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Global Trends by Martin Khor

Monday 26 March 2018

The biggest threat to human life

Antibiotic resistance may be an even greater threat to human life and health than climate change, if we don’t recognise it or don’t act immediately to address the crisis.

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There is a threat to the future of humanity, so silent that few people notice it, so pervasive that many families have suffered from it, and so dangerous it may soon be the most important cause of premature deaths worldwide.

If climate change has now become more obvious and visible as the number one risk to our civilisation, antibiotic resistance will soon rival it as the gravest threat to human life and health. 

Many friends have told me of how their relative contracted an infection during a hospital stay, and could not get cured from a normal dose of antibiotics.  Some of them died.  For example, the mother of a close friend of mine died from MRSA (methicillin-resistant staphylococcus aureus) after a visit to the hospital for treatment of an unrelated minor ailment.

MRSA is an antibiotic-resistant pathogen that causes a variety of serious infections.  It is well known for being spread in hospitals, but also in the community.

Resistance of bacteria to many antibiotics is growing.  The genes of some bacteria which survive an antibiotic attack change and adapt to better defend themselves, and tougher new generations of these bacteria become increasingly immune to the same or to other and stronger antibiotics.

In the never-ending race between stronger bacteria and stronger medicines, unfortunately the bacteria are winning.  The war zone is in our bodies.  The bacteria that survive, widely called “superbugs”, are growing and becoming more immune to antibiotics treating the same disease. 

Their resistance genes can also spread to other bacteria that cause other diseases, thus jumping species barriers, resulting in resistance moving quickly to threaten our ability to treat many diseases. 

In fact there are specific genes (such as NDM-1  and MCR-1) that specialise in resisting antibiotics and in jumping species barriers to enter other pathogens. These “jumping genes” are now spreading resistance quickly, so that antibiotic resistance is now moving ahead at rapid speed, affecting treatment of a wide range of diseases, and leaving humanity to face a most uncertain future.

In 2013, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB).  There are high proportions of antibiotic resistance in bacteria that cause common infections (for example, urinary tract infections, pneumonia, bloodstream infections) in all regions of the world. Gonorrhoea is now almost untreatable in many countries. 

The problem is not confined to antibiotics and resistant bacteria. Besides bacteria, there are other pathogens (such as viruses that cause AIDS and hepatitis, and parasites that cause malaria) that are treated by other anti-microbials. 

These other microbes are also getting resistant to medicines.  For example, malaria is now getting more resistant to artemisinin-based therapy in some Southeast Asian countries, and AIDS patients are increasingly not responding to first-line anti-AIDS medicines. 

So the problem of antibiotic resistance has now broadened to anti-microbial resistance (AMR).  And the crisis now covers more people and more diseases.

Presently an estimated 700,000 people worldwide die annually from antimicrobial resistance. 

The number is projected to grow to 10 million a year by 2050, according to a 2015 review on AMR of the United Kingdom government.

The report also estimates that 300 million people will die prematurely because of drug resistance in the next 35 years (2016-2050) and between now and 2050 the world can lose US$60 to 100 trillion of economic output if AMR is not tackled. Most of the deaths and economic losses will be in developing countries. 

Health leaders are finally sounding the alarm bell. The Chief Medical Officer of the United Kingdom Dame Sally Davies has warned of a “catastrophe”.  The then head of the World Health Organisation Dr Margaret Chan spoke of the end of modern medicine in a post-antibiotics era in which common infections such as strep throat or a child’s scratched knee could once again kill. 

These warnings have come very late, but it is “better late than never”.   In the 1980s, the Consumers’ Association of Penang (CAP), where I used to work, published studies on unethical marketing by drug companies of almost 20 medicines, which led to their inappropriate use, contributing to resistance.  The health authorities took action to ban or restrict the sales of most of them. 

CAP also published a book in the mid-1990s on Revenge of the Killer Germs, warning of the looming AMR crisis and asking for urgent action.  CAP was “ahead of the curve” and its warnings have been vindicated.

A recent international action is the 2015 Global Action Plan on AMR adopted by the World Health Assembly, which has spurred most countries to formulate their own national plans.  Malaysia launched its AMR plan earlier this month.

Another action is the United Nations summit-level event on AMR in 2016, where heads of governments pledged to take action to address the crisis.  This led to an inter-agency coordinating group that will come up with recommended actions in 2019.

At national level, a lot more can be done, including surveillance and data collection, infection control, better diagnosis aided by diagnostic tools,  introduction of many new regulations and guidelines on drug marketing, proper prescription and dispensing, and a policy of ensuring that new antibiotics are freely or cheaply available to the public.

The recognition of AMR as a crisis is only at the beginning stage.  Much needs to be done.  Every day of delay will allow the bugs to become super-bugs and then super-super bugs with dire consequences for all of us and those that come after.

 


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