Even a short conversation with UW-Madison alumna and Global Health Symposium keynote speaker Mary Wilson, M.D., raises deep concern about how little we know about antibiotics and the bugs that become resistant to them.
“People are dying today from antibiotic-resistant infections,” Wilson says. “Looking ahead, it’s something that’s going to get worse.” How much worse? A 2016 report from the British Society for Antimicrobial Chemotherapy estimates 700,000 people a year die from drug-resistant infections with projections into the millions in coming years.
Wilson’s talk opens the 15thannual Global Health Symposium, “Health in the Balance: Acting Now for a Healthy Tomorrow.” The symposium will be from 4:00 to 9:00 p.m. April 16 in the Health Sciences Learning Center atrium and adjoining rooms. The symposium is hosted by the UW-Madison Global Health Institute (GHI) with support from the Evjue Foundation. It is free and open to the public but registration is requested.
The symposium brings together campus faculty, staff, students and clinicians, and community colleagues to present their global health work in podium and poster presentations and a panel presentation. The evening showcases the broad spectrum of disciplines needed to address global health challenges, from human and animal health to engineering, education, agriculture and much more. The program concludes with a panel discussion: “Planetary Health: Recognizing Earth’s Limits to Advance Health for All.”
In her keynote address, “Bugs and Drugs: A Changing Landscape,” Wilson plans to take a close look at the many causes and consequences of antibiotic resistance and what we can do about it. A clinical professor at the University of California, San Francisco, School of Medicine and adjunct professor in the Harvard T.H. Chan School of Public Health, her new book, “Antibiotics: What Everyone Needs to Know®,” will be available in May from Oxford University Press.
“Mary Wilson has been a long-standing expert in global health and understands how human-induced disruptions—including climate change, ecological change and the overuse of antibiotics—lead to emerging and resurgent diseases,” says GHI Director Jonathan Patz, the John P. Holton Chair of Health and the Environment. “She has been a pioneer with her work at the intersection of global environmental change and infectious disease.”
The challenge of too good
Antibiotics such as penicillin have been one of modern medicine’s greatest success stories, providing relief for patients with infections from strep throat to pneumonia. Drugs with antibacterial, antimalarial and antiviral activity are collectively called antimicrobials and include treatments for diseases such as tuberculosis, malaria, and HIV/AIDS. “Now, time with these drugs is running out,” the World Health Organization wrote when it named antimicrobial resistance one of the top 10 threats to world health in 2019.
The rise of antibiotic resistance has continued despite development of new and broader spectrum antibiotics to replace those that no longer work. The golden era of easy antibiotic discovery, however, is over, Wilson says. Many pharmaceutical companies have stopped developing new antibiotics and focus instead on medications to treat chronic diseases that often require daily doses and, in contrast to antibiotics, continue to work year after year.
The challenge of confronting antibiotic resistance—and untreatable disease—is multifaceted, and the answers cut across the health of humans, animals and the ecosystem.
Wilson calls antibiotics “social” drugs. “Antibiotics are a shared resource. Most drugs, if you take them, will have no impact on other people,” she says. “When you take an antibiotic, if your bacteria become resistant to it, they can potentially spread to other people or reach the environment. Taking an antibiotic can have a community impact .”
Use and overuse of antibiotics – that can give rise to resistant bugs – in humans and animals is one facet of the problem. The discrepancy between drugs available in wealthy and resource-poor settings is another. While many antibiotics are overused in the U.S., in some countries people are dying because they lack access to antibiotics. Wilson also looks further downstream at what she calls “the afterlife of antibiotics.”
The drugs don’t disappear after they’re used to treat infections, she says. Instead, some part of the antibiotic flows back out of the body, either unchanged or as biologically active molecules, in human and animal waste. While human waste is often treated in the U.S., in many countries it is not, and animal waste often is left untreated. “Can it affect human and animal health? We have looked at what antibiotics do to the human gut microbiome, but few have looked the beyond human body. We haven’t thought enough about what impact residues of antibiotics from human and animal use are having on bacteria in the environment, in water and soil.”
In her talk, Wilson will suggest a multi-pronged approach to protect all health. “There are a lot of things we need to do beyond just decreasing the use of antibiotics,” she says. “We need to engage the global community in a one health approach and work to reduce the need for antibiotics.”
An unlikely path to global health
Wilson’s career began with an undergraduate degree in French, English and philosophy in an era when women were expected to teach, not become doctors. She did teach French and English for three years, nearly finished her master’s in English literature, prepared to go for a Ph.D. – “and realized it was nuts. What I really wanted to do was go to med school.”
Her medical career began with a cold call to the UW-Madison medical school from the teacher’s lounge where she was teaching to ask if she could talk with someone about applying. From M.D. to internal medicine residency and infectious disease fellowship at Beth Israel in Boston to more than 20 years as chief of infectious diseases at the Harvard-affiliated Mount Auburn Hospital, her interest expanded from clinical to global medicine. She lectured in Harvard’s Center for Health and the Global Environment course and found colleagues interested in looking at big issues that affect global health, including climate, marine biology and vector-borne infections.
During her Harvard infectious disease fellowship she spent some months in Haiti working at the Albert Schweitzer Hospital. It was apparent that the socioeconomic, environmental and other factors were vital to health. Clinical work sparked Wilson’s interest in antibiotics and antibiotic resistance. “It was very clear that growing antibiotic resistance affected decisions on a daily basis, as it still does,” she says.
Wilson also has been deeply involved in international work with infectious disease and antibiotics. As a member of the Pew National Commission on Industrial Farm Animal Production, she visited massive farm operations a decade ago and learned how broadly antibiotics are used in animal-production facilities in the U.S. “I don’t think most people are aware that more antibiotics go into food animals in the U.S. than into people,” she says. “They’re also used in aquaculture, used to treat honeybees, fruit trees and other plants … In many instances, they’re the same antibiotics we give to humans. We need much more integrated communication across sectors.”
As a special advisor to the GeoSentinel Surveillance Network, Wilson continues to explore how disease differs by location and how travel affects the spread of pathogens and antibiotic resistance. She’s served on the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention and on the Academic Advisory Committee for the National Institute of Public Health in Mexico.
Wilson has worked and lectured in many countries including Bangladesh, Brazil, Italy and China and also wrote “A World Guide to Infections: Diseases, Distribution, Diagnosis.” She is also a member of the Board of Visitors for the UW-Madison Global Health Institute.
The UW-Madison Global Health Institute encourages collaboration across disciplines and supports research, education and outreach to improve the health of humans, animals and the planet. GHI is guided by a global health ethic that looks to improve health today while ensuring that resources are available to provide health for all tomorrow.
By Ann Grauvogl/ February 11, 2019