Val McDermid’s radio play Resistance, broadcast on Radio 4, with lead actor Gina McKee, concluded last Friday on a chilling note. Her calculated vision of a world beset with a lethal bacterium immune to antibiotics not only carried a compelling story, but also engaged with the core elements of the debate on AMR (Antimicrobial Resistance). The origins of the outbreak, responses from the authorities, and even the dramatic conclusion were all well-presented and carried an eerie sense of reality.
The first indication that this was more than just another addition to the ‘disaster’ genre, came with its mature treatment of swine erysipelas, which can produce a mild skin infection in humans, mutating to produce a pandemic infection which wipes out the world’s populations. Starting with the 100,000 attendees at a rock festival in the North East, the SIPS infection rapidly spreads across the UK, Europe, America, and the rest of the world. However, the bacteria didn’t appear from nowhere and begin killing people, originated at an unsanitary pig farm discovered by the journalist Zoe during her investigations. It’s a story that campaigners for Antibiotic Research UK know all too well. Factory farming cuts costs but can result in infection rapidly spreading. So antibiotics are then required to control the infection spreading in the herd or flock. The same antibiotics that are used to treat humans are used to treat animals, putting more selection pressure on the bacterial population giving rise to resistance.
One of the more alarming elements of McDermid’s tale is the development of the Resistance superbug. SIPS begins at the Solstice festival as no more than an unpleasant gastric bug producing mild skin lesions that passes through the system within 24 hours. However, within seven days, the infection becomes virulent again through successive mutations and the ‘harmless’ bug’s increase in infectivity and virulence turns it into a deadly illness. An indicator of the infection are the characteristic purple skin lesions on the arms. Resistance is an unsettling showcase of how fast an innocuous bacterium can morph into a deadly epidemic without the proper drugs available to combat them. Dr. Adamson, whilst perhaps a bit relaxed about the sudden outbreak of a mystery disease, is as calm as you might expect any medical professional to be, having been educated on the premise that antibiotics would always be a viable option. The play drives home the fact that without AMR, ‘SIPS’ would likely have been just another illness that came and went, touching only a few lives.
Even once the bacteria is a known threat, the pharmaceutical industry’s response echoes their current stance in reality. As Dr. Siddiqi explains in the show, there is simply no profit in making a drug that people only take a few times in their lives. The sizeable cost of developing any new drug makes research into new antibiotics unprofitable. With shareholders to keep happy, investment into antibiotic research is deemed ‘unviable’ in almost all cases. The blending of fictional setting with a nuanced understanding of the facts, underpinning the debate, is what makes McDermid’s play so strong. We cannot ignore the science behind Resistance because the drama constructs it as a key element of the plot. At the end of the play, there are just two million survivors out of a world population of 7 billion, i.e. just 0.03% survivors.
Resistance is an eerily well-written rendering of what the world might look like if we continue our current course. It’s a warning that communicates one of the greatest threats to our existence through a medium everyone can understand, while still being, at its core, a great story. If you did miss it, I highly advise to go and find it on the Radio 4 website. Melodrama aside, it’s a thrilling listen.
Our trustee, Professor Christopher Dowson, was a programme consultant for Resistance. He says: “This fantastic production presents in an emotionally engaging manner some of the important issues that have given rise to our current predicament – ever rising resistance and fewer effective antibiotics. My hope is that listeners will go on to ask ‘what can I do to be part of the solution?’”
In April, look out for our interview with him about his experience as programme consultant.
Resistance was a drama conceived and developed through the Experimental Stories scheme, a collaboration between BBC Radio 4 and the Wellcome Trust.