Global Trends by Martin Khor

Monday 16 June 2014

Action to use medicines wisely?

A resolution by Health Ministers to formulate a global plan to deal with antibiotics resistance and a new coalition of NGOs to campaign on this issue gives hope that action may finally be coming.


Momentum is building to get doctors to prescribe and patients to use medicines properly in order to slow down the increasing ineffectiveness of antibiotics to treat dangerous infections.

The World Health Organisation (WHO) was recently given the go-ahead to draw up a global plan of action to combat antibiotic resistance, which experts and health leaders have warned will cause “the end of modern medicine” if nothing is done.    

Health Ministers asked the WHO to present them with the plan within a year, with a draft to be ready by January 2015.

In a resolution adopted at the World Health Assembly (WHA) in May, they also agreed to accelerate their own efforts to use antibiotics responsibly and develop national plans to contain the resistance of bacteria to antibiotics and other antimicrobials.

Resistance is making many antibiotics ineffective for increasing numbers of patients around the world who suffer from stomach, skin and respiratory infections and from serious diseases including TB, malaria, pneumonia and gonorrhoea.

Patients in hospitals are also commonly infected with dangerous “superbugs” like MRSA which are difficult to treat, including when they undergo surgical operations.

Although this problem has been known for decades, little action has been taken at global  level or in most countries to prevent the over-use and wrong use of antibiotics, and the build up of resistance in the bacteria has now reached crisis proportions.

Health leaders such as WHO director-general Margaret Chan and the United Kingdom’s Chief Medical Officer Dame Sally Davies have sounded the alarm bells about the crisis leading to a pre-antibiotic age where millions will die from presently treatable diseases or from non-dangerous operations because of the resistant bacteria.

At the WHA session, Malaysia was one of the countries speaking in favour of the resolution.

The Malaysian health delegate said there is need for awareness and action at the highest level, and need for concrete action including sanitation and hygiene, use of vaccines when possible, innovation in service delivery as well as health promotion and communication programmes to change the present culture on anti-microbials use.

India and Ghana, representing Africa, voiced a common concern of developing countries. The action plan must take account of the special needs of developing countries, including supporting the measures they have to take, and making sure they have access to the new antibiotics at affordable prices.  

This touches on one of the crucial issues in the resistance discussion.  The situation is very worrying because no new class of antibiotics has been discovered since the mid-1980s.

There is no guarantee that new ones will be found.  Since the existing antibiotics may become ineffective in some years due to resistance, people worldwide will be defenceless against the superbugs.

Even if new antibiotics are discovered and sold, they will likely be under patent protection.  The prices could be so high that most people, especially in developing countries, can’t use them.

The developing countries were asking the WHO to make sure its action plan deals with these issues.  The United Kingdom, a champion of the resistance issue, assured India and Africa that their concerns would be addressed.  

According to the WHA resolution, the action plan should contain proposals on establishing a national plan to fight resistance, as well as to strengthen surveillance and laboratory capacity, ensure access to medicines, enhance infection prevention and foster research to discover new antibiotics.

Importantly, the plan will also propose how to “regulate and promote rational use of medicines, including for animal husbandry, and ensure proper patient care.”

Just before the WHA, 50 health groups from Asian countries (including Malaysia), Africa, the US, Europe and Latin America met at the South Centre in Geneva and formed a new alliance, the Antibiotic Resistance Coalition, to campaign for actions to be taken to curb the resistance trend.

The actions they call for include:

  • End the use of antibiotics given to livestock to promote their growth.  Much of the antibiotics that are sold are used for fattening animals, and resistance in bacteria in the livestock are transferred to humans through the food chain.
  • Promotion of antibiotics including incentivising medical personnel to overuse or inappropriately prescribe antibiotics is harmful and should be prohibited.
  • Guidelines should be given to hospitals and private doctors on the proper use of antibiotics in treating patients.
  • Introduce comprehensive monitoring of the medical and farm use of antibiotics and the trends of the state of resistance in various pathogens. 
  • Support innovation towards new antibiotics, and in ways that de-linking the costs of R&D from the price of medicines so that they can be affordable.

Although the moves in the WHA towards a global plan were widely supported, there is also a danger that after its adoption it will remain only on paper, like many similar previous plans, and not implemented.

Thus the start of a campaign by civil society to highlight the dangers of resistance and the need for many types of urgent action is just as significant.

With an official global plan and concerted NGO action, there is finally some hope that antibiotics resistance will be tackled more seriously in future.