Engaging with the Public on Antibiotic Resistance

We outline our recent experience with public engagement — what we did and what we learned.

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. However, 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 at the Wellcome Sanger Institute 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.

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.

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 an antibiotic
  • 57 per cent said they believed there was nothing they could do to prevent the spread of antibiotic resistance

Simple steps everyone can take to combat the antibiotic resistance crisis

  • Regularly wash hands, practice good food hygiene, avoid close contact with sick people and keep vaccinations up to date
  • Only use antibiotics when prescribed by a certified health professional. Never demand antibiotics if your health professional says you don’t need them
  • Always take the full prescription
  • Never use left-over antibiotics or share antibiotics with others

Tracking the spread of antibiotic resistance

We opted to run an activity at one of the Open Saturday events that run on campus every month. The Open Saturday consists of a series of stations with different staff members running activities. There is a tour people can sign up for which leads them around the different activities. I signed up with three colleagues to run the activity — Sophia and myself are scientists, and Rebecca and Richard are web developers.

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

  1. Encourage general awareness of antibiotic resistance
  2. Talk to people about their understanding of antibiotic resistance and address any misconceptions
  3. Specifically target some known misconceptions:
    - Bacteria, not humans, become resistant to antibiotics
    - Viral infections shouldn’t be treated with antibiotics
  4. Show people what we do and give the younger audience an opportunity to see if they’d 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 with 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. We had a collection of human cells, parasites, viruses and bacteria. The cuddly microbes activity achieved exactly what we’d hoped — the kids were excited to play with the microbes and learn about the bugs to complete the activities.

Showcasing scientific software

Our third activity was the main event for the session. We showcased Microreact, one of the tools we’ve developed to use in our 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.

Sophia and Rebecca demonstrating how to investigate drug-resistant bacteria using Microreact

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, where we see a concentration of vulnerable people. Unfortunately, in hospital settings we also see a lot of antibiotic use, meaning that if Klebsiella are going to persist in these settings, it pays to be resistant to antibiotics.

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 the antibiotics 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 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 investigate the data yourself, click here

Tracking antibiotic resistance across the globe

120 people signed up for the tours, giving us a great turnout and a captive audience. 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, read the questions we’d set, and started 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 Sanger! ( 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 and antibiotic resistance face-to-face. The interactive tracking of a resistant bacterium spreading around the world 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.

Many people believe humans become resistant to antibiotics. Consistent with broader surveys of the public, some attendees believed that people have different levels of resistance to antibiotics. They believed that this was caused by our genetics, rather than behaviour. 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 science really looks like, and to 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 kids who hated science but loved design. The activity we ran showed them how effective design can make a difference to research and communicating findings.

Our take-homes

We went into this project 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 to 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!

Find out more

Follow us on Twitter: @TheCGPS

To see more about what we do, visit our website; to learn more about what we’re doing to track the global spread of antibiotic resistance, see the Global Health Research Unit.