A return to the dark, pre-antibiotic era of public health is looming. Here’s how to fight back
Aggressive superbugs that have the power to kill are a reality. Inappropriate use of antibiotics has led to the evolution of illness-causing microbes, resulting in approximately 700 000 people dying each year from conditions that were once straightforward to manage – from seemingly benign cuts and abrasions to diarrhea and skin sores.
By 2050, if present trends continue, that figure is expected to rise to 10 million. The reduced effectiveness of antibiotics – an outcome of antimicrobial resistance – is real, and constitutes a mortal threat to health security. It must be arrested now.
Countries in the WHO South-East Asia Region are particularly vulnerable. Alongside gaps in health care services, dense populations and often poor sanitation contributes to a breeding ground for superbugs that kill with impunity.
In Jaipur, India, in 2011, countries in the Region recognized the imperative of prioritizing measures to prevent and contain the problem, and acknowledged that the most significant factor driving it is irrational use of antibiotics from over-the-counter availability and over prescription. They also recognized that while the problem could lead to an epidemic, it is already leading to loss of lives, long-term suffering, disability, and reduced productivity and earnings.
While concrete measures have been taken, more must be done. With a dearth of new antibiotics being developed, we must closely guard the efficacy of those that we already have. Now is the time to turn pledges into action.
There are simple and effective measures that governments can take. They should ensure legitimate antibiotics are only obtained via a doctor’s prescription, not over-the-counter, and should strengthen and enforce legislation to prevent the manufacture, sale and distribution of substandard antibiotics. This will disrupt our tendency to reach for, say, amoxicillin at the first sign of a cough or skin sore, and will ensure that the antibiotics consumed are of the highest quality.
Governments should also promote changes in the prescription habits of doctors by emphasizing the diminishing returns of antibiotics. This will help medical professionals feel confident in the treatments they recommend and will enhance their ability to resist pressure – whether from industry or patients –to prescribe powerful antibiotics as an easy fix.
And governments must take urgent action to regulate the use of antibiotics for purposes that have no relation to health. In the South-East Asia Region, this means ensuring that the livestock and fisheries industries desist from using life-saving antibiotics for ‘growth promotion’ in animals.
Unless these and other steps are taken, we face a return to the dark, pre-antibiotic era of public health. Advances in the quality of health care across the Region are already being reversed, with resistance to first-line antibiotics making treatment of once-basic illnesses more difficult, costly and time-consuming.
In resource-poor settings, this matters. Not only is a farmer in Nepal, a fisherman in Sri Lanka, or a factory worker in Indonesia biologically imperiled by antimicrobial resistance, as we all are, but they must also deal with the potentially ruinous burden of having to pay more for care while taking a greater amount of time off of work in order to get well.
The wider economic implications of this are troubling. If present trends continue, it has been estimated that by 2050 antimicrobial resistance will result in a 2% to 3.5% reduction in Gross Domestic Product, representing a significant opportunity cost for the Region’s developing economies.
The good news? Commitment to tackle the problem is crystallizing. Governments, pharmaceutical companies and multilateral organizations have recognized that concerted action is needed, and that adhering to WHO’s Global Action Plan on Antimicrobial Resistance is the surest way to fight back.
At a meeting of SEA Region Member Countries in New Delhi this week, governments are working on a roadmap to achieve the Global Action Plan’s targets, including drafting and implementing national action plans with clear outcome-based protocols for measuring, documenting and reporting progress. What can’t be measured, after all, can’t be achieved. WHO will work closely with Member States to monitor their progress and help them reach these goals, thereby making the Region a leader in the global fight-back.
As with all public health interventions, the push to reverse antimicrobial resistance and the menace it represents to health security requires intelligent policymaking backed by keen and effective enforcement. It also demands more than a little old-fashioned grit and a society-wide resolve to see these efforts through. If words aren’t transformed into meaningful, multi-sector action, antimicrobial resistance’s future consequences will be many times more catastrophic than they already are.