Imagine bringing the topic of antimicrobial resistance to life by engaging students in learning biology, history, and science through musical theater.
A play has its US premiere this week in Washington, DC, at the Atlas Center for Performing Arts in conjunction with IDWeek2022, the major annual gathering of infectious disease societies. It’s moving to the Science Gallery at Pullman Yards in Atlanta, home of the CDC, for performances Nov. 1-6.
The concept was the brainchild of Dr. Meghan Perry, a Scottish doctor and infectious disease researcher. She then worked with composer Robin Hiley, author Thomas Henderson and the Charades Theater Company to produce the unlikely musical. It was a sold-out hit at the Edinburgh Festival Fringe and was then performed by students at the National Museum of Scotland in Edinburgh and the Science Museum in London. CarriAyne Jones Parr, PhD, Head of the UK Science and Innovation Network in the US Southeast explained that there was also a “partnership with the British Society for Antimicrobial Chemotherapy which gave them some money and helped them develop the educational resources”. They also helped design the program so that it could be “scientifically evaluated for its ability to affect knowledge transfer.”
There are extensive teacher resources and lesson plans, all available for free! These focus on a typical 5th-class syllabus and includes biology – cells and microorganisms and the history of WWI and WWII. They show what life was like before we had antibiotics that could cure infections. Now the focus is slightly more on infection prevention and control measures, as well as on effective drugs and therapeutics to prevent/control infection).
In addition to the lesson plans, the free units include detailed videos so students can learn the music and choreography to stage the musical for their schools or communities.
Based on the story of Alexander Fleming, who discovered penicillin in 1928, the play takes us from before the antibiotic era and the devastating deaths from infections during World War I to the present day. Jones Parr said, “It wasn’t even 100 years ago and we basically built this modern medical system on the backbone of antibiotics and now we’re in danger of losing them.”
Professor Dame Sally Davies is the UK’s Special Envoy on Antimicrobial Resistance (AMR) and England’s former Chief Medical Officer (CMO). She has long been involved in the fight against antimicrobial resistance. Her hope for bringing the musical to the US is “to get the public involved because AMR kills 1.2 million people worldwide every year.”
A critical problem is that pharmaceutical companies have largely backed out of antibiotic development because it is risky and not sufficiently profitable in their eyes. Dame Sally promotes a subscription model for drug development.
“The UK has shown that you can use a subscription method to drive innovation in new medicines. We have trialed two new drugs and we have reached a satisfactory level of payments,” she said. Both the government and the pharmaceutical companies have approved the plan. The first drugs are cefiderocol and ceftazidime-avibactam, each used only for patients with severe antibiotic resistance and limited treatment options.
New antibiotics often have restricted uses to prevent resistance from developing quickly and becoming useless. Due to these restrictions, sales are limited. Under the subscription plan, the company is promised a fixed annual fee regardless of the amount used. Fees are based on the National Health Service’s estimate of the value of drugs using a measurement called quality-adjusted life years (QALYs). This includes how much a drug or treatment “prolongs and/or improves patients’ lives.” In this case, Dame Sally noted that they also considered the benefit of protecting the patient’s family from contracting the drug-resistant organism.
It is no small irony that Britain is stepping up efforts to encourage more limited and rational use of antibiotics (aka antibiotic stewardship), Thérèse Coffey, Britain’s Health Secretary, said this week she gave leftover antibiotics to a friend. Coffey also proposes allowing pharmacists to prescribe antibiotics. Given the current shortage of doctors in the UK and the long waiting times for treatment, their hasty attitude is understandable. The concern is that pharmacists are not trained diagnosticians and there would be overuse of antibiotics, leading to worsening resistance.
When asked about this suggestion, Dame Sally noted that pharmacists could be trained to use algorithms to diagnose and treat certain limited conditions, such as strep throat. She also suggested trials to see if this works before applying changes more broadly.
There is no easy solution. We are fighting AMR on many fronts – from the massive overuse of antibiotics in commercial meat production, to over-the-counter sales in some countries and profit pressure from pharmaceutical companies. Education about the problem of AMR is urgently needed at all levels. This innovative approach to teaching science and history through a musical might just be what the doctor ordered.