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Time to act! With the misuse and overuse of antibiotics leading to the emergence of antibiotic-resistant bacteria, the world stands on the brink of 'a post-antibiotic era'. At this year's World Health Assembly in Geneva, member states of the World Health Organisation underscored the urgency of tackling the crisis and expressed support for a global action plan to contain it. Shila Kaur reports. ON 24 May, in the face of what is undoubtedly a global health emergency, the Antibiotic Resistance Coalition, a multi-sectoral collaboration among civil society organisations, called on World Health Organisation (WHO) member states to pass a critical resolution on antimicrobial resistance (AMR) at the 67thWorld Health Assembly (WHA). This resolution, which was eventually adopted by the WHA, will give WHO member states the mandate to develop or strengthen national plans and strategies and international collaboration for the containment and control of the escalating AMR crisis. (According to footnote 1 of the resolution, 'Antimicrobial resistance refers to the loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and anti-parasitic medicines. Antibiotic resistance refers only to resistance to medicines in bacteria.') Every year governments meet at the WHA, WHO's highest decision-making body, to discuss and seek consensus on tackling urgent global public health issues. At this year's WHA, held from 19-24 May in Geneva, 35 WHO member states (some of whom spoke on behalf of the EU, African, Middle Eastern and CIS countries) sent a clear and strong message of support for the resolution and the global action plan to contain the spread of AMR, which has reached crisis levels across national boundaries. Antibiotic resistance threatens to undermine the effectiveness of modern medicine as increasingly more strains of bacteria become resistant to an ever-rising number of antibiotics. The ramifications will be devastating to both human and animal health because there are no new antibiotics to treat some of the most serious infections. Millions of people have been infected with antibiotic-resistant bacteria and hundreds of thousands lose their lives each year. Without a radical change in antibiotic usage, antibiotic resistance will become one of the greatest threats to humankind, to security and to the global economy. The seriousness of the AMR threat was underscored during an event on the sidelines of this year's WHA. The side event was jointly organised by the delegations of the UK, the Netherlands, Turkey and Ghana on 20 May. Led by Dame Sally Davies, the Chief Medical Officer of the UK and a formidable global advocate on AMR, the four-member panel addressed national challenges and responses to AMR in Ghana, Turkey and the Netherlands. Dame Sally stated emphatically that the UK government was committed 'to the highest level' in the fight against the bugs. She emphasised that currently there was insufficient data across the world on the true state of AMR; there was a critical need, therefore, for countries to recognise the challenges and reduce the threats that AMR posed to public health. The spread of NDM1 to 18 countries within the time period of one year had shown that there was an urgent need for global cooperation. The situation is dire because there are no incentives for industry to 'get the innovation pipelines right'. 'There is a public health tension in that governments want to conserve the [antibiotics] that exist while the industry's motive is to market for profit,' she stated. Effective surveillance systems, rapid diagnostics, appropriate vaccines and innovative approaches are the need of the day. 'If we fail, we face daunting economic consequences,' she stated. On 30 April, ahead of the WHA, WHO had launched its first Global Report on Surveillance 2014. This report, with data provided by 114 countries, is the most comprehensive to date and reveals that antibiotic resistance is no longer a prediction for the future but is happening right now, across the world. Standard treatments no longer work; infections are harder or impossible to control; the risk of the spread of infection to others is increased; illness and hospital stays are prolonged, with added economic and social costs; and the risk of death is greater - in some cases, twice that of patients who have infections caused by non-resistant bacteria. 'The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era - in which common infections and minor injuries can kill - is a very real possibility for the 21st century,' states the report. The most important findings of the report are: * There are very high rates of resistance globally in common bacteria (such as Escherichia coli, Klebsiella pneumonia and Staphylococcus aureus) that cause common healthcare-associated and community-acquired infections (such as urinary tract infections, wound infections, bloodstream infections and pneumonia). * Many gaps exist in information on pathogens of major public health importance. There are significant gaps in surveillance and a lack of standards for methodology, data sharing and coordination. Overall, surveillance of antibiotic resistance is neither coordinated nor harmonised. At the time of the launch of the WHO report, more than 20 civil society organisations from all sectors on six continents came together for a meeting to hash out a Survival Plan on AMR. The 28 April-1 May meeting resulted in the formation of the Antibiotic Resistance Coalition (ARC), which agreed to work together urgently to avert the looming post-antibiotic catastrophe (see following article). The Coalition affirmed that in order to conserve their effectiveness, it was imperative that clinically useful antibiotics be viewed as a finite resource and a global, essential public good. Current thinking which viewed bacteria as adversaries had to be changed in order to better understand their importance for human, animal and ecosystem well-being with particular respect to policy and practice for antibiotic use. No new antibiotics have been created since 1987. Since then, the spread of antibiotic resistance has increased dramatically. 'Public leadership is crucial to enact new, needs-driven research and development models, with open research and transparent data, which support rational use and equitable access to antibiotics,' said the Coalition. In 2012, there were about 450,000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 92 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB. Resistance to earlier-generation antimalarial drugs is widespread in most malaria-endemic countries. Further spread, or emergence in other regions, of artemisinin-resistant strains of malaria could jeopardise important recent gains in control of the disease. Treatment failures due to resistance to treatments of last resort for gonorrhea (third-generation cephalosporins) have now been reported from 10 countries. Gonorrhea may soon become untreatable as no vaccines or new drugs are in development. Last year the US Centers for Disease Control (CDC) came out with its Threats Report which stated that over two million Americans fall sick each year with antibiotic-resistant infections, with at least 23,000 dying as a result. The CDC cautions that this is a minimum estimate. The ARC has stressed: 'National-level action is paramount, international cooperation is essential, and the collective responsibility of all stakeholders is crucial in order to bring about a solution to the escalating healthcare crisis caused by antibiotic resistance.' One driver of antibiotic resistance is the unnecessarily reckless use of antibiotics in food animals for industrial meat production. For example, 80% of the antibiotics sold in the US are directed towards industrial meat and dairy production, largely to spur growth - not to treat disease. The more antibiotics are used and interact with bacteria, the faster resistance to antibiotics develops. Effective action on antibiotic resistance therefore requires multi-sector collaboration. While the EU countries are far ahead with regard to regulations and control on the use of antibiotics in food animals, many countries lag far behind. This year, the US Food and Drug Administration (FDA) came out with voluntary guidelines to stop the use of antibiotics as growth promoters in animals. The meat and drug industries have seemingly embraced these guidelines because there is no enforcement and it is easy to use the same drugs under the guise of prophylactic treatment. And in 2013, even the World Economic Forum, where governments and big business meet, issued a high-profile Global Risks Report that describes how antibiotic resistance can not only overwhelm our health systems but also damage our social and economic systems. Clearly, there is 'no time to lose', as an Institute for Agriculture and Trade Policy report with the same title documents. The science is clear, the crisis is urgent. Countries cannot afford to lose any more time in tackling the AMR threat. We must act now to implement the WHA resolution on combating antimicrobial resistance, including antibiotic resistance. Shila Kaur is health consultant with the Third World Network. |
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