Managing antibiotic resistance is a global public health problem. Disrupting health, agricultural and ecological systems, antibiotic resistance affects the lives and livelihoods of millions of people globally. As their effectiveness wanes antibiotics are becoming a limited resource. Different groups in the community, and different professional groups, take very different positions on how we should seek to curb our antibiotic use. Policy problems like this are well-suited to deliberation in a community jury.
Community juries are a lot like juries in a court room. They are made up of about a dozen people, who meet over two days. They hear expert testimony and then deliberate to make a decision about what they think is the right thing to do. The Community Jury process is an effective way to involve citizens in developing a thoughtful, well-informed solution to a public problem or issue. On the final day of their moderated hearings, the members of the Community Jury vote on the issues and present their recommendations to the public.
Who was in the Community Juries
We held two separate juries at Westmead Hospital (Sydney NSW) and Dubbo (Western Plains NSW) between August and November in 2016.
Thirty members of the public were purposively selected to participate from people who responded to public advertisements in Sydney and Dubbo. Juries were comprised of community members of a range of ages from diverse social and cultural backgrounds. People with close ties to a pharmaceutical company or prescribing authority [themselves or a close family member] were excluded.
A community jury is group of people (usually 12-15 individuals) brought together over a weekend to hear evidence about an issue from experts, ask them questions, discuss and deliberate as a group, and decide upon a set of recommendations. Community juries have been used around the world to engage members of the public in a structured dialogue with experts about how we should seek to resolve difficult or controversial issues.
The Questions put to the Juries
Antibiotics are often used when they are not needed. If this situation continues, antibiotics will no longer be effective when they are needed to treat a serious infection that could be fatal without effective treatment. The following measures have been proposed to help make sure that antibiotics continue to be effective when we really need them.
- Prohibit antibiotics from being dispensed on the day of prescription (i.e. require them to be dispensed 3 or more days later) — this could apply to prescriptions written by GPs, veterinarians and/or dentists.
- Prohibit or severely restrict community-based practitioners such as GPs, veterinarians and/or dentists from prescribing antibiotics of last resort.
- Ban the use of growth promoting antibiotics in food-producing animals.
- Ask GPs, veterinarians and/or dentists to hang a signed poster in their consulting room pledging to only prescribe antibiotics when they are needed.
- Require GPs, veterinarians and/or dentists to write a justification on the patient’s record each time they prescribe antibiotics.
Part A. Are there any other measures to promote sustainable antibiotic use that the jury thinks should be added to the list for consideration?
In Part B, you will decide which of these 7 measures is the best way to make antibiotic use more sustainable. Before you rank these 7 measures, you may want to add more to the list.
Part B. In this task, we are asking the jury to reorganize the list of measures. Put the best measure to make antibiotic use more sustainable at the top, and the worst measure at the bottom. Put all of the measures in order, from best to worst. Please carefully record the reasons for your decisions.
The Experts and the Evidence Presented to the Juries
Background Information: ABC Catalyst Documentary: Antibiotic Resistance
Jurors were first show a 30 minute documentary on antibiotic resistance produced by the Science Unit at the Australian Broadcasting Corporation in 2016. At the end of the documentary jurors were able to ask questions of Professor Jon Iredell – one of the experts interviewed as part of the program.
Expert 1. Professor Jon Iredell
Jon is Director of Infectious Diseases and a senior microbiologist based at Westmead Hospital. His research through the University of Sydney is based at the Westmead Institute and his laboratory works on the genetics of antibiotic resistance in bacteria.
The National Health and Medical Research Council supports studies into new ways to manage antibiotic resistance in bacteria, including ways to target specific bacteria while in the gut or even to remove resistance genes from bacteria without killing the bacteria themselves.
To watch the ABC Catalyst Documentary please click this link
Professor John Turnidge: “Changing antibiotic use in Australia”
John graduated in medicine from Sydney University and subsequently trained in infectious diseases and microbiology at Flinders Medical Centre. He has a long-standing interest in antimicrobial prescribing and antimicrobial resistance, and has contributed nationally in these areas to government, international organisations and learned societies, including the NHMRC, the WHO, the US-based Clinical and Laboratory Standards Institute, and the European Committee on Antimicrobial Susceptibility Testing.
He co-founded the Australian Society for Antimicrobials, which now has over 800 members. He retains expertise in diagnostic microbiology and infectious diseases clinical work, and his advice is sought on all aspects of antimicrobials from laboratory testing to development and appropriate use.
He is currently working in the Australian Commission on Safety and Quality in Health Care to develop and implement the first comprehensive national surveillance system for antimicrobial use and resistance in Australia.
To watch Prof Turnidge’s presentation please click this link
Professor Lyn Gilbert: “Human health perspectives on managing AMR”
Lyn is an infectious diseases physician and clinical microbiologist, with a research interest in the politics and ethics of communicable diseases of public health importance including healthcare-associated infection and antibiotic resistance. She is professor in infectious diseases and senior researcher at the Marie Bashir Institute for Emerging Infections and Biosecurity and the Centre for Values, Ethics and the Law in Medicine at the University of Sydney; and consultant emeritus at Westmead Hospital, Western Sydney Local Health District.
To watch Prof Gilbert’s presentation please click this link
Associate Professor Jacqueline Norris: “Animal health perspectives on managing AMR”
Jacqui is a registered practicing veterinarian and veterinary microbiologist at University of Sydney. She is passionate about providing clinically relevant infectious disease courses for veterinary students, practitioners and breeders. She is heavily involved in developing the new Doctor of Veterinary Medicine (DVM) curriculum. Her research includes: Development of diagnostics and treatments for companion animal infectious diseases; preventable risk factors in veterinary practice and the risks to health in human communities; determining how these bacteria move through populations and acquire/transfer resistance; informing infection control practices to decrease transmission within human and animal populations.
To watch A/Prof Norris’s presentation please click this link
Associate Professor Ky-Anh Nguyen: “Oral health perspectives on managing AMR”
Ky-Anh is Associate Professor at the Faculty of Dentistry, a Faculty Member at the Westmead Institute for Medical Research and a practising dentist. He is the Faculty of Dentistry Post-graduate Coordinator and member of the Research Committee. His career has included a two-year term as postdoctoral scientist with Professor Jim Travis at the University of Georgia, Athens, USA. Ky-Anh’s research focuses on using molecular studies to understand how certain oral bacteria cause periodontal (gum) disease and systemic diseases.
To watch A/Prof Nguyen’s presentation please click this link
Professor Angus Dawson: “Ethical perspectives on managing AMR”
Angus is Professor of Bioethics and Director of the Centre for Values, Ethics & the Law in Medicine at the University of Sydney. His background is in philosophy but he has taught and researched in applied ethics for over twenty years. His main research interests are in ethical issues to do with public health including vaccinations, obesity, migration and climate change. He works with the World Health Organization on developing ethical guidelines and is a member of the research ethics board of Médecins Sans Frontières (Doctors Without Borders).
To watch Prof Dawson’s presentation please click this link
For more information about research being conducted at the University of Sydney on infectious disease and biosecurity please go to the Marie Bashir Institute website [Link].
For more information about antibiotic resistance – a recent report on the problem faced published by the Wellcome Trust (UK) can be found here [Link].
More information about the Australian National Antimicrobial Resistance Strategy 2015-2019 can be found here [Link].
This study has been approved by the University of Sydney Human Research Ethics Committee. Any person with concerns or complaints about the conduct of this study should contact the Ethics Coordinator who is the person nominated to receive complaints from research participants. You should contact them on +61 2 8627 8176 and quote HREC/2015/009
Images used on this site are sourced from Wiki commons. They are: “Dingoes feeding on a cattle carcass” by CSIRO, “Greyman cattle” by Cgoodwin, “Hens DSC00365” by David Monniaux, “Numurkah_flying_foxes.007” by Terra, “Wild_ducks_in_Ryckevelde” by Michiel Dumon, “Wind farm” by David Clarke [Public domain], “MRSA Brown” by , via Wikimedia Commons.