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Waking the public up to the threat of antibiotic resistance Date: 07/31/19

Since the dawn of antibiotics, there has been antibiotic resistance. Until about 20 years ago, this threat remained muted because there were plenty of new antibiotics in the pipeline to replace those that had stopped working.

Today, there are fewer than 50 antimicrobials in the pipeline, according to Pew Charitable Trusts. Resistant bacteria, meanwhile, are slowly but surely spreading across the planet. If nothing changes, a British think tank, the Wellcome Trust estimates that 10 million people will die annually from a resistant microbe by 2050.

Getting the public to understand and pay attention, however, remains a challenge for health journalists. Matt Richtel, a science reporter for The New York Times decided to take on the task on of trying to get Americans to understand the growing threat with a series that began in April 2019. He co-wrote “A Mysterious Infection, Spanning the Globe in the Climate of Secrecy” about the rapid spread of the resistant fungus Candida auris and the many people globally who have been infected by it, and then likely died from it. The Times has now published 11 stories in the series and has many more to come.

Richtel talks to AHCJ’s Bara Vaida about how he approached the story and its challenges:

Q: How did the New York Times conceive of this story series?

A: My editors knew I needed something meaty to work on after my Planet Fat series [which ran in 2018 and was about obesity in America]. Antibiotic resistance was a topic they knew needed to be thought about differently, so they asked me if I’d be interested. I understood some of the basic scientific framework of it, because I wrote a book about the immune system.

If I had known how little I actually understood about [antibiotic resistance] I might have said, ‘No thank you’ because, as it turns out, this is extremely difficult to understand and to communicate … [but] I spent a couple months really delving into it … to find out if there was something there that we could tell with a compelling narrative.

After two months, I found a number of potential stories. We built this conception of the series … to be that there was this big disconnect between the public and what was happening … which is that there is a major storm brewing ahead [with antibiotic resistance] and yet people see that as disconnected from their personal lives. We had to find stories that would make it impossible for the reader to turn away.

 What then really set us off in motion is that we got our video team engaged and they saw a way to build an explainer [about the bigger picture problem of antibiotic resistance] and that [helped] us to build a narrative around this complicated subject.

Q: Your first set of stories in the series was about the rapid, global spread of an antibiotic-resistant fungus Candida auris, and how it seems like the entire health care system across the globe was trying to keep the story of this fungus under wraps. How did you get the first stories in this series?

A: I cannot say enough about how boring investigative journalism is. The series was an exercise of, get excited, think you have a lead and realize you don’t, then sit on the couch, have some coffee, hang your head and then repeat. We searched and called people and asked for medical records. How did we find our stories? I’ll give props to our editors for their patience and their continuing to push me to keep looking for the perfect Candida auris case. It meant asking for help from my colleagues in the U.S. and overseas … to using Linked In and Facebook, to calling academics. Then we found someone in Venezuela that had died of Candida auris that we verified.

Q: How else did you find patients and cases and what would you recommend to other journalists interested in investigating antibiotic-resistance in their communities?

A: Look through [scientific] journal papers on antibiotic resistance. Many of the authors are germ hobbyists of the highest order and are willing to help. For example, I found Jacques Meis, who is a disease hunter in the Netherlands. I just kept asking him to introduce me to people around the world, from Argentina, to Brazil, to India. And I kept making calls. The other thing I did was try to find doctors and nurses that would talk to me. I found them by using LinkedIn and Facebook and I’d just introduce myself and say ‘Hey, I’m Matt Richtel; I am from the New York Times. I’m doing this story, would you help me? Or do you know a friend, who might know a friend who could help?' I also called lawyers that sue on public health issues. ... They sometimes have documents from the discovery [process.] and that can be useful. Check in with nonprofits. We got lucky because a nonprofit handed me something that helped us. Some states have sunshine laws. Like in Washington state, we were able to get information by filing a request under sunshine laws.

Since the series has run, we are now getting patients to come to us. They are scared.

Q: What were some of the challenges you have been facing with this series?

A: Sometimes stories require even more tenacity than I think. I had grown accustomed to anticipating [challenges] but this one exceeded them all. I think it is because forces that are normally inclined to talk to the public – hospitals, doctors, public health officials, patients – clammed up…. [For example] early on, I was surprised when a major medical figure in Alaska, who had been keen to talk, stopped returning my calls. A hospital stopped calling me back when they found out I wanted to talk about a case of MRSA [methicillin-resistant staphylococcus aureus] at their hospital. I thought, hospitals, doctors, they always want to talk. They are on the side of good. But a lot of people wanted to talk about [antibiotic-resistance] in theory, but not when it was happening in their orbit. I underestimated how hard this would be.

Q: Why do you think they clammed up?

A: For the families and the patients, I think it is that they don’t want to be marked by this or that disease. There are also huge economic interests in keeping things the way they are … at hospitals, they are scared of losing patients, in the pharmaceutical industry, they want to sell as many antibiotics as possible, in animal farming, they don't want to lose access to antibiotics. In public health, I had a person who only wanted to talk to me if I was willing to report they are doing a good job, and I said, how can I determine that if you won’t talk to me? It has been easy until now for all these interests to maintain a veneer of secrecy because the stakes remained at a distance and there were antibiotics in the pipeline. [There are few antibiotics in the pipeline today] and the stakes are getting much closer.

Q: In one of the stories in your series, you focus on the rapid spread of antibiotic-resistance urinary tract infections, yet there is little research on how widespread it is. Why do you think that is?

A: I think it is because of the historic nature of women’s issues. [UTI’s mainly effect women because of the location of the urethra in the body.]  If it had been the penis, there would have been volumes of research. There has long been a schism in the history of medicine and women’s health. When I worked on my book, I couldn’t believe how widely ignored autoimmune issues were, and it is partly because it was women who were suffering.

Q: What impact has your series had?

A: It has been a tremendous start. Our [reader] traffic has been nothing shy of astronomical. It is gratifying in that I think it has awakened people to the understanding of the growing antibiotic resistance [problem] in nursing homes [and hospitals]. But there has been a disproportionate response too. We took pains with this to make sure we didn’t use the phrase  “super bug” because that implies a bug that is killing everyone and that isn’t the case. It is those with compromised immune systems that are most at risk with Candida auris, but this still was covered [with some hysteria by other news organizations] like this was a pandemic.

Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter for the New York Times based in San Francisco. He joined the staff in 2000, and his work has focused on science, technology, business and narrative-driven story telling around these issues, including cancer immunotherapy, electronic cigarettes, and the impact of heavy technology use on behavior and the brain.