Household toilets, one of the most important medical advances of the past two centuries, may be taken for granted in many parts of the world. But in places where they are lacking, people continue to die needlessly from diarrheal infections. The recent emergence of antibiotic resistance has made a terrible problem far worse. Now more than ever, sanitation must be a public-health priority.
Some 4.5 billion people--61 percent of the global population--live without proper toilets, including 892 million who relieve themselves in fields, rivers and other open spaces. The rest share facilities with other households or use latrines that aren't connected to septic tanks or sewers.
In India, where more people have access to a mobile phone than to a proper toilet, 15 percent of clinical E. coli specimens are resistant to all penicillin- and cephalosporin-based drugs as well as to carbapenems, a last-resort class of antibiotics.
In India, Prime Minister Narendra Modi's ambitious Clean India Mission includes an effort to build 110 million toilets in five years, and to conduct a massive public relations campaign against open defecation.
Success for India, Tanzania and other countries would reduce the spread of dangerous microbes, including the most dangerous, drug-resistant ones. While all efforts against antibiotic resistance are essential, including limits on overuse of the drugs and work to create new ones, improvements in sanitation can make great progress--at relatively little cost.
Editorial on 08/19/2018