This year, European Antibiotic Awareness Day (EAAD) promotes the theme “From Resistance to Resilience: healthcare workers leading the change,” highlighting the significant challenges faced by nurses, carers, and hospital staff in addressing severe infections caused by antimicrobial-resistant organisms. While the theme is noble in intent, the idea that healthcare workers alone can “lead the change” is somewhat idealistic. In practice, systemic pressures, resource constraints, and existing hospital practices limit what even the most committed staff can achieve.
Turning to our microcosm, Cyprus, a country viewed by the “big guys” through a microscope as a naughty, resistant little bug, the campaign takes an even more absurd twist. Its message “Maintaining the effectiveness of antibiotics is everyone’s responsibility” shifts the blame (again) on… us. Patients are told to “be responsible,” “stop misusing antibiotics,” and “change behaviour,” as if the island’s sky-high antibiotic use stems from public mischief rather than deep-rooted systemic failures in healthcare delivery.
The problem with this framing is that patients do not prescribe antibiotics. Many of us never demanded them. We were given them routinely, easily, and unquestioningly. Pharmacies dispensed them for years with minimal oversight. Pharmaceutical companies profited. Doctors, operating in a system with no holistic support and heavy patient loads, leaned on antibiotics as the fastest, most convenient solution.
Anyone familiar with long-term care in Cyprus knows the pattern all too well. Leave an elderly patient in a hospital or care home for more than a few days and they will likely develop a hospital-acquired infection, usually from the resistant bacteria circulating in these facilities. For vulnerable patients these infections often become the complication that ultimately ends their life.
Those who have watched an elderly relative decline rapidly due to a urinary tract infection understand how devastating it can be, with delirium, confusion, and sudden weakness. Add pneumonia and the situation becomes life-threatening. Faced with this, what do doctors prescribe in a system without proper geriatric care, integrated infection control, or preventative support in homes and hospitals? Antibiotics. Often the strongest ones. Not because patients demanded them, but because the system has left clinicians with few practical alternatives.
We see the same pattern across sectors. Campaigns urge people to “drive less” when reliable transport is absent. They encourage youth to join the healthcare workforce while offering salaries that hardly dignify the profession. Patients are scolded for “abusing the health system” at the very moment they are finally allowed an MRI without endless battles.
Enough with the public responsibility narrative. Awareness matters, yes, but the idea that antibiotics are not painkillers and should never be taken without a prescription is old news. What remains stubbornly unchanged is something far more dangerous: the near total absence of systemic accountability, the most resistant “superbug” of all. No campaign can cure that.