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22 February 2024 | Story André Damons | Photo SUPPLIED
Prof Robert Bragg
Prof Robert Bragg is a researcher in the Department of Microbiology and Biochemistry at the University of the Free State (UFS) and believes hospital-acquired infections (HAIs) might already be “Disease X”.

During the World Governments Summit, the World Health Organisation (WHO) warned world leaders about the likelihood of a Disease X outbreak, saying it is “a matter of when, not if” a new pathogen and pandemic will strike. If there is an outbreak of this disease tomorrow, the world still would not be ready. 

During his speech earlier this month at the summit in Dubai, Tedros Adhanom Ghebreyesus, Director-General of the WHO, said COVID-19 was a Disease X – a new pathogen causing a new disease. He said: “There will be another Disease X, or a Disease Y or a Disease Z. And as things stand, the world remains unprepared for the next Disease X, and the next pandemic. If it struck tomorrow, we would face many of the same problems we faced with COVID-19.”

Though Disease X is a hypothetical placeholder representing yet-to-be-encountered pathogens, Prof Robert Bragg, researcher in the Department of Microbiology and Biochemistry at the University of the Free State (UFS), believes hospital-acquired infections (HAI) might already be “Disease X”. He says data shows that deaths from HAIs will become the leading cause of human deaths. This problem is rapidly growing as most of the pathogens which people contract while in hospital are now resistant to antibiotics, making them very difficult to treat.  

Prof Bragg, whose main research is in disease-control, first in the agricultural industry, and now human health, also previously warned about a disease that would make COVID-19, which killed more than seven million people to date globally, look like a dress rehearsal. His PhD student, Samantha Mc Carlie, investigating how bacteria become resistant to disinfectant and sanitiser products. This is a serious problem for the future, as disinfection could be our last line of defence.

Heading for a crisis in health care

“The world is rapidly heading for a crisis in health care regarding hospital-acquired infections. It is common knowledge that we are quickly running out of antibiotics (and antifungals) to treat bacterial and yeast infections. Without antibiotics and antifungals, the outcome of many of these bacterial and yeast hospital-acquired infections will be very severe. They will, unfortunately, in many cases, result in the death of the patient,” says Prof Bragg. 

According to him, the WHO suggests that 30% of patients in ICUs in developed countries and 70% in underdeveloped countries will contract a HAI. Of these, the mortality rate can be as high as 70%. 

“Most of these infections are caused by multiple drug resistance strains of bacteria such as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species. Additional bacteria and yeast, which can also cause HAIs, such as Serratia species, are also becoming a concern due to their intrinsic higher levels of disinfectant resistance.”

Prof Bragg explains that in 2014, a high-profile review was first published, commissioned by the UK Prime Minister, entitled, “Antimicrobial Resistance: Tackling a crisis for the Health and Wealth of Nations” (the AMR Review). This review estimated that antimicrobial resistance (AMR) could cause 10 million deaths annually by 2050 (The Review on Antimicrobial Resistance 2016). This is the same number of deaths caused by cancer today, making AMR the leading cause of human mortality by 2050. When it was finalised, this report was highly criticised as an over-dramatisation, as when this prediction was made, the number of mortalities related to HAIs was around 700 000 – a very long way off 10 000 000. However, according to recent estimates, five years later, in 2019, 1.27 million deaths were directly attributed to drug-resistant infections globally, and this had reached 4.95 million deaths associated with bacterial AMR (including those directly attributable to AMR) by 2022 (Murray et al. 2022). 

The overuse of disinfectants during the COVID-19 pandemic, according to Prof Bragg and Mc Calie, has contributed to the crisis by fostering resistant strains and contaminating environments. Based on the current trajectory of mortalities, the 10 million mark will be reached way before 2050.

Need for a paradigm shift

The researchers say an urgent need to change the paradigm in medicine from “treatment” to “prevention” is necessary and that the old saying ‘prevention is better than cure’ has never been truer. 

According to Bragg: “The golden era of antibiotics is rapidly coming to an end. It is highly unlikely that we will discover new antibiotics, and even if we do, the likelihood that the bacteria will already have or will be able to develop resistance in a very short time is highly likely. 

“We need to think of what happed with quinolones, where we thought we had won the war with a groundbreaking new antimicrobial agent. The bacteria did not have millions of years of evolution to develop resistance to quinolone, yet in only three years, the first resistant bacteria were isolated. There is currently great excitement around AI-derived new antibiotics. However, the end result is likely to be the same. We need an alternative to treatment – in other words, a paradigm shift.” 

Improved biosecurity 

Prof Bragg says highly improved biosecurity is the only viable option for disease control in a post-antibiotic era. By using good biosecurity in poultry production, he says the mortality rates were reduced by 50%. 

Research has shown a direct link between the environmental microbial load in a hospital and HAIs; with a lower microbial load linked to lower incidence of HAIs including C. difficile infections (Boyce et al. 2008; Suleyman et al. 2018; Umemura et al., 2022). Therefore, the new paradigm is to reduce microbial contamination in the hospital environment to prevent HAIs. If there are fewer dangerous microorganisms in an environment, patient and staff exposure to these microorganisms will decrease, reducing the level of HAIs for staff and patients. However, to reduce the microbial loads in healthcare settings, effective cleaning and disinfection products need to be used. 

News Archive

But do you forgive yourself, Eugene de Kock? asks Candice Mama
2015-03-16

From the left are: Prof Pumla Gobodo-Madikizela, Candice Mama and Prof André Keet, Director of the UFS Institute for Reconciliation and Social Justice.
Photo: O'Ryan Heideman

 

Candice Mama: Audio

Candice Mama and her family met with her father’s assassin. Eugene de Kock. Prime Evil. Commander of the apartheid government’s covert Vlakplaas police unit. And what followed from this meeting was one of our country’s most poignant gestures of reconciliation. One by one, each family member expressed their forgiveness of De Kock, and soon afterwards, he was granted parole.

Candice recently visited the Bloemfontein Campus to talk about ‘An Unexpected Encounter with Eugene de Kock: A Journey of Transformation’. The event was a collaborative effort between the Institute for Reconciliation and Social Justice and Trauma, Forgiveness, and Reconciliation Studies.

“What makes it possible to cross the boundary from loss and pain to bond with the person who hurt you?” Prof Pumla Gobodo-Madikizela, asked Candice. “I had to educate myself about the when, where, and how, to get a context for Eugene de Kock,” she answered. With the encouragement of her mother, Candice became an avid reader from an early age. She devoured information, so that she could build a picture of this man within a specific historical and political context. What also contributed to this moment of reconciliation for her was De Kock humbling himself and taking full responsibility for his actions.

This meeting was not without inner conflict for Candice, though. “Why am I crying for hím?” she asked herself as she listened to him speak. “Why am I laughing?” she chastised herself as De Kock preened shyly for a group photograph with the family. “Is there something wrong with me to connect with him?” She questioned her values and beliefs. But instead of a monster, Candice saw the true essence of a repentant human being.

But how do you know he didn’t fake it, many people asked. Because it was “one of the most sincere and honest encounters I’ve experienced,” she said. During their meeting, Candice saw a man “crushed by the world”. Everything he believed as a young man, he realised, was a lie.

“Do you forgive yourself?” Candice asked the one question De Kock feared most. And in that moment, he was humanised for her. “When you’ve done the things I’ve done,” De Kock replied, “how do you forgive yourself?”
It remains an open question. But this act of forgiveness gives an entire country hope.

 

For more information or enquiries contact news@ufs.ac.za.

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