SWINE FAQs

 

Pig sick: Frequently asked questions

FAQ on antibiotics and why their overuse in pig farming is causing the spread of multi resistant bugs

By Juliet Gellatley, founder & director, Viva! and zoologist

Additions by Justin Kerswell, deputy director, Viva!

Antibiotics are now failing to work because they have been overused for people and farmed animals. This is a danger to us because antibiotic-resistant bacteria can quickly spread between people. This can result in new strains of infectious disease that are more difficult (potentially impossible) to cure and more expensive to treat.

Antibiotic resistance occurs when an antibiotic can no longer control or stop bacterial growth. This leads to bacteria becoming resistant and multiplying despite the presence of therapeutic levels of an antibiotic. When bacteria become resistant to most antibiotics they are referred to as ‘superbugs’.

Drug resistance is already here. Resistant infections are already on the rise with up to 50,000 lives lost each year to antibiotic-resistant infections in Europe and the United States alone. Worldwide that figure rises to 700,000 each year as people die of drug resistance (not just to antibiotics but to several types of drugs that have been over used) in illnesses such as bacterial infections, malaria, HIV/Aids or tuberculosis. If nothing is done, it is predicted that many millions will die each year – especially in poorer countries. The UK government warned in April 2016 that 10 million people a year could die from antibiotic resistance by 2050, saying: “Antimicrobial resistance to antibiotics will present a greater danger to humankind than cancer by the middle of the century unless world leaders agree international action to tackle the threat.”

Leading scientists are now warning that we are in danger of entering a ‘post antibiotic’ age, which may make many routine surgical operations dangerous and could cut life expectancy. The Chief Medical Officer for England, Professor Dame Sally Davies, stated in 2012: "Antibiotics are losing their effectiveness at a rate that is both alarming and irreversible - similar to global warming." And the Director of Health at the United Nations Development Programme, Mandeep Dhaliwal, warned of a return to the era before Alexander Fleming’s discovery of penicillin. “We are on the road back to the days of people dying from common infections and injuries.”

Sources of Quotes:

https://www.gov.uk/government/news/antibiotic-resistance-poses-alarming-...

https://www.theguardian.com/society/2016/apr/14/antimicrobial-resistance-greater-threat-cancer-2050-george-osborne

It may be possible but no new antibiotics have been discovered in the last four decades. Dr David Brown, director at Antibiotic Research UK, told the Guardian newspaper in 2015: “It is almost too late. The issue is people have tried to find new antibiotics but it is totally failing – there has been no new chemical class of drug to treat gram-negative infections for more than 40 years.”

https://www.theguardian.com/society/2015/dec/22/almost-too-late-fears-of-global-superbug-crisis-in-wake-of-antibiotic-misuse

Not quite, but it could soon be. Global livestock antibiotic use is forecast to increase by 67 per cent by 2030. Dr David Brown, director at Antibiotic Research UK, told the Guardian newspaper: “I think we have got a 50-50 chance of salvaging the most important antibiotics, but we need to stop agriculture* from ruining it again.”

*Dr Brown is referring to the overuse of antibiotics in farmed animals (in the UK and around the world) ruining the chance of antibiotics working effectively

https://www.theguardian.com/society/2015/dec/22/almost-too-late-fears-of...

Antibiotic resistance occurs when bacteria change in some way that stops the effectiveness of drugs designed to cure or prevent infections.

Every time we take an antibiotic we are putting pressure on bugs to find ways to resist the antibiotic. If you don’t finish a course of antibiotics, the ‘weakest’ bugs have been killed (and you start to feel better) but unfortunately, the most resistant bugs survive and they reproduce. This is why it is so important to always finish a course of antibiotics. If you don’t take all the antibiotics, the bacteria survive and continue to multiply causing more harm. Bacteria can do this through several mechanisms. Some bacteria develop the ability to neutralise the antibiotic before it can do harm, others can rapidly pump the antibiotic out, and still others can change the antibiotic attack site so it cannot affect the function of the bacteria.

Antibiotics kill or inhibit the growth of susceptible bacteria. Sometimes one of the bacteria survives because it has the ability to neutralise or escape the effect of the antibiotic; that one bacterium can then multiply and replace all the bacteria that were killed off. Exposure to antibiotics therefore provides selective pressure, which makes the surviving bacteria more likely to be resistant.

In addition, bacteria that were at one time susceptible to an antibiotic can acquire resistance through mutation of their genetic material or by acquiring pieces of DNA that code for the resistance properties from other bacteria. The DNA that codes for resistance can be grouped in a single easily transferable package. This means that bacteria can become resistant to many antimicrobial agents because of the transfer of one piece of DNA.

 

In summary: bacteria develop sneaky ways to resist antibiotic drugs. The more antibiotics are used in people (especially if they do not finish the course) and in farmed animals, the more likely the bacteria will become resistant so that they are no longer killed by the drug. Worse still, bacteria can pass on their resistance to other species of bacteria.

Although resistance in human infections is mainly caused by human antibiotic (mis)use, for a serious number of bacteria, farm animal use is the principal cause of resistance.

According to the Alliance to Save our Antibiotics, the overall weight of scientific research has led to a consensus that:

· for some bacterial infections, such as Campylobacter and Salmonella, farm antibiotic use is the principal cause of resistance in human infections.

· for other infections, like E. coli and enterococcal infections, farm antibiotic use contributes, or has contributed, significantly to the human resistance problem.

· the emergence of resistance to critically important antibiotics, in particular of ESBL resistance in E. coli and Salmonella, is a major development which has occurred in recent years and has been driven by inappropriate use of these antibiotics in both human and veterinary medicine.

· livestock-associated strains of MRSA infecting humans are also a developing problem, which results from the high use of certain antibiotics in farmed animals.

· some other emerging antibiotic resistant infections in humans may be, in part, due to farm antibiotic use, but while research is ongoing, there is currently insufficient evidence to draw clear conclusions.
 

A main concern is that agricultural antibiotic use is driving up levels of antibiotic resistance, leading to new superbugs. Most public health experts agree that resistant bacteria are created in farmed animals by antibiotic use and that some of these are being transmitted to people and one of the major concerns to emerge in connection with such over-use is new E.coli and MRSA superbugs on farms.

More: http://www.sustainweb.org/publications/antimicrobial_resistance/

Antibiotic-resistant bacteria that originated in farmed animals can pass to people in several  ways, mainly on foods such as meat, but also by direct contact and through the environment. Resistant bacteria can also pass from people to farmed animals. Here they can multiply and acquire additional resistance genes, then pass back to humans. In each case, the resistant farmed-animal bacteria can contribute to higher levels of resistance in human infections in two main ways:

• they can directly cause an infection in humans, and this infection will be antibiotic-resistant.

• they can colonise the human gut (and potentially other sites such as the nostrils) without causing an infection, and pass on copies of their resistance genes ‘horizontally’ to bacteria already living in the human gut. The human-adapted bacteria receiving the resistance genes may subsequently, possibly at a much later date, cause an infection, if they get into the wrong part of the body e.g. a urinary-tract infection. In this case, the pathogen will be of human origin, but its resistance will originate (either wholly or partly) from the farm use of antibiotics.

Source: http://www.sustainweb.org/publications/antimicrobial_resistance/

The European Food Safety Authority, 9 July 2008 stated:

 “Resistant [bacteria] involved in human disease are mostly spread through foods.

With regards to Salmonella, contaminated poultry meat, eggs, pork and beef are prominent in this regard.

For Campylobacter, contaminated poultry meat is prominent.

Cattle are a major reservoir for E. coli [verotoxigenic Escherichia coli] and resistant strains may colonise humans via contaminated meat of bovine origin more commonly than from other foods.

Animal-derived products remain a potential source of methicillin-resistant Staphylococcus aureus (MRSA). Food-associated MRSA, therefore, may be an emerging problem.”

Pig farming is one cause of MRSA, but the major cause is human overuse of antibiotics. However, strains of MRSA are emerging from farm animals – and frighteningly quickly.

 

MRSA (methicillin-resistant staphylococcus aureus), is a form of bacterial infection that is resistant to numerous antibiotics including methicillin, amoxicillin, penicillin and oxacillin, making it challenging to treat the infection successfully.

 

‘Methicillin’ refers to the semi-synthetic form of penicillin that was once effective against staphylococci bacteria. 

 

Staphylococcus aureus (S. aureus) is a type of bacteria that is commonly found in the nose and skin of humans. In the USA, one third of the population is colonised with staph (bacteria is present but not causing infection), and around two per cent of the population is colonised with MRSA.

 

The bacterium that can cause staph skin infections can divide every half-hour in optimum conditions. Theoretically, a single cell can form a colony of more than a million cells in 10 hours.

 

S. aureus can cause skin infections including:

MRSA is associated with hospitals, because there is more chance the bacteria can spread from person to person via towels, sheets, razors, door handles, sinks, floors and skin to skin – but, of course, it also has more chance to enter the body, and invade the bloodstream through broken or damaged skin or during medical procedures, causing infections and resulting conditions that range from mild to severely life-threatening. These conditions may include:

 

 

Around 94,360 invasive MRSA infections are diagnosed annually in the US, with 18,650 associated deaths.

Source: http://www.medicalnewstoday.com/articles/10634.php#what_is_MRSA

According to the Alliance to Save Our Antibiotics:

 

MRSA are strains of Staphylococcus aureus with resistance to beta-lactam antibiotics (a broad class of antibiotics that includes penicillin derivatives, cephalosporins, monobactams, and carbapenems), and often resistance to other antibiotics as well. Strains of MRSA have emerged in farmed animals in recent years, which can colonise and multiply on most species, including humans. The most common of these, MRSA ST398, was first detected in the Netherlands in 2005.

The spread of MRSA ST398 throughout Europe’s pig population in particular (it is also present in poultry and cattle), is recognised to have led to a growing number of these infections in humans. This strain now accounted for approximately 42% of human cases of MRSA in the Netherlands in 2008 and 2009, but following large reductions in farm antibiotic use, the proportion fell to 29% by 2014. Although farmers and those in direct contact with livestock are those most at risk, MRSA ST398 can also sometimes pass from human to human. Consumers of meat contaminated with MRSA are not thought to be at great risk, but further research is needed to clarify this.

Most MRSA infections in humans in the UK currently have nothing to do with agriculture, but the recent detection of a small number of cases of MRSA ST398 and other types of MRSA in British cattle is cause for concern. MRSA ST398 has also now been found in British poultry and British pigs.

Livestock-associated MRSA have already caused infections in humans in the UK, and experience from abroad suggests that, for MRSA ST398 in particular, there is a real danger that it will spread widely in livestock unless changes in farm antimicrobial use are introduced urgently.

Several further types of MRSA are now emerging in pigs in Europe, North and South America, and Asia, and some of these are epidemic human strains which are thought to have transferred initially from humans to animals. If these strains become widespread on farms, there is a real danger that livestock will become a very important reservoir of human MRSA infections.

It is worth noting how quickly the livestock-associated MRSA problem has emerged. Less than ten years ago, MRSA had never been detected in pigs, and the very small number of cases found in other farm animals were believed to have been incidental transfers from humans. More recently, MRSA has been found in abattoir studies in 61% of Spanish pigs, in 60% of German pigs and 39% of Dutch pigs. The emergence of this problem, like the emergence of the highly resistant ESBL E. coli, is believed by scientists to be particularly linked to the increased use in farming of modern cephalosporins, which are classified by the WHO as critically important antibiotics in humans.

Source: http://www.sustainweb.org/publications/antimicrobial_resistance/

A last line antibiotic, used when all else has failed is called colistin. It is an old drug, introduced in 1959. It has been used sparingly in people for most of the years since, because it can be seriously toxic to the kidneys and nervous system. And precisely because it hasn’t been used much, bacteria have not developed much resistance to it. Until now – due to prolific overuse of colistin in farmed animals.

In China (2015) E coli bacteria were discovered in a pig that were resistant to colistin. Scientists then tested samples from animals as they were slaughtered, retail meat from supermarkets and street markets, and samples previously taken from patients in two hospitals, collected between 2011 and 2014.

Here’s what they found. The gene they discovered, called MCR-1, which causes resistance to colistin, was present in:

  • 78 (15 per cent) of 523 samples of raw pork and chicken meat
  • 166 (21 per cent) of 804 pigs in slaughterhouses
  • and in 16 (1 per cent) of 1,322 samples from hospital patients with infections

Worryingly, the MCR-1 gene is on a plasmid, a small piece of DNA that is not part of a bacteria’s chromosome. Plasmids move freely around the bacterial world, hopping from one bacterium to another.

The MCR-1 gene is spreading fast. It has now been found across the world in human samples from Malaysia, England, China, Europe, Africa and the United States.

Resistance to colistin has happened because of gross overuse of the drug in thousands of millions of animals. It is cheap and used to promote growth and against disease in filthy, overcrowded factory farms.

According to National Geographic: “China is one of the world’s highest users of colistin in agriculture. Driven largely by China, the global demand for colistin in agriculture is expected to reach 11,942 tonnes per annum by the end of 2015 (with associated revenues of $229·5 million), rising to 16,500 tonnes by the year 2021, at an average annual growth rate of 4·75%. Of the top ten largest producers of colistin for veterinary use, one is Indian, one is Danish, and eight are Chinese. Asia (including China) makes up 73·1% of colistin production with 28·7% for export including to Europe.”

Public Health England said the risk posed to humans by the mcr-1 gene was "low" but was being monitored closely.

Government scientists re-examined 24,000 samples of bacteria from food and humans in the UK following the discovery of mcr-1 in China in November and found the gene in just 15 samples.

The mcr-1 was found in E. coli from two pig farms, in stored E. coli from a pig and in three E. coli samples from two human patients, which were also found to be resistant to other antibiotics.

It was also found in 10 human salmonella infections and in salmonella from a single imported sample of poultry meat. The earliest British positive sample was a salmonella from 2012.

The resistance to the colistin antibiotic is considered to be a major step towards completely untreatable infections, and it is legal to use colistin in farmed animals in the UK. Viva! filmed evidence of its use in a pig farm in 2016.

Europe.http://phenomena.nationalgeographic.com/2015/11/21/mcr-gene-colistin/

Antibiotics are given to both treat existing disease and to prevent it in case it happens. Like us, animals are more likely to become ill if they are stressed, overworked or kept in filthy, overcrowded conditions. It is difficult to think of places that fit those criteria more than pig and chicken factory farms across Britain. Viva! has filmed at dozens of pig (and chicken) farms over the past few years and we found suffering, filth and degradation at them all.

It is little wonder that these animals become ill.

Viva!’s report, Pig Farming: The Inside Story (www.viva.org.uk/pigreport) explains why an incredible range of diseases run rife in the UK – including Respiratory disease, Pleuropneumonia, Porcine reproductive and respiratory syndrome (‘Blue ear’), Porcine Respiratory Disease Complex (PRDC), Pneumonic pasteurellosis, Scours (severe diarrhoea), Salmonella, Escherichia coli, Lameness, Swine Dysentery, Meningitis, Glässer’s Disease, Post-Weaning Multisystemic Wasting Syndrome (PMWS) and Porcine Dermatitis and Nephropathy Syndrome (PDNS).

Further, piglets are weaned far too early, being taken away from their mothers at just three weeks old. This usually leads to digestive problems and diarrhoea (scours) – which are entirely avoidable. Antibiotics are routinely given in pig farms from the moment the piglets are weaned. On a British farm Viva! visited in 2016, investigators found piglets being treated for scours with Colistin– an antibiotic that is the last line of defence for human health. Amazingly, the use of Colistin on British pig farms is still legal despite scientists finding a gene in pigs, which makes bacteria resistant to it.

Factory farmed animals are treated with antibiotics to tackle the diseases that are caused by the terrible conditions in which they are imprisoned. In other words, their use and overuse is largely avoidable – by ending factory farming, by not buying the meat. However, antibiotic use is increasing in farmed animals. It is not being reduced or prohibited because factory farming would collapse without it.

Antibiotic growth promoters have been banned in the European Union since 2006. However, they are still used in other parts of the world, including China. Some antibiotics have the side effect of promoting growth in animals (and Viva! have filmed these on British farms in 2016). Since the ban in growth promoters the use of antibiotics on British farms have actually increased. It seems likely that some producers are sidestepping the ban on growth promoters (saying that the drugs are being used to prevent disease) and this is driving antibiotic resistance.

Perhaps the ultimate irony is the fact that without antibiotics factory farms could not exist, yet once antibiotic resistance is complete the animals on those farms will also not respond to drugs. It will mean the end of factory farming, but by then it would also herald the post-antibiotic age for the human race.

 

How many antibiotics are given to farmed animals in the UK?

About half of all antibiotics sold in the UK are used on farmed animals with 60 per cent of these being used on pigs.

The Veterinary Medicines Directorate shows that in 2010, an estimated 211 tonnes were sold for use in pigs, 138 tonnes for poultry, 11 tonnes for cattle, one tonne in fish and less than 0.5 tonnes were sold for use in sheep.

Far from being reduced, more antibiotics are being given to pigs as these figures show:

Use of antibiotic per animal for pigs, 2007 to 2010 (grams of active ingredient per animal per year)

2007 41.2

2008 38

2009 41.2

2010 47.3

Source: Soil Association. 2016. E. Coli superbugs on farms and food 

 Antibiotics are used in farmed animals for three reasons: to promote growth; to treat disease (therapeutic use), and to prevent disease (prophylactic use).

An EU-wide ban on the use of antibiotics as growth promoters in animal feed came into effect on January 1, 2006. On the surface this sounds a positive move; however, antibiotic use is increasing.

Intensive farms make ideal breeding grounds for bugs. However, factory farmed pigs are routinely fed antibiotics, even when they are healthy. The high stocking density, the stress of factory farming on animals and the low level of genetic diversity all increase the potential for the spread of diseases amongst animals. To stop the spread of diseases, factory farms usually use high levels of antibiotics, often to prevent disease rather than cure existing conditions.

However, it is widely known that pigs are fed antibiotics to make them grow more quickly. Though growth promoting antibiotics have been banned in the EU, more are simply used but under the label of disease prevention.

In China, growth promoting antibiotics are legal. China alone produces and consumes roughly half the planet’s pigs—about 500 million annually. The use of antibiotics in pigs is largely unregulated. The crucially important antibiotic, Colistin (the last line of defence in people) is being heavily used in China as a growth promoter.

Worldwide, the demand for colistin in agriculture was expected to reach almost 12,000 tonnes per year by the end of this year, rising to 16,500 tonnes by 2021.

The use of antibiotics to increase the growth of pigs is most studied of all livestock. This use for growth rather than disease prevention is referred to as sub-therapeutic antibiotic use. Studies have shown that administering low doses of antibiotics in livestock feed improves growth rate, reduces mortality and morbidity, and improves reproductive performance. Although it is still not completely understood why and how antibiotics increase the growth rate of pigs, possibilities include metabolic effects, disease control effects, and nutritional effects. 

The large amount of antibiotics used in factory farming is a significant cause of the resistance of many common bacteria to the antibiotics used to treat infections in humans. 

In 2015, a scientific journal, Antimicrobial Resistance & Infection Control, published an alarming paper stating:

“What is beyond doubt is that we have a major problem with antibiotic resistance and that this problem is much worse in the developing countries. While many governments – importantly including China and India - have taken steps to curtail overuse of antibiotics by people, antibiotics in animal feed are still poorly regulated.

Consequently, large volumes of antibiotics are used in food animals contributing to the problem of antimicrobial resistance. In addition, water is frequently contaminated with large numbers of resistant bacteria and their resistance genes - both by faecal contamination from people (poor sanitation) and animal manure. This contaminated water then recirculates to people and food animals given antibiotics, which then allows even more resistance to develop and spread. In India a large proportion of E.coli causing community onset urinary tract infections because of antibiotic resistance are for practical purposes untreatable. In many waterways in India (and elsewhere) multi-resistant bacteria are frequently present.

China produces and consumes roughly half the planet’s pigs—about 500 million annually. It is estimated that half of the antibiotics used in China are given to farmed animals.

 

More: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415312/

In July 2014, then Prime Minister David Cameron was sufficiently concerned about antibiotic resistance that he commissioned a review by economist Jim O’Neill to analyse the problem. Cameron said: “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine."

The review concluded that antibiotic use in farmed animals should be cut, but the suggested reduction did not go far enough. David Cameron also suggested a ban on farm use of antibiotics which are classified as critical for human health. This has yet to happen and may now not, as Cameron’s influence dwindles now he has stepped down. Many of his fellow politicians – including those running the Governments agricultural departments – remain sceptical and fearful of angering farmers.   

According to Antibiotic Research UK:

Many of the large pharmaceutical companies have closed down their antibiotic research divisions because they cannot see how they can make money from antibiotics (they answer to shareholders after all!). Drugs like those used to treat cancer are often given for life and so provide a sufficient income stream to pharmaceutical companies to warrant research investment. Antibiotics are given for just a short course of treatment and so sales are very limited. In addition, governments hold down the price of antibiotics, leaving little financial incentive for pharmaceutical companies to invest in research.

Whenever a new antibiotic is introduced, it is not long before bacteria become resistant to it. If a new antibiotic is reserved only for use in treating resistant infections, then most of the time it will sit on the pharmacy shelf not being used until a patient presents with an antibiotic resistant infection. Again this dis-incentivises any commercial company to develop new antibiotics.

http://www.antibioticresearch.org.uk/about-antibiotic-resistance/

Money. Any cut in their usage will cut their profits accordingly. In fact, the pharma industry actively campaigns to keep antibiotics being used in the farming industry – and promote even more being produced and dished out.

In the UK, the Responsible Use of Medicines in Agriculture Alliance (RUMA), an alliance representing the interests of the pharmaceutical and intensive-farming industries which is opposing attempts to ban the routine preventative use of antibiotics in farming, has dismissed the claim that the overuse of antibiotics in intensive farming adds to the serious public-health threat from antibiotic resistance as a ‘myth’, despite the wealth of evidence to the contrary.

The Alliance to Save Our Antibiotics state:

 

“Although government scientists have produced many high-quality studies over the past decades examining the farm resistance issue, government officials recognise that implementing significant restrictions on antibiotic use in farming could increase costs. A report published in 2012 by Defra and Department of Health scientific advisors and officials argued against taking too many measures at an EU level, saying this could put EU farmers at a commercial disadvantage leading to more imports.

They warned that costs might increase because, they claimed, fewer animals might survive, but also because ‘livestock have to be kept more extensively or in better buildings to minimise risks of becoming infected, such as avoiding pneumonia by building better designed, well-ventilated buildings’. The report concluded that ‘Unless consumers are prepared to pay a premium for food produced by means designed to lower the risk of transmitting antimicrobial resistance (while not compromising animal welfare) the potential for unintended consequences of certain measures that may be used to control antimicrobial resistance is high’.

As a result, despite accepting that improving the conditions in which animals are reared can result in significant improvements in antibiotic use, Defra officials largely continue to support the status quo.”

http://www.sustainweb.org/publications/antimicrobial_resistance/

Like doctors being encouraged to prescribe fewer antibiotics to people vets have also been encouraged to prescribe fewer antibiotics to farmed animals. Some surely are. However, those working within farmed animal practices rely on the custom of farmers and if they refuse to give out antibiotics those farmers could go elsewhere. Vets are aware that factory farming practices drive illness and disease and so increase antibiotic usage yet continue to prescribe drugs to treat avoidable disease and illness. It is also unclear how many vets have ties to pharmaceutical companies. 

 

How about just eating organic meat?

Whilst it is true that fewer antibiotics are used in organic farming, it is a myth that organic farming is automatically antibiotic free. Antibiotics will be given to animals in organic farming on the advice of vets. Meat from organic animals cannot be sold if the animal is receiving antibiotics or for a period afterwards, but organic farming still plays its part in driving antibiotic resistance. Whilst welfare on less intensive systems can be better (although not always) there are other issues to consider. Extensive farming takes up a lot more room and there simply isn’t enough space in Britain to farm all the animals we currently do in less intensive systems. Organic animals tend to be slaughtered at a later age than intensively farmed ones, so often more feed will need to be produced for organic herds. And, of course, all animals – whether organic or factory farmed – end up at the abattoir for something that we don’t even need and that harms our health.
 

The bad news is that being vegan will not stop you falling victim to antibiotic resistance if drugs stop working. However, going and being vegan means that you are healthier and less likely to get ill. For example, 95 per cent of food poisoning cases are caused by consuming animal products. Also, as the risk of antibiotic resistance increases each time an antibiotic is used, as a vegan it means that no animals will be raised for meat, fish, dairy or eggs in your name and so fewer antibiotics are used. The more of us who reject factory farming and choose a kinder future will help protect us all. You can forget governments, supermarkets, vets and farmers being key to the solution. Being vegan is the best chance we have to collectively prevent reaching the point of no return. In fact, it may be our only chance.