Stop antibiotic resistance now

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 nearly 700,000 people dying each year from conditions that were once straightforward to manage — from seemingly benign cuts and abrasions to diarrhoea 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, 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 healthcare services, dense populations and often poor sanitation contributes to a breeding ground for superbugs.

In Jaipur, India, in 2011, countries in the region recognised the need to prevent and contain the problem, and acknowledged that the most significant driving factor is irrational use of antibiotics from over-the-counter availability and over prescription. They also recognised 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 some 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.

There are simple and effective measures governments must take. They must ensure legitimate antibiotics are only obtained via a doctor’s prescription and must 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 must also promote changes in the prescription habits of doctors by emphasising 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.

Advances in the quality of healthcare across the region are already being reversed.

Resistance to first-line antibiotics means treating once-basic illnesses is 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 imperilled 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 per cent to 3.5 per cent reduction in GDP, representing a significant opportunity cost for the region’s developing economies.

The good news is that commitment to tackle the problem is crystallising. Governments, pharmaceutical companies and multilateral organisations have recognised that concerted action is needed, and that adhering to WHO’s Global Action Plan on Antimicrobial Resistance is the surest way to fight back.

Governments are now 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.

As with all public health interventions, the push to reverse antimicrobial resistance and the menace it represents to health security requires intelligent policy-making 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.

The writer is regional director of WHO South-East Asia