What do ISIS and Antibiotic Resistant Bacteria have in common? A lot.

How the battle against antibiotic resistant organisms should inform our approach to ISIS.

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“While all these efforts are encouraging and important, it is clear that much more effort to fuel the…battle is needed. Progress has been made, but it is still piecemeal. Efforts are too often uncoordinated, targeting only specific [threats] or only specific countries. Funding is too often narrow, project-specific and time-limited. Perhaps most importantly, strong…leadership is lacking. Real leadership, at all levels—national, regional and global—is critical and necessary now.”

This quote could certainly describe current sentiment about efforts to combat ISIS and other radical jihadists, but its authors had no such intention. Instead, it was written about another threat; an ongoing menace that kills 23,000 Americans annually and has led experts to predict global, near-future death tolls of 10 million people per year.[1] The quote is from ReAct[2], and the assailants they are describing are antibiotic resistant bacteria. Beyond the phraseology of the quote, however, there are marked similarities between multidrug resistant organisms (MDROs) and the self-described Islamic State. Recognizing the uncanny parallels between these two is critical to defeating them both.


1.  Both MDROs and ISIS are living entities dependent on population growth.

Bacteria reproduce by binary fission (dividing). In optimized conditions, a lone bacteria becomes 2, 2 doubles to 4, 4 to 8, 8 to 16, and so on until the bacterial population crests 1 million after 21 generations and 16 million 4 generations later. It’s this propensity for reproduction that can lead a patient’s small skin infection to become lethally systemic in a few days. Of course ISIS doesn’t yet rely on biological reproduction to propagate (although I suspect future jihadists are now being born), but its aggressive recruitment and radicalization efforts have led to a similarly exponential rate of growth. Knowing that both bacterial pathogens and ISIS only pose a threat when they reach a critical mass, curtailing growth is essential to combating both. With respect to ISIS, this means that it is imperative that we stop aiding and abetting their growth strategies. We must refrain from using incendiary language, the us-against-them rhetoric that indiscriminately bleeds over to include all followers of Islam or residents of the Middle East. Our military maneuvers and economic policies cannot ignite resentment in otherwise neutral parties, and we must continue to shine as a beacon of opportunity for, and champion of, innocent people trapped in oppressive regimes.


2.  MDROs and ISIS take hold and proliferate in areas previously weakened.

Staphylococcus aureus is a bacterium commonly found on the skin and in the nasal passages of healthy people. In small numbers and held in check by intact barriers like the skin and immune system, these bacteria don’t pose a major threat to health. However, when tissues are injured or the immune system is compromised, these previously controlled populations proliferate and generate a life-threatening staph infection. Similarly, terrorism thrives in failed states where recruitment, training, and planning operations occur outside the reach of effective law enforcement and other stabilizing conditions. Returning the whole ‘body’ to health is necessary to tackle the challenge of ISIS and MDROs, and this is why military engagement cannot be the sole strategy to attack ISIS. The use of diplomacy and economic instruments to provide opportunity, equality, health, resilience, and hope in the region in-and-around ISIS is imperative to stemming the spread of their infection. It’s probably the only long term solution, as well.


3.  When threatened, MDROs and ISIS both seek new defenses from unlikely partners.

Bacteria aren’t willing to go down without a fight. When faced with environmental threats, including antibiotics, bacteria actively seek out new adaptations to overcome the assault. Bacteria cleverly gain these new defenses by uniting with other bacteria and exchanging packets of genetic instructions called plasmids (this process of horizontal gene flow between two distinct bacteria is called conjugation). In bacteria, desperate times lead to desperate plasmid exchange, and it’s a way for embattled bacteria to share strategies in an effort to survive and thrive. Similar utilitarian partnerships have emerged between ideologically distinct terrorist groups. First an uneasy alliance for purely practical purposes arose between ISIS and Al Qaeda, and more recently ISIS has sought cooperation with Al-Nusra Front to resist military pressure from the Syrian government and its Russian allies. Then there are the rumors of ISIS’ attempts to secure bomb-making material from disenfranchised groups in eastern Europe. Understanding these seemingly unlikely sources of assistance and blocking the exchange of strategies and resources is as necessary in defeating ISIS as it is combating disease-causing bacteria.


4.  The problems posed by MDROs and ISIS can be made worse by the weapons we have to combat them.

Ever since Sir Alexander Fleming serendipitously discovered penicillin in the 1920s, antibiotics have been our chief weapon in the fight against bacterial infection. However, widespread misuse of antibiotics—namely their inappropriate prescription, widespread prophylactic use in livestock, patients’ premature cessation of treatment, and an uninformed arrogance that antibiotics would forever be a panacea to infectious disease—contributed to the emergence of drug resistant bacteria. The logic is simple: expose a population of bacteria to antibiotics and the first to die are those that are the most susceptible to the drug’s mechanism of action. With each subsequent exposure, only the most disguised, defended, and resistant organisms survive. Stop short of complete annihilation and you have inadvertently helped create a population of super bacteria, and, to make matters worse, you have eliminated their main microbial competition. After incomplete-treatment, the remaining bacteria are free to reproduce and give rise to super resistant colonies, far harder to defeat than their predecessors.

Attacking the Islamic State has proven eerily similar. Western experts gleefully advertised the fall of radical jihadists as American boots marched out of Iraq in 2011, but their victory speeches proved premature when surviving factions emerged, expanded into newly uncontested territory, and adopted strategies even more resistant to defeat. Moving forward, the military hegemon that is the United States and its allies has a diverse arsenal of weapons to combat ISIS. Everything from drone-enabled targeted killing and Special Ops-led assaults to resource embargoes and economic isolation exists as tools to combat ISIS. Relying on a single, unchanging approach, or giving in to hubris or politics to prematurely declare victory, and all that will remain will be the most fortified and strategically evasive terrorists. From these select ashes, they will again rebound and rise stronger than ever. We are at the unfortunate place in the progression of the disease where the only success is complete success; it’s time for us to take our medicine until the ISIS infection is gone for good.


5.  While no one is immune from MDROs or terrorism, prevention is better than any treatment.

While this advice falls into the too-little too-late category given that both ISIS and MDROs exist, the idea that ‘an ounce of prevention is worth a pound of cure’ still bears mention. After all, history has a funny way of repeating itself, and it’s true that the lessons learned in one arena (say, the fight against antibiotic resistant bacteria) can often provide insight into seemingly distant affairs (like the international fight against terrorism). In such a curiously analogous world, let’s learn from our mistakes and adopt a forward-looking, predictive mindset guided by science and an understanding of our past mistakes. Such prevention-minded approaches will always trump reactionary steps to problems in full bloom. Ultimately this reminds me of another thing I learned in Biology 101, “The Precautionary Principle,” but that’s a lesson for another time.

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[1] http://amr-review.org/home

[2] http://www.cgdev.org/article/it%E2%80%99s-time-revise-book-infectious-diseases