Global Trends by Martin Khor

Monday 4 December 2017

Can we prevent the end of modern medicine?

We are on the brink of a dangerous era where antibiotics won’t work anymore, and many actions must be taken now to avoid a health catastrophe.

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The next time you have a bad cold and reach for the antibiotics left over from your last visit to the doctor, think again.

Firstly, the antibiotics won’t work as they only act against bacteria while the cold is caused by a virus.

Secondly, you will be contributing to the arguably the world’s gravest health threat – antibiotic resistance.

The wrong use of antibiotics is one of the main causes why they are becoming increasingly ineffective against many diseases, including pneumonia, tuberculosis, blood disorders, gonorrhoea and foodborne diseases.

Health leaders keep ringing the alarm bell.  “Antimicrobial resistance is a global health emergency,” warned World Health Organisation’s Director-General Tedros A Ghebreyesus.  

“The world is facing an antibiotic apocalypse,” said the United Kingdom’s Chief Medical Officer Dame Sally Davies. 

“It may spell the end of modern medicine.”

The tipping point may have been reached recently when some bacteria evolved to be resistant to colistin, the antibiotic of last resort which is used on a patient when all other antibiotics are ineffective.

In 2016, researchers in China found colistin-resistant E. coli bacteria in 20 per cent of animals, 15 per cent of raw meat samples and 1 per cent of hospital patients that were sampled.  The colistin resitance gene (mcr-1) could easily be transferred among the different bacteria in the samples.

Malaysia was one of the first countries where scientists found colistin-resistant bacteria.  “Since the publication of our findings, mcr-1 gene has been found in many other countries,” said Associate Professor Dr Chan Kok Gan of University Malaya. 

“This is a frightening scenario and the whole world should sit up and take action to prevent further abuse of antibiotics.”

If this resistance continues to spread, colistin will become less and less effective and we will eventually lose the “antibiotic of last resort.”

The colistin story also carries another lesson: resistance is being spread through the agriculture sector and the food chain.

In many countries, much of the antibiotics used (80% in the United States) are fed in farms to animals to fatten them and to prevent or treat diseases.

Resistant bacteria build up in the animals and are present in raw meat.  From there, some bacteria are passed on humans when they eat the meat.

In Malaysia, the Department of Veterinary Services in 2012 found that half of the domestic chickens tested had bacteria that were resistant to three types of antibiotics (ampicillin, sulphonamide, tetracycline), as cited in a memorandum by the Consumers’ Association of Penang.

The environment is another source of the spread of resistance.  Residues and wastes containing resistant bacteria flow from farms and medical institutions and contaminate soils, rivers and seas.  Some of the bacteria find their way to humans. 

The European Union banned the use of antibiotics as growth promoters in animal feed in January 2006 while the US started action to phase them out in December 2013. In most developing countries, little action has so far been taken.

Hopefully that will start to change.  Last month, on the eve of World Antibiotic Awareness Week (13-19 November), the WHO issued new guidelines on the use of antibiotics in food-producing animals.

A WHO-sponsored study found that actions restricting antibiotic use in animals reduced antibiotic-resistant bacteria in these animals by up to 39%.

WHO’s new guidelines include:

·         An overall reduction in the use of all classes of medically important antibiotics in food-producing animals.

·         Complete restriction of using these antibiotics for growth promotion and for disease prevention without diagnosis.

·         Healthy animals should only receive antibiotics to prevent disease if it has been diagnosed in other animals in the same flock or herd or fish population.

·         Antibiotics used in animals should be from the WHO list as “least important” to human health and not from “highest priority critically important.”

In 2015, Health Ministers attending the World Health Assembly adopted a Global Plan of Action on anti-microbial resistance, and they agreed that each country should prepare a national action plan by 2017.

Thus urgent, coordinated action is now needed.  Since there are many sources of antibiotic resistance, the national effort must include not only the health authorities but also those responsible for agriculture and the environment.

The Health Ministry should control the spread of infections (including in hospitals), carry out surveillance of antibiotic resistance, introduce and implement regulations and guidelines on proper prescriptions, ethical marketing of drugs and rational drug use.

The Agriculture Ministry should phase out inappropriate use of antibiotics for animals, especially for growth promotion, while the Environment Ministry should prevent resistant bacteria and genes from contaminating soils, rivers and seas.

There should be campaigns to raise the public’s awareness of the dangers of wrongly using antibiotics and of demanding their doctors give them antibiotics unnecessarily.

The medical profession should adhere to guidelines on the proper use of antibiotics, while drug companies should not push for maximum sales but instead advocate prudent use of their antibiotics in both the health or animal sectors.

These are the more obvious actions that need to be taken and immediately to slow down the alarming rate of antibiotic resistance.   If we fail, it may well be “the end of modern medicine”, as the global health leaders and the scientists have warned us.