Author: Elizabeth Bennett

Antibiotic resistance occurs when germs such as bacteria and fungi are no longer as affected by antibiotics. This means that current treatments for various infections will no longer work because the germs that were once vulnerable to antibiotics have adapted to resist them. This can occur when antibiotics are used to destroy some of the bacteria, but the stronger ones that were able to survive continue to multiply, causing antibiotic resistance to occur. The risk of antibiotic resistance greatly increases when antibiotics are over-prescribed or not used in an effective way. Since overuse allows for the germs to eventually develop resistance to the treatment, areas that lack standard guidelines for treating diseases and prescribing medications are likely to see more infections caused by antibiotic resistant diseases. Healthcare, veterinary, and agriculture industries are also likely to have antibiotic resistant bacteria present due to the higher number of antibiotics used in those settings.

Currently, approximately 700,000 people die per year due to antibiotic-resistant bacteria. According to the World Health Organization, Antimicrobial Resistance (a germ’s ability to resist antibiotics as well as other microbes) is one of the ten greatest public health threats and will cause an estimated 10 million deaths by 2050. One of the greatest threats are superbugs—bacteria which develops the ability to resist more than one type of antibiotics. Infections that are curable now, such as pneumonia, tuberculosis, blood poisoning, gonorrhea, and foodborne diseases could become impossible to cure as resistant strains spread.

Antibiotic Resistance in the United States

In 2013, the CDC released the first Antibiotic Resistant Threat Report. Since then, different policies have been implemented to reduce the spread of antibiotic resistance. These efforts include Executive Orders issued to direct federal agencies to follow guidelines to combat antibiotic resistance, increased CDC disease monitoring, and FDA directives to ensure that antibiotics are only used for treating and preventing infections in food animals and not for growth promoting. However,there have also been contradicting steps taken, such as the US Department of Agriculture rejecting the WHO’s guidance to limit antibiotic use in livestock feed.

According to the CDC’s 2019 AR Report, the total number of deaths from antibiotic-resistant bacteria fell in the United States by 18% from 2013 to 2019. However, the CDC still estimates there are about 2.8 million infections each year and 35,000 deaths in the United States due to antibiotic-resistant bacteria. Additionally, the number of infections of several strains of bacteria have actually increased, with the germs becoming more resistant and progress to stop infections slowing down. This makes it difficult to find ways to treat those infections and given the interconnectedness of the world, these diseases could then continue to spread. The CDC also estimates that 47 million courses of antibiotics are prescribed each year for cases that do not need it. This is seen in such instances as viral infections like the cold or flu (viruses are not impacted by antibiotics), thereby increasing the prevalence of antibiotic-resistant bacteria as well as allowing already resistant bacteria to develop further difficulties to treatment.

Covid-19 and Antibiotic Resistance

The Covid-19 pandemic has complicated the usage of antibiotics. Antibiotics do not work on viruses, so it would have no impact on Covid-19 treatment. However, since it is possible to get Covid-19 and a bacterial infection at the same time, antibiotics are prescribed to nearly 72% of Covid patients despite only 6.9 percent being reported to have bacterial co-infections. Before there was available widespread Covid-19 testing, it was more common to prescribe antibiotics to patients displaying respiratory symptoms, since it could have been caused by bacterial or fungal pneumonia. Additionally, preemptive antibiotics are often prescribed to stop bacterial infections from occurring at the same time as Covid-19 due to the patient’s weakened immune system. It is important to prevent secondary bacterial infections in Covid-19 patients, though the rates in which antibiotics are prescribed is higher than the rates of which the bacterial infections occur with the infections tending to occur in already vulnerable patients. In fact, increases in resistant infections occurred amongst those Covid patients, highlighting how overprescribing antibiotics can create an increase in resistant germs.

Additionally, Covid-19 has generated other obstacles to preventing antibiotic resistance. Due to a shift in focus towards Covid-19, funding has been cut and legislation delayed which would combat antibiotic resistance. Similarly, there may be crisis fatigue in which a loss of motivation arises to tackle another public health crisis. On the other hand, Covid-19 could help set a model for surveillance and containment of other pathogens like antibiotic resistant bacteria. Since antibiotic resistant infections spread very rapidly in hospitals where antibiotics are used, the adopted containment measures from Covid-19 could be beneficially applied towards reducing antibiotic resistant infection spread. Furthermore, the pandemic has highlighted a lack of surveillance measures among health care infrastructures which creates potential opportunities for surveillance improvements in the future. It is possible that public health approaches learned from Covid-19 could be used to prevent and contain antibiotic resistant infections.

Ways Forward

The CDC has proposed five core actions to reduce the antibiotic resistance threat in the United States: 

1. Prevent and control infections before they arise 
2. Improve data tracking and sharing about diseases 
3. Improve antibiotic use and remove inappropriate access 
4. Increase vaccines, therapeutics, and diagnostics to improve prevention and detection 
5. Prevent antibiotic resistant diseases from entering the environment through sanitation and access to clean water.

There are several ways these goals can be achieved. Increasing funding for agencies responsible for prevention or monitoring of such infections (such as the  Food and Drug Administration, the National Institutes of Health, the Biomedical Advanced Research and Development Authority and the U.S. Department of Agriculture) could be beneficial for tasks such as collecting data to track resistant bacteria, improving antibiotic use, and funding antibiotic research. Optimizing current antibiotic use both for human and animal consumption would also help reduce the risks while existing programs that regulate antibiotic distribution could be monitored and directed to ensure the usage of antibiotics is appropriate. Furthermore, developing new antibiotics would help stop antibiotic resistance, since current germs would not have developed resistance towards them. Different bills introduced in congress such as the PASTEUR Act would create incentives for innovation with different antibiotics. There are a variety of ways in which antibiotic resistance could be combated, and it is important for individuals to consider what methods the government could use to help prepare for such actions.

A vaccine passport is documented proof that someone has received immunization against a specific disease. With the creation of a Covid-19 vaccine, vaccine passports are now being discussed on a local, national, and international level. Vaccine passports have been debated in the United States since the 19th century, when proof of immunization against smallpox (in the form of a scar on the left arm) was required to travel, attend schools, and work certain jobs. Additionally, forms of vaccine passports already exist in the United States, such as students being required to have proof of vaccinations to attend school. According to the Biden Administration, a national vaccine database for Covid-19 is unlikely in the near future. However, different states have differing policies on the issue.

Vaccine Passports on State, Local, and National Levels

New York has established the Excelsior Pass which can be used to track vaccination status and whether someone has tested negative for Covid-19. The Excelsior Pass can be used to gain entry to various businesses and event venues such as theaters, sports stadiums, and wedding receptions It can be used digitally on one’s phone or as a printed paper which documents the individual’s vaccination status. While New York is the first state to implement this technology, other states such as Florida and Arkansas have passed laws which prohibit businesses from requiring proof of vaccination. The EU and Israel have implemented vaccine passports. The EU’s Digital Green Certificate provides documentation of either Covid-19 vaccination or a negative Covid-19 test and allows for members to freely travel throughout the EU. Similarly, Israel’s Green Pass enables those who are vaccinated to enter locations such as hotels and theaters.

Arguments Against Vaccine Passports

One of the biggest concerns when it comes to vaccine passports is individual privacy. Some consider being forced to disclose health information an infringement of privacy. Additionally, the manner in which the data is stored and delivered could raise concerns because there are no standard federal privacy laws regarding the sharing of vaccination status. For example, if vaccine providers such as CVS and Walgreens are not held to the same standards as other medical providers when it comes to handling health information, it can create risks to individual privacy when those companies are delivering individuals’ health information to others. To resolve this,health care entities are working together to develop standards to deliver information while also maintaining individual privacy. New technology could be used to deliver the information without storing individual data, such as CommonPass  which communicates with airlines information about vaccinations amongst the travelers without providing private patient data.  

Arguments For Vaccine Passports

While some feel uncomfortable with information sharing, others believe the benefits to overall public health outweigh any privacy or liberty drawbacks. In 1905, the Jacobson v. Massachusetts Supreme Court case determined that it was within the rights of the states to mandate vaccination in order to protect public health. At the time, Massachusetts allowed some cities to require laws mandating vaccination against smallpox; however, Jacobson refused to get vaccinated and was fined. The matter was brought to the Supreme Court where it was determined that the states were within their rights to allow vaccination mandates. This is an important component to the Covid-19 vaccine passport discussion since it addresses the question of public health vs personal privacy. Implementing vaccine passports would help to reduce the spread of the disease by creating incentives for individuals to get vaccinated as well as ensure that those who are not vaccinated don’t spread the virus as much.

Other Issues

Another important aspect is equity of vaccine distribution. Lower income communities have less access to the vaccine and receive the vaccination at lower rates. Requiring vaccine passports could further harm those already disenfranchised communities by limiting opportunities that otherwise would have been open. Since the distribution of the vaccinations are not equitable, the impacts of the passports could also fall along similar lines. On an international level, higher income countries are more likely to have implemented vaccine requirements to travel, which further restricts the ability of those from lower income countries to access areas of the world.

Potential Logistics

After receiving the vaccination, there are several different strategies for potential vaccine passport implementation. It is possible for people to either carry the information on a card or store their vaccination records on a digital device such as their phone. Databases, either run by governments or private entities, such as those delivering the vaccines, could also be established to disseminate vaccination information.