Tackling Antimicrobial Resistance Through Comic Books

Dr. Hsu Li Yang and Sonny Liew, creators of The Antibiotic Tales, share how they made a comic book addressing the growing threat of antimicrobial resistance.

AsianScientist (Jan. 21, 2020) – The discovery of antibiotics is the stuff of scientific legend. One fateful day in 1928, Alexander Fleming returned to his laboratory after a holiday only to discover something odd: a forgotten petri dish dotted with Staphylococcus colonies—save for one area contaminated by mold. The immediate surroundings of the mold were clear, as if the mold had secreted a substance that had prevented bacterial growth.

As we now know, that substance was penicillin, the world’s first antibiotic. Its discovery heralded a new age in medicine, enabling the treatment of once-fatal bacterial infections. But the overuse of antibiotics has given rise to antimicrobial resistance (AMR)—the ability of microbes to evolve defenses against drugs designed to kill them. As these microorganisms increasingly acquire resistance to more antibiotics, they effectively turn into ‘superbugs’ that are harder to treat.

Dr. Hsu Li Yang, head of the Infectious Diseases Programme at the National University of Singapore (NUS)’s Saw Swee Hock School of Public Health, has dedicated his career to addressing the emerging threat of AMR to public health. On top of conducting research and treating patients, he also leads dialogue and action on AMR in his role as the co-director of the Leadership Institute for Global Health Transformation, a platform that aims to drive dialogue and collaboration on health issues affecting Singapore and the rest of Asia. In his latest venture, Hsu is turning to comics to popularize the increasingly urgent issue of AMR.

Joining forces with award-winning graphic novelist Sonny Liew, the duo created The Antibiotic Tales, a comic that aims to dispel misconceptions and explain the consequences of the careless use of antibiotics in an accessible, yet fascinating manner. In this interview with Asian Scientist Magazine, Hsu and Liew detail their writing process and share their thoughts on communicating public health issues through comic books.

Authors Sonny Liew (left) and Dr. Hsu Li Yang (right) signing copies of The Antibiotic Tales at its launch in Jurong Regional Library in November 2019. (Credit: Dr. Clarence Tam/NUS Saw Swee Hock School of Public Health)

1. Antimicrobial resistance (AMR): how bad is it and why should we be worried?

Hsu: AMR is probably the greatest infectious disease public health threat today, although unfortunately, it does not grab headlines and attention the way emerging infectious diseases (such as Ebola or the new Wuhan coronavirus)—which cause far fewer deaths collectively—do. The closest corollary would be climate change: slow, insidious especially at the start, driven by human activity that actually has brought about great good (i.e. food production and treatment of diseases), and very difficult, if at all possible, to reverse. We should definitely be worried!

2. What inspired you to present AMR in a comic book format, as opposed to other types of media?

Hsu: For health professionals and public health professionals, the topic of antibiotics and AMR has become something of an echo chamber. Just like with climate change, the truly innovative ideas and interventions are more likely to come when a greater and more diverse population know about the issues and apply their minds to them. I had wanted to engage children, and through them, their parents. A comic book seemed an ideal way to reach out to them. It would be great if even just a few read the comic and went on to try to learn more about the issues around AMR.

3. Can you walk us through your writing process for The Antibiotic Tales? Specifically, how did you distill a complex scientific issue like AMR into an easy-to-follow comic narrative?

Liew: The research part of the project was made a lot easier in this case since Li Yang could help explain the major issues as well as provide clarifications on any questions I had about AMR. Once I had processed the information, I tried to come up with different narrative scenarios; from one involving time travel to a story told from the perspective of bacteria.

We eventually settled on comic-within-comic approach, with one narrative that showed a family visiting the doctors and another showing a worst-case post-apocalyptic world.

I guess the challenge was to try to make the story engaging enough while being clear about the issues, and what we can try to do in our everyday lives to help alleviate some of the pressures that drive AMR—I hope we’ve succeeded to some degree!

Authors Dr. Hsu Li Yang (left) and Sonny Liew (right) at the launch of The Antibiotic Tales (Credit: Dr. Clarence Tam/NUS Saw Swee Hock School of Public Health)

4. What do you consider the benefits and limitations of using comic books as a medium for public health education?

Hsu: The main benefit of comic books as a medium is that there is a great and diverse crowd that enjoys reading them. Any public health (or other) message can therefore potentially reach some of these people who would otherwise not be reached by the more traditional public health education approaches (like newspapers, journal articles, courses, etc). It is, however, just one of many avenues for public health education, and I think it is important that a number of such avenues be used, with new ones explored for their possibilities as these appear.

The main challenge of comic books in my view is that there must be an interesting story in addition to good graphics. It cannot be just an “information dump” because no one would then buy and read it—people do not naturally buy comics to be educated but to be entertained. The public health (or other) messages must then be incorporated into the story in a way that does not feel like an overload or that detracts from the story.

Dr. Hsu Li Yang answering questions from the audience at the launch of The Antibiotic Tales (Credit: Dr. Clarence Tam/NUS Saw Swee Hock School of Public Health)

5. In addition to comic books, you frequently write op-eds and take media interviews. How can we encourage more medical professionals to make their voices heard in the public square?

Hsu: I think this will happen when medical professionals and scientists are passionate about the topics they work on. There are many more options today with social media—many scientists and clinicians use Twitter and Instagram to highlight their work, for example.

6. If you are given the chance to write more comic books, what other public health issues would you like to highlight?

Hsu: As a matter of fact, I am working with Sonny to develop more comics that dwell on public health issues. The next one, which hopefully will be ready by the end of the year, will be on vaccines and immunization.


Copyright: Asian Scientist Magazine.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

A molecular biologist by training, Kami Navarro left the sterile walls of the laboratory to pursue a Master of Science Communication from the Australian National University. Kami is the former science editor at Asian Scientist Magazine.

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