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���������ANTIMICROBIAL ACADEMY 2021

Communicating Drug Resistance

Trent Yarwood – HNAA / QSAMSP / SICN / Cairns

September 2021

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Acknowledgement of Country

I would like to begin by acknowledging and paying my respects to the Djabugandgi people, the Traditional Custodians of the land on which I am presenting to you from.

I would like to pay my respects to their Elders, past, present and emerging, and acknowledge all Aboriginal and Torres Strait Islanders here today, also paying my respects to your Elders, past, present and emerging

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Outline of session

  • How do we communicate about resistance now?
  • Is it working?
  • Is there a better way?
    • Reframing Resistance
  • What about for First Nations people?

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  • If you can’t communicate effectively about what you’ve done…
    • You can’t influence people’s behaviour
    • Was there any point doing it in the first place?

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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World Antimicrobial Awareness Week

  • Week inclusive of 18th November each year
  • Yearly theme
    • 2021: Spread awareness, Stop resistance

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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https://www.who.int/campaigns/world-antimicrobial-awareness-week

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Australian Government Page

  • Did you know it existed?
  • How would you have searched for it?
  • Is the information on the page fit for purpose?
    • Is the purpose fit for purpose?

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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https://www.amr.gov.au

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Searches

Google: AMR

Google: Superbug

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Search interest – vs Sepsis

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

7

Google Trends – https://trends.google.com

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Search interest – drug resistance only

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

8

Google Trends – https://trends.google.com

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

9

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Once you’ve found the page…

  • The web design isn’t terrible
  • Once you dig through, the advice is sound

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  • However…

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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https://www.amr.gov.au

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The O’Neill Review

  • The readability of the landing page is for US college graduates
  • The report is 85 pages long
    • cf Australia’s AURA report 328 pages
  • Once you get to the content
    • Antimicrobials / AMR
    • Billions of lives
    • Trillions of dollars

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Review on Antimicrobial Resistance: https://www.amr-review.org

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Antimicrobial Use and Resistance in Australia - AURA

  • Coordinated by The Commission for Safety and Quality in Healthcare
  • Umbrella for multiple surveillance programs
    • NAUSP (hospital usage)
    • NAPS (hospital prescribing quality)
    • PBS data (community usage)
    • APAS (passive resistance surveillance)
    • AGAR (hospital surveillance)
    • CARAlert (sentinel resistances)
  • Exceptionally complicated
  • Released as a 300+ page PDF every 18mo or so

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

12

https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system

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Wellcome Focus Groups

  • UK Wellcome Trust
  • Focus groups of UK population
  • Asked a range of questions about drug resistance
    • ZERO knowledge of “AMR”
    • Very little knowledge of “antimicrobial resistance”
    • Antibiotic resistance better
    • “Superbugs” better still
  • -illion based scaremongering does not work

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

13

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Resistance: Reframed

  • Report aimed at experts, communicators, journalists
  • How to communicate about AMR effectively
  • Promote public understanding and motivate to action

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  • Based on extensive interviews with experts
  • Quantitative and Qualitative message testing
    • 12,000 people – Germany, India, Japan, Kenya, UK, USA, Thailand
    • Media and social media analysis

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

14

https://wellcome.org/reports/reframing-antimicrobial-resistance-antibiotic-resistance

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Why is it needed?

  • Coordinated global action on drug resistance is occurring too slowly
  • Political leaders are aware of the issue but it isn’t prioritised
  • Public awareness and concern drives political engagement

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  • Public awareness of drug resistance as a major threat is extremely limited
  • …especially in COVID times

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Current State

  • Multiple terms
    • AMR ; DRI; Superbugs; Antimicrobial vs Antibiotic
  • Multiple frames
    • “War on superbugs” ; mortality, economic effects, health system effects
  • Disjointed coverage
    • Outbreak-focused rather than big picture
  • Low-volume social media coverage
    • Experts tweeting at each other

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Principles of Reframing Resistance

  1. Drug-resistant infections are undermining modern medicine
  2. Explain the fundamentals succinctly
  3. Emphasise it is a universal issue – it affects everyone, including you
  4. Focus on the here and now
  5. Encourage immediate action

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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1. Undermining Modern Medicine

  • Drug resistance is seen as a niche issue
  • Not as pervasive a threat as cancer, heart disease or stroke
  • Little public appreciation that resistance impacts
    • Chemotherapy for cancer
    • Intensive care
    • Most surgery but especially joint replacements

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  • Stories directly relevant to the health experiences of the consumers
  • Tailor messages relevant to the community of your audience

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

18

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Message Testing

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

19

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2. Explain Succinctly

  • Baseline knowledge is very poor
    • Still widespread belief it is the patient who develops the resistance
      • Resistance is from misuse of antibiotics
      • I don’t take many / I don’t take them incorrectly
      • Resistance is not a problem for people like me
  • Message must be simple – without jargon
    • Bacteria > germs > microbes
      • Even though 4/5 are aware of the term microbe, this doesn’t translate to understanding

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Communication – No umbrella term

  • Think of climate change / civil rights / passive smoking
  • We have
    • Superbugs
    • Antibiotic resistance
    • Antimicrobial resistance
    • Drug-resistant infections
    • Antibiotic-resistant bacteria
    • AMR

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  • Avoid AMR & antimicrobial outside specialist comms
  • Drug-resistant infection is Wellcome’s preferred term

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Wet and DRI?

  • Drug-resistant is already in common use for TB
    • MDR-TB / XDR-TB
  • Drug is simple and catches all classes for the antimicrobial pedants
  • Resistance includes the problem in the name

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  • “But not all resistance causes infection! What about colonisation?”

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  • Sometimes technically correct is not the best sort of correct

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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3. A Universal Threat

  • To motivate action, individuals need to see they (or their loved ones) could be at risk
    • Increase the sense of personal jeopardy
    • However, “Everyone is at risk” is too generic
  • Use common, relatable infections
    • Dental abscesses
    • Urinary tract infections

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  • Use human faces and human stories

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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4. Focus on the Here and Now

  • Apocalyptic castastrophising catches attention
    • But does not motivate change
  • “Post antibiotic era” and “Dark ages of medicine” convey urgency, but reduce credibility
    • Seen as sensationalist and therefore less likely to be true
    • “Clickbait headlines”
  • Dry economic projections don’t engender urgency

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  • Drug resistance is harming us now and will become more severe if not addressed

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

24

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5. Encourage Immediate Action

  • Frame the problem as having a solution
    • “…but we can make a difference if we act now” increased resonance by 10%
  • Provide specific examples
    • “We need to act” vs
    • “You can make a difference by not take antibiotics for a cold or flu”

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  • Communicate that the problem can be solved
  • Make a specific call to action
  • Give a specific (and implementable) example

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Where to from here?

  • Be the change we need to see

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  • Advocate for action in your communities

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  • Think about how we can apply this messaging to Mob?

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Exercise: Let’s fix the mess

Antimicrobial resistance (AMR) continues to be one of the greatest threats to human and animal health, as well as for food safety and agriculture.

This has been recognised in Australia by Australia’s National Antimicrobial Resistance Strategy – 2020 and beyond and internationally, by the World Health Organisation. AMR threatens the ability to provide safe healthcare now, and in the future.

Resistance to antimicrobials occurs when bacteria change to protect themselves from these medicines. When this happens, infections that could once be prevented or treated with antimicrobials can become life threatening once more.

Reducing antimicrobial resistance will help keep us healthy, and ensures that these precious medicines will be useful for future generations.

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Exercise 2: What will you say in your clinic?

Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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Summary

  • Undermining modern medicine today
    • With relatable examples
  • Explain the fundamentals in simple language
  • Emphasise universality
    • Yes, that includes you
  • Focus on the here and now
  • Encourage immediate action
    • With specific examples

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  • We would love to hear your thoughts on how to do this better

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Antimicrobial Academy

Northern WA, NT, Far North QLD

E: Statewide.ams@health.qld.gov.au

T: (07) 3646 1886

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