Selective pressure

Part of my research focuses on understanding why do some disease causing bacteria stop responding to antibiotics — a phenomenon known as antibiotic resistance. Antibiotic resistance remains one of the greatest challenges in global health affecting patients in every country. Conservative estimates put the current number of people dying every year because of antibiotic resistance to around three quarters of a million. If the current trends were to stay, by 2050 as many as 10 million people would die yearly and trillions of dollars would be lost in economies, mostly in low and middle income countries.

One of the reasons bacteria become resistant to antibiotics is through a process called selective pressure. To understand this, we need to recognise that in a population of bacteria not all are the same. Early treatment of antibiotics kills some bacteria, but not all. Most bacteria in the population die early, while a small fraction of the population require a long course of the drug for them to be eliminated. The ones that survive the early assault are likely the stubborn ones — and by using antibiotics incorrectly, using them when they are not needed, or not using the whole dose, we help the stubborn ones survive and thrive. Over time, through evolution, they become more and more resistant and their population grows. Ultimately they become completely resistant and even an aggressive antibiotic is unable to eliminate them from the system.

Any infectious disease doctor will tell you that antibiotic resistance is primarily driven by our behaviour, and our actions of applying selective pressure, are only bringing misery upon all of us.

I am fascinated by bacteria and the history of resistance. Bacteria have been around for a long time — billions of years longer than humans on this planet. They have seen a lot and still continue to change and adapt as the world changes around them. As I study them and spend time thinking about them, I cannot help but feel that they have a thing or two that they can teach us about our actions. Perhaps in the rise of resistance, there are some universal laws. These laws remain true whether they are applied to single cells or to societies at large.

Selective pressure, for example, whether applied to diverse community of bacteria or a diverse society — is a recipe for disaster. Humans may be more complex beings than bacteria — but poor actions driven by greed and hubris, whether by consumers of antibiotics, or policymakers eventually lead to a situation when the outlook for our collective well-being starts to look bleak. Let us evaluate our actions of just the last few days and weeks.

When it comes to our Covid policy, we cannot put the pressure only on those who we dislike, shame them to stay indoors and call them the most dangerous elements of the society, while looking the other way when hundreds of thousands of maskless people show up at Minar-e-Pakistan. Choosing our outrage at one group that shouts political slogans at one monument, while closing our eyes when another organises funeral prayers at another is not going to go well in the long term. Creating an international platform to support Muslims living in the West against Islamophobia, while denying basic citizenship rights to the vulnerable communities in Pakistan is not going to turn out well. Tweeting our anger at the French for their new draconian laws targeting their Muslim minority, while calling systematic and unparalleled persecution of Muslims in the neighbourhood a non-issue is not just hypocritical, it is also a poor decision.

The pace of evolution may be slow, but ignorance and hubris are no match for the force of nature.

Published in The Express Tribune, November 24^th, 2020.

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