since the major conflict started in March of this year, including over 2,300 civilians. The UN estimates that almost two-thirds of reported civilian deaths are caused by coalition airstrikes, though indiscriminate shelling by Houthi forces kills large numbers of civilians as well. Coalition airstrikes are also responsible for about two-thirds of collateral damage to civilian public buildings.

Recently, the Dutch spearheaded a UN proposal to send experts to Yemen to investigate the conduct of the war. The proposal called for warring sides to allow humanitarian access to deliver aid and for the commercial import of goods like fuel to keep hospitals running. While initially supportive, the proposal was blocked by Western governments, including the United States, and by strong, vocal Saudi opposition. Instead, a Saudi-led resolution was backed to support Yemen in setting up a national inquiry into human rights violations.

This conflict has understandably exacerbated previously existing problems in Yemen. Prior to the March conflict escalation, almost half the Yemeni population lived below the poverty line, with basic social services on the verge of collapse. Almost 16 million people (about 61% of the population) were in need of some form of humanitarian assistance. At the end of August, the BBC reported 4 out of 5 Yemenis in need of aid and 1.4 million displaced. 20.4 million people now lack access to safe drinking water, an increase of 52% since March. This worsening crisis is largely due to restrictions on fuel imports, needed to maintain the water supply, as well as war-related damage to pumps and sewage treatment centers.

Further, 12.9 million are considered food insecure, an increase of 20% in six months, according to the World Food Program (WFP). Yemen usually imports about 90% of its food, and naval embargos and fighting around ports have prevented many imports. Lack of fuel, damage to markets and roads and general insecurity have prevented the distribution of supplies. 15.2 million people also lack access to basic healthcare, which is a 40% increase since March.

Humanitarian aid organizations within the region are attempting to combat all of the issues that plague the general populace; however, they are struggling due to lack of funding and access constraints caused by the conflict and blockade. “The images I have from Sana’a and Aden remind me of what I have seen in Syria,” said Peter Maurer, president of the International Committee of the Red Cross, one of the most active humanitarian aid organizations in the country. “So, Yemen after five months looks like Syria after five years.” Maurer attributes this to entrenched poverty, months of intensified warfare, and limits on imports. The heavy firepower employed, in particular, is causing more suffering due to already weak and inadequate infrastructure.

The cost of the conflict in Yemen is incalculable on a national and an international scale. Without worldwide attention and political pressure, the long-term implications of this war could be devastating for international trade and security and shameful in terms of the scale of humanitarian disaster. Unfortunately, regardless of the speed of conflict resolution, the Yemeni populace will be recovering for a long time. While the instability and crisis in Syria and other longstanding issues in the Middle East continue to be important, the crisis in Yemen is of paramount importance and demands the world’s immediate attention.