THE European Union and global health bodies have called for help for poorer countries as growing resistance to antibiotics threatens to become a “global health tragedy” and is jeopardising Sustainable Development Goals (SDG) in some parts of the world.
Anti-microbial resistance (AMR) has risen by as much as two thirds in the last two decades, according to some studies, and is now responsible for an estimated 700,000 deaths annually worldwide. This is projected to rise to 10 million deaths per year by 2050 and cost up to US$100 trillion (RM416.65 trillion) unless governments ramp up efforts to tackle it.
The growing problem with AMR is largely to inappropriate use of antibiotics for both humans and animals.
As antibiotics have been used more widely and more frequently, bacteria have built up resistance to them, rendering them ineffective in some cases. Doctors say this would make routine operations more dangerous and certain medical treatments, such as for some cancers, would disappear completely.
When antibiotic resistance emerges in one place, it also quickly spreads to other locations, meaning it must be tackled on a global scale.
While all World Health Organisation (WHO) member states signed up to a multi-sectoral Global Action Plan on AMR in 2015, progress on its implementation has been mixed.
Some countries, notably in Europe, have made good progress, in other parts of the world things have moved much more slowly, raising fears that in poorer countries the problem is worsening and SDGs may not be met.
EU Commissioner for Health and Food Safety Dr Vytenis Andriukalitis said: “We need a global framework for tackling AMR in all regions, not just Europe.”
The size of the challenge presented by AMR in developing countries has been underlined in a slew of data and studies released during the World Antibiotic Awareness week last month.
A study by the Organisation for Economic Cooperation and Development (OECD) showed that while AMR rates averaged 17 per cent in OECD countries in 2015, rates in India, China and Russia averaged 42 per cent and were as high as 90 per cent for some antibiotic-bacteria combinations.
Meanwhile, AMR is forecast to grow up to four to seven times faster in some low and middle-income countries than in OECD states. In countries where healthcare systems are financially constrained, AMR is likely to cause “an enormous” death toll, mainly among newborns, infants and the elderly.
Another study earlier this year by researchers at ETH Zurich, the University of Antwerp and Princeton University showed that while global use of antibiotics in humans was estimated to have risen 65 per cent between 2000 and 2015, use in low- and middle-income countries increased 114 per cent.
Developing new antibiotics is complex — it has been decades since new classes of antibiotics were invented — and much of the focus in fighting AMR is being put on prevention.
The Global Action Plan is based on a multi-sectoral approach to AMR and charges governments with adopting national action plans involving improved awareness, understanding, surveillance, stewardship and prevention and control measures.
In many developing countries, lack of funds in both healthcare and animal industries, as well as weak legislation and enforcement are major barriers to the measures being implemented.
In India, for example, where it is thought that as many as 120,000 babies alone die every year from sepsis caused by antimicrobial-resistant infections, doctors say two of the key factors behind rising AMR are pharmacies selling antibiotics without a prescription and poor infection control in overcrowded healthcare facilities.
There are also concerns over the use of antibiotics in livestock.
According to the European Commission, in Europe, 70 per cent of anti-microbials are consumed in food-producing animals. The figure is similar in the United States, and is over 50 per cent in China.
Monitoring antibiotic use in the animal industry in poorer countries is often more difficult.
While legislation on animal antibiotic use exists and is closely checked in developed states, particularly in the EU, in poorer countries it is sometimes absent or adherence is impossible because of a lack of resources.
WHO has said that many middle- and low-income countries may need long-term development assistance to implement their AMR plans effectively and sustainably. But many experts on healthcare in developing countries say a one-size fits all approach would not work.
“Measures need to be different for different countries, especially when we are talking about poorer states. You cannot compare somewhere like India and Liberia,” said Andriukalitis.
“In some countries, they have problems with access to simple antibiotics, but in others, there are problems because people are self-treating with no proper controls. In some places, there is a lack of any basic understanding of hygiene and sanitation. We need long-term local strategies for (different) countries,” he added.
Meanwhile, AMR is jeopardising SDGs in some places. If left unchecked, it could contribute to health, poverty and sustainable economic growth SDG targets being missed.
Longer hospital stays because of slower patient recovery and greater risk of treatment complications would put a massive strain on already struggling healthcare systems and worsen mortality rates and quality of life. AMR also makes illnesses more expensive to treat and, as universal health coverage is limited in many poor countries and people have to pay out of their own pockets for treatment, these increased costs. Potential loss of income from morbidity and mortality could drive individuals and families with limited resources into even greater poverty. — IPS