When epidemiology PhD student Jean-Paul Soucy checked his email while munching on lunch with his fellow graduate students on a Monday afternoon, he fell silent.
It was the first day of what was supposed to be a usual workweek, and an email with the words “Letter of Offer’’ could have applied to a mundane range of things. He passed his laptop to a colleague. “See if it says what I think it says,” he remarked.
It said just that. He had become part of the newest selection of Canadian doctoral students to be named Vanier Scholars. The Vanier scholarship is a highly prestigious award for doctoral students that is granted by the Government of Canada.
The award will provide Soucy with $50,000 per year for three years while he works with his colleagues at the Dalla Lana School of Public Health to conduct research and develop community-based solutions to rein in the excessive prescription of antibiotics in Canada.
In particular, Soucy’s research focuses on developing “antimicrobial stewardship” programs to facilitate best practices in antibiotic prescription by family physicians.
Why Soucy’s research field is critically important to global health
A 2014 World Health Organization (WHO) report warns that the world may be entering a “post-antibiotic era, in which common infections and minor injuries can once again kill.”
While harmful bacteria have a natural ability to develop resistance to antimicrobial drugs, the way that healthcare providers across the globe have prescribed these drugs has accelerated drug resistance.
Misuse and overuse of antibiotics facilitates the exposure of bacteria to drugs for longer than necessary to treat infection. This exposure allows microbes the conditions that foster the evolution of drug resistance.
Soucy illustrated an example of misuse with the prescription of antibiotics for the treatment of respiratory tract infections — such as the common cold and flu.
“Respiratory tract infections… are commonly caused by viruses,” said Soucy. “[But] antibiotics can’t do anything against [viruses].”
“Unfortunately, in a lot of cases, we have respiratory tract infections being treated by antibiotics.”
The consequences of the misuse and overuse of antibiotics
Such misuses of antibiotics have led to a weakened effectiveness of treatments against potentially lethal diseases.
Research reported by the WHO identifies conditions such as pneumonia and urinary tract infections as being in urgent need of new treatments, due to the advent of antibacterial resistance.
Forms of tuberculosis resistant to at least four drugs have been identified in 105 countries, while strains of gonorrhea resistant to last-resort antibiotics have been identified in 10 countries, including Canada.
In addition to accelerating the resistance of microbes to drugs, inappropriate antibiotic prescriptions can also increase the vulnerability of patients to particular infections.
“In the hospital setting, we have this nasty Clostridium difficile [bacterium],” said Soucy. “When your microbial ecosystem is disrupted by taking antibiotics, especially these broad-spectrum antibiotics that target a lot of [bacteria] at once, it creates a hole in that ecosystem that C. difficile may then enter,” he explained.
Antibiotic stewardship as a solution to excess prescription of antibiotics
Soucy’s project will revolve around antibiotic stewardship. “Antibiotic stewardship is basically the idea of making sure that we use antibiotics in a judicious way, that we’re preserving our [antibiotics’] efficacy by not giving unnecessary prescriptions, and making sure we give the right prescriptions [for microbial infections] as soon as possible,” he said.
Stewardship programs have found a footing in hospitals, but not in the community where there is a lack of comparable infrastructure. More importantly, an overwhelming majority of Canadian antibiotics — a whopping 92 per cent — is prescribed by family physicians and dentists.
The project will develop an online tool to provide “feedback to family physicians about their prescription practices,” helping them compare their own prescription practice with local guidelines and with other physicians in the area.
Soucy emphasized the importance of community-based solutions for tackling antibacterial resistance. By facilitating stewardship programs without requiring the infrastructure of a hospital, the tool will be adaptable to a wider range of less resource-intensive healthcare systems.
The path that led Soucy to epidemiology research
Soucy’s multiple interests led him to conduct research in infectious disease epidemiology. His undergraduate degree trained him in ecology, evolutionary biology, and mathematics, fostering his expertise in the mathematical modelling of infectious diseases.
Add to this his interest in the social factors that cause disease to spread, and the field of infectious disease epidemiology formed the right fit.
In parting, Soucy emphasized the role played by research mentors, friends, and the community he found through extracurriculars, which enabled him to pursue his passions. These people have helped him through “all sorts of research opportunities,” keeping him motivated and resolute throughout the challenging years of research.
When asked for advice for budding researchers, he recommended students to adamantly challenge their fears.
“The way that I get past that feeling that says, ‘You can’t do this, you can’t figure this out,’ is [that] I just commit myself to doing it,” he said. “Then I have to do it — I have to figure it out.”