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Global Trends by Martin Khor

Monday 25 May 2015

Antibiotic resistance: a global plan at last

This week the World Health Assembly will adopt a global plan to address antibiotic resistance and other forms of antimicrobial resistance, which poses a threat to human health and survival.  But will the plan be implemented?

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Action may be coming at last to deal with one of the most important threats facing humanity – the fast-increasing resistance of bacteria to antibiotics and other medicines.

For years and decades this problem has been growing, without serious efforts being taken across the world to stop it in its tracks.

Patients are the ones that suffer the most.   Old medicines no longer work against many diseases and newer and more potent medicines (often with stronger side effects) are also getting useless.

Pathogens are getting increasingly resistant to drugs, affecting treatment for tuberculosis, malaria, influenza, HIV-AIDS, gonorrhoea, and common infections such as pneumonia and urinary tract infections.

Patients going to hospitals are now increasingly acquiring infections unrelated to their original ailment, caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), which have caused thousands of deaths.

Despite the publicity about resistance, there has been little action in most countries, until the problem has blown up to crisis proportions at national and global level.  The World Health Organisation director-general Margaret Chan has called ours a post-antibiotic era – meaning that we are now living in a world where antibiotics may not work anymore.

The consequences are horrifying to contemplate.  In Thailand, antimicrobial resistance was found to kill 30,000 people a year and its economic impact amounted to 0.6% of the country’s GNP, according to the Thai Minister of Public Health, speaking at a panel discussion at the World Health Assembly last week.

A similar study should be done in Malaysia.  I wonder what it will reveal.

There is no time to lose for comprehensive action to be taken before the resistance crisis worsens.

Fortunately, a global action plan on antimicrobial resistance (AMR) will be adopted this week by Health Ministers gathered at the World Health Assembly in Geneva.

The plan has five objectives – to use medicines properly in human and animal health; reduce infection by sanitation, hygiene and infection prevention measures; strengthen surveillance and research; educate the public as well as doctors, veterinarians and farmers on proper use of antibiotics; and increase investment in developing new medicines, diagnostic tools and vaccines. 

The plan calls for actions by governments, the WHO Secretariat, international organisations, civil society groups and professional bodies.

Most importantly, all governments are expected to have in place a national action plan on antimicrobial resistance within two years.

These national plans are to be aligned with the global action plan and with international agencies’ standards and guidelines.

The national actions should include:

  • Developing a national surveillance system for antimicrobial resistance to collect data on resistance by bacteria to various medicines, and as well as surveillance in the animal health and agriculture sectors.
  • Effective regulation and governance for the licensing, distribution, prescription, dispensing and use of medicines in human and animal health.
  • Improve laboratory capacity to identify pathogens and their antimicrobial susceptibility in order to guide optimal use by doctors of antibiotics.
  • Elimination of economic incentives in all sectors that encourage inappropriate use of antibiotics and introduction of incentives to optimise use.
  • Introduce policies for proper use of antibiotics in animals, fishery and agriculture sectors, including phasing out the use of antibiotics for animal growth promotion.
  • Actions to reduce infection through sanitation, hygiene and infection prevention measures.
  • Increase national awareness of antimicrobial resistance through public education programmes, medical and school curricula, and establish coalitions including of civil society groups, scientific and industry bodies.
  • Participate in research for developing new medicines, diagnostic tools and vaccines.

At the World Health Assembly session discussing the global plan, some developing countries’ health officials highlighted the special needs of developing countries in implementing the global and national action plans.   

These include obtaining the necessary funding and technical equipment to implement a national action plan, as well as assurance that people in their countries will have access to the new medicines, vaccines and diagnostic tools that will be developed in future, and at affordable prices.

It would be terrible if the present antibiotics don’t work anymore and when new ones are developed, the patients in developing countries cannot have access to these, because they are patented and thus have high prices.

The global plan also calls on WHO to support countries to develop and implement their national plans, and to lead and coordinate support to countries to implement their investment needs and to publish progress reports. 

The adoption of the global action plan will be a landmark and gives hope that international and national actions will now take off in a serious way to tackle antimicrobial resistance.

Now that the plans are drawn up and approved, the difficult part has to be done:  implementation. Our lives depend on it.

To remind us of the seriousness of the problem, the WHO issued a Fact Sheet on

antimicrobial resistance.  Its key points include: 

  • Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.
  • Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g. antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
  • Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
  • In 2012, WHO reported a gradual increase in resistance to HIV drugs, albeit not reaching critical levels. Since then, further increases in resistance to first-line treatment drugs were reported, which might require using more expensive drugs in the near future.
  • In 2013, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 100 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB.
  • In parts of the Greater Mekong subregion, resistance to the best available treatment for falciparum malaria, artemisinin-based combination therapies (ACTs), has been detected.
  • Spread or emergence of multidrug resistance, including resistance to ACTs, in other regions could jeopardize important recent gains in control of the disease.
  • There are high proportions of antibiotic resistance in bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections) in all regions of the world. A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as MRSA or multidrug-resistant Gram-negative bacteria.
  • Treatment failures due to resistance to treatments of last resort for gonorrhoea (third-generation cephalosporins) have been reported from 10 countries. Gonorrhoea may soon become untreatable as no vaccines or new drugs are in development.
  • Patients with infections caused by drug-resistant bacteria are generally at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.

 


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