A crisis of epidemic proportions

At the peak of the discovery and use of antibiotics, a US Surgeon-General said: “The time has come to close the chapter of infectious diseases”. Sadly, this was not to be.

Disease-causing microorganisms have effectively countered antibiotics by developing resistance to their action, called antimicrobial resistance (AMR).

Several germs have accumulated resistance against almost all available antibiotics, making them “superbugs”.

The world is at the brink of a disaster. Unless concerted global actions are initiated immediately, it is heading for the pre-antibiotic era with unstoppable progress of infectious diseases.

This is considered as the greatest threat to mankind’s battle against communicable diseases. It is destined to impact not only the future of infectious diseases but shall also substantially negate the progress made in the past in treating and controlling infectious diseases.

Antimicrobial resistance also has enormous social and personal costs. When infections become resistant to first-line antibiotics, treatment has to shift to second- and third-line drugs which are nearly always much more expensive and sometimes more toxic as well. In some countries, the cost is prohibitive, with the result that some of these cases can no longer be treated.

One can argue that if germs develop resistance to antibiotics, modern science and technology should be able to develop and produce newer and more efficacious drugs. Sadly, this is not happening. Discovery, development and distribution of new antibiotics is a long drawn out and expensive process.

A huge amount of money and years of research are needed to develop a new antibiotic, which is then rendered ineffective in short time due to rampant use.

A very low return on investment discourages the pharmaceutical industry from undertaking research and development. Thus, we are now at a stage where the discovery of new antibiotics has slowed to a crawl. During the past 15 years, only two new classes of antibiotics have been discovered.

The appearance of resistance in germs is a natural evolutionary phenomenon which can neither be predicted nor contained. However, this resistance spreads because of the irrational use of antibiotics by humans. In that sense, we are responsible for the spread of resistance.

A shortened, incomplete or inappropriate dose of an antibiotic kills those bugs that are most susceptible to the drug but leaves alive those that have some resistance to it. These stay alive to reproduce and pass on their genetic resistance.

Antibiotics are being indiscriminately and widely used, both in the health sector as well as in the veterinary sector. In the latter, these medicines are used not only to treat diseases but also to enhance the body mass of animals to increase their food yield.

Misuse of antimicrobial agents is rampant in both developed and developing countries. These are extensively used in conditions in which these are not indicated.

Ailments like common cold and watery diarrhoea do not warrant any antibiotics, yet these are widely prescribed. This practice does not help the patient but promotes the spread of resistance.

The World Health Organization (WHO) considers combating AMR a priority. The Jaipur Declaration on Antimicrobial Resistance, 2011, articulates several actions that countries have initiated.

A regional strategy on prevention and containment of antimicrobial resistance was developed to support Member States in scaling up efforts in this direction. A plan will be submitted to the World Health Assembly in 2015.

Much needs to be done, not only by governments but also by the private sector, which manages a big proportion of health care, as well as the veterinary sector.

We must recognise that antibiotics are a precious resource for mankind. We all need to work together to preserve and prolong their efficacy through their rational use and by reducing the burden of infectious diseases through all possible means.

We cannot, at any cost, allow our world to slide into the dark days of the pre-antibiotic era.

The writer is Regional Director (South East Asia), WHO

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