Poverty and antibiotic resistance are intimately connected

Johan Bengtsson-Palme

The Einhorn SIGHT Award 2022 of SEK 100,000 goes to Johan Bengtsson-Palme, a researcher in environmental infections and antibiotic resistance. The prize was awarded at the Royal Swedish Academy of Sciences on November 22, 2022.

Text: Ulrica Segersten/Alexander Farnsworth • Photo: Martina Butorac

Congratulations Johan Bengtsson-Palme on the Einhorn SIGHT Award 2022, an award given to promising researchers in global health! You have been praised for your research efforts that benefit global health. Does this connection seem obvious to you?

“Absolutely. Bacterial infections that are increasingly resistant to antibiotics are one of the major global health challenges of our time. The spread is not limited by national borders but is instead dispersed through our environment and behavior. The same applies to antibiotic resistance,” says prize-winner Bengtsson-Palme, Assistant Professor at the Department of Biology and Biotechnology at the Chalmers University of Technology.

Early warning signs
Calculating how many deaths per year are linked to antibiotic resistance is difficult, as there is very little recorded data for deaths linked to antimicrobial resistance, or AMR. There are also very few professional bodies that study the issue, either. Nevertheless, if antibiotics stop working, modern healthcare is brutally thrown back in time. Without them, modern medical procedures such as surgical interventions, prematurely-born babies, cancer treatments, and life-threatening bacterial infections due to bad water become untreatable. The poor suffer the most in these circumstances.

Antibiotic resistance and infections linked to the environment have been the focus of Johan Bengtsson-Palme’s research for the past ten years. Professor Joakim Larsson at the Department of Biomedicine at the University of Gothenburg first introduced him to the issue. In his work, Larsson clearly demonstrated how antibiotic resistance occurs and is promoted in the human and global environment.

“It should be a moral responsibility and pure self-preservation for the rich world to invest money where it does the most good to prevent both infections and resistance,” says Johan Bengtsson-Palme. “It is crucial that we create the conditions for more people to have access to clean water and sewage systems. At the same time, it is equally important to collect the data in order to develop easy-to-handle and cheap risk models and early warning systems for new antibiotic-resistant bacteria.”

Just as miners in the past brought cages of canaries down into the coal mines so that they could detect dangerous emissions earlier than humans, Johan Bengtsson-Palme wants, through his research projects, to develop cheap methodologies to proactively monitor AMR (antimicrobial resistance) in different environments to find early warning signs that can be acted upon. In the long term, he wants to create tools to predict which specific environments will be riskier than others for antibiotic resistance.

His hope is that the research will lead to improvements where they are most needed, for example, where the prevalence of antibiotic resistance is greatest. This applies both in Africa and also countries and continents that do have functioning healthcare but have large differences in living standards such as India, China, and South America, and areas affected by natural disasters, floods, or war.

In Ukraine, for example, there is a high domestic level of healthcare expertise, yet as the country fights a war, the risk of spreading infections increases.

Saving the world
After a heavy dose of awards recently, Johan Bengtsson-Palme is getting used to accolades, even if he thinks it’s a bit strange since research is to such a large extent a function of teamwork. Earlier this year, for example, he was named a Future Research Leader by the Swedish Foundation for Strategic Research.

Bengtsson-Palme speaks quickly and intensely. In addition to the research position at Chalmers, he leads a research project in data-driven life science funded by the Wallenberg Foundation, which is part of Sweden’s second-largest privately funded research project of all time, as well as a SIDA-funded project in Bolivia.

He partly blames his group of friends from high school for becoming a researcher in microbiology and microbial ecology. Among his friends, there was a strong will to save the world, he recalls.

“One of us chose law and later became a litigator in international relations. I would, by contrast, save the world by developing medicines,” he says.

But Johan Bengtsson-Palme ended up on the other side of the pharmaceutical table with his ambitions. He started researching how emissions from pharmaceutical production and Swedish sewage treatment plants affect antibiotic resistance.

And according to Bengtsson-Palme, there is a lot of potential for improvement when it comes to emissions from production facilities for generic antibiotics, not only in India where there is a large production but also in Europe and Sweden.

“Strangely enough, there is still no legislation to reduce emissions of antibiotic substances from pharmaceutical production. To my knowledge, only India has a law on permitted levels,” he claims.

In fact, the Indian emissions legislation is based on results from Johan Bengtsson-Palmes and Joakim Larsson’s research.

“That’s the kind of thing that can make me really, really happy,” says Bengtsson-Palme. “When research results become so understandable and useful that they can influence legislation and change the EU’s water directive, for example, to limit the release of at least some antibiotics, that’s amazing.”

Given that Sweden takes over the EU presidency in 2023, do you have a wish list for issues around AMR that Sweden could pursue?
“I think Sweden could drive the procurement issue by getting the EU to come together and create uniform requirements for emission levels from pharmaceutical production. And to speed up the work with monitoring, so that the EU gets an ‘antibiotic roadmap’ for monitoring what lies outside the purely clinical work against antibiotic resistance.”

What has perhaps become more difficult in today’s political climate of protectionism, but which would actually benefit the countries of Europe, is more resources for low- and middle-income countries’ water and sewage infrastructure, instead of large investments at home to monitor resistant bacteria in sewage.

“It will be expensive,” says Bengtsson-Palme. “The issue of clean water in low- and middle-income countries should really be easy to sell as something that benefits us all in the end.”

When asked what makes Bengtsson-Palme angry as a researcher, he has a quick answer.

“I get very upset that injustices that could be avoided still persist. Many measures to improve global health are fairly simple and are low-hanging fruit, but action is nonetheless delayed. That frustrates and angers me,” he says.

Bengtsson-Palme is of course happy to receive the Einhorn SIGHT Award in 2022. And he is grateful both to the award committee and research colleagues both past and present. In particular, he would like to thank professors Joakim Larsson and Erik Kristiansson, who introduced him to AMR and the environmental path.

“They have also taught me a lot about leadership, about how to conduct research and feel good at the same time,” says Bengtsson-Palme with a big smile.

As a researcher, Bengtsson-Palme feels fulfilled when his work can investigate a problem and discover a solution, and when doctoral students in the research team start to think independently.

“These developments are fantastic to be a part of,” he says.

But according to Bengtsson-Palme, what really warms his soul is being able to get out into nature on the West Coast of Sweden, where he has access to forests, lakes, and the sea.

“When I am out in nature and picking mushrooms, I become calmer and happier and gain perspective on life. And if I manage to attract the children as well, well then happiness is a given,” he says.


Prize motivation:

“For his outstanding research work in developing tools to limit the global challenge of infectious diseases and antibiotic resistance. The work is particularly important for health in low- and middle-income countries.”

The research:
Johan Bengtsson-Palme conducts research in microbiology and microbial ecology at Chalmers University of Technology (formerly at the University of Gothenburg), with a particular focus on antibiotic resistance, pathogenic bacteria, and how microbes interact with each other. Both bioinformatics and metagenomics, i.e. large-scale sequencing of DNA from all bacteria in a sample, are used in the research, among other things, to provide answers to:

  1. How does antibiotic resistance develop and how does it spread?
  2. What makes disease-causing (pathogenic) bacteria pathogenic? What distinguishes pathogenic bacteria from non-pathogenic bacteria, especially when it comes to bacteria that are closely related to each other?
  3. What mechanisms underlie interactions between bacteria, and what happens when those interactions are disrupted?

About the Einhorn SIGHT Award:

The award, which was established with support from the Einhorn Family Foundation in 2017, will be awarded on November 22 during the student event Global Health Night & Einhorn SIGHT Award 2022 at the Royal Academy of Sciences in Stockholm. Read the interview with the award’s founder Stefan Einhorn

In connection with the award ceremony, a seminar is held for students with a panel discussion on ‘Food security in conflict’ where food systems, climate change, war, and food security are discussed.

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