"If people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective” . Credit: Adil Siddiqi/IPS

By Baher Kamal
MADRID, Apr 11 2023 (IPS)

Research after research, world’s scientists renew their loud alerts against the high dangers of human-driven ‘superbugs’ – bacterias and pathogens that no longer respond to antimicrobials, making infections harder to treat and increasing the risk of disease spread, severe illness and death.

No way.

The pressure of giant industrial sectors appear to be heavier than the needed political well to reduce the dangerous impacts of the excessive use of those drugs which are widely employed to prevent and treat infections in humans, aquaculture, livestock, and crop production.

Antibiotics are perhaps the most familiar ones, but there are many others, including numerous antivirals, antifungals and antiparasitic agents that have been largely used and misused to treat diseases but that end up spreading them.

They are known as ‘superbugs’ resulting from their increasing resistance to those medicines. And they are antimicrobial resistant germs which are found in people, animals, food, plants and the environment (in water, soil and air).

“They can spread from person to person or between people and animals, including from food of animal origin,” as further explained by the UN Food and Agriculture Organization (FAO).

Such an increasing abuse of antimicrobials and other microbial stressors (e.g. the presence of heavy metals and other pollutants) creates favourable conditions for microorganisms to develop resistance.

The big threat

They represent one of the most complex threats to global health, and food safety and security. Much so that the World Health Organization (WHO) lists Antimicrobial Resistance (AMR) among the top 10 threats for global health.

The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten the ability to treat common infections, WHO explains.

Alarming advance of multi-resistant bacterias

“Especially alarming” is the rapid global spread of multi- and pan-resistant bacterias that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.

“The clinical pipeline of new antimicrobials is dry.” In 2019 WHO identified 32 antibiotics in clinical development that address its list of priority pathogens, of which only six were classified as innovative.

Moreover, estimates suggest that by 2050 up to 10 million additional direct deaths could occur annually. That is on par with the 2020 rate of global deaths from cancer.

Additionally, in the next decade, AMR could result in a Gross Domestic Product (GDP) shortfall of at least 3.4 trillion US dollars annually and push 24 million more people into extreme poverty.

Antibiotics, increasingly ineffective

According to the World Health Organization, the lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health-care systems.

“Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and death.”

New antibiotics urgently needed

New antibacterials are urgently needed – for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list.

“However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.”

Meanwhile, FAO reports, “the situation is expected to worsen as global demand for food increases,” adding that it is therefore paramount that the agrifood systems are progressively transformed to reduce the need for antimicrobials.

What drives antimicrobials?

As mentioned above, such a threat is primarily driven by the excessive application of antimicrobials, the international body adds. In fact, currently, more than 70% of antimicrobials sold worldwide are used in animals for human consumption.

While AMR occurs naturally over time, usually through genetic changes, FAO reports that their main drivers include:

– misuse and overuse of antimicrobials in human health and agriculture;

– lack of access to clean water, sanitation and hygiene for both humans and animals;

– poor infection and disease prevention and control in healthcare facilities and farms;

– poor access to quality, affordable medicines, vaccines and diagnostics; and

– weak enforcement of legislation.

Who influences the spread of superbugs?

According to UN reports, three economic sector value chains profoundly influence AMR’s development and spread:

• Pharmaceuticals and other chemicals manufacturing
• Agriculture and food including terrestrial animal production, aquaculture, food crops or those providing inputs such as feed, textiles, ornamental plants, biofuels, and other agricultural commodities.

• Healthcare delivery in hospitals, medical facilities, community healthcare facilities and in pharmacies where a range of chemicals and disinfectants are used.

Other major consequences

Another leading specialised body, the UN Environment Programme (UNEP) warned in its February 2023 report: Bracing for Superbugs about the need to curtail pollution created by the pharmaceuticals, agricultural and healthcare sectors.

The study focuses on the environmental dimensions of AMR, reporting that the pharmaceutical, agricultural and healthcare sectors are key drivers of AMR development and spread in the environment, together with pollutants from poor sanitation, sewage and municipal waste systems.

Inger Andersen, the UNEP Executive Director, explained that the triple planetary crisis – climate change, pollution and biodiversity loss – has contributed to this.

“Pollution of air, soil, and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems,” she warned.

Climate, biodiversity, pollution, nature loss…

According to UNEP, global attention to AMR has mainly focused on human health and agriculture sectors, but there is growing evidence that the environment plays a key role in the development, transmission and spread of AMR and is a key part of the solution to tackle AMR.

In fact, AMR is closely linked to the triple planetary crisis of climate change, biodiversity and nature loss, and pollution and waste, driven by human activity, unsustainable consumption and production patterns.

The world leading environmental body explains the following:

— Climate crisis and AMR are two of the greatest and most complex threats the world currently faces. Both have been worsened by, and can be mitigated by, human action.

— Higher temperatures can be associated with increases in AMR infections, and extreme weather patterns can contribute to the emergence and spread of AMR.

— Antimicrobial impacts on microbial biodiversity may affect the cycles of carbon and methane, which are directly involved in regulating Earth’s climate.

— Biodiversity loss: Land-use changes and climate change alter soils’ microbial diversity in recent decades, and microbes inhabiting natural environments are sources of pharmaceutical discovery.

— Municipal solid waste landfills and open dumps are prone to wildlife and feral animal interaction and can contribute to the spread of AMR.

— Pollution: Biological and chemical pollution sources contribute to AMR development, transmission, and spread.

Africa’s laboratories need to step up testing to aid in fighting Anti-Microbial Resistance. This photo is a 3D computer-generated image of Mycobacterium tuberculosis bacteria, the pathogen responsible for causing the disease tuberculosis (TB). Credit: CDC/Unsplash

By Francis Kokutse
ACCRA, Nov 3 2022 (IPS)

African countries must find a way of fighting Anti-Microbial Resistance in the healthcare system to avoid unnecessary deaths.

A few months ago, the President of the Ghana Public Health Association, Amofah George, narrated how he saw a patient die after failing to respond to all the available antibiotics used for managing her septicemic condition, blood poisoning, especially caused by bacteria or their toxins. He attributed the situation to antibiotic resistance, or Anti-Microbial Resistance (AMR) which he said has become a growing pandemic.

The problem is simple: Africa’s healthcare system does not routinely rely on laboratories to produce tests for treatment. AMR programme manager of the African Society for Laboratory Medicine (ASLM), Edwin Shumba, told IPS, “Ghana, like other countries on the continent, rely on a few medical laboratories to conduct bacteriology testing as part of the routine clinical services.”

“This means that doctors are flying blind when prescribing a treatment to their patients, and public health experts do not have an insight of what is ongoing in terms of AMR, at hospital and national level,” Shumba said.

“The growing threat of AMR has implications for patient care: the antibiotics that used to work will not be able to cure the infections caused by resistant bacteria anymore. This means more that infections might take longer to cure, might be more severe (mortality, morbidity), and will cost more to the society.”

Worried by the increasing cases of AMR, the African Society for Laboratory Medicine (ASLM) has spearheaded a study, and data from 14 sub-Saharan countries show that only five out of the 15 antibiotic-resistant pathogens – a bacterium, virus, or other microorganisms that can cause disease –designated by the World Health Organization (WHO) as a priority are being consistently tested, and that all five demonstrated high resistance.

Across the 14 countries, clinical and treatment data are not being linked to laboratory results, making it hard to understand what’s driving AMR. Out of almost 187,000 samples tested for AMR, around 88% had no information on patients’ clinical profile, including diagnosis/origin of infection, presence of indwelling devices (such as urinary catheters, feeding tubes, and wound drains) often associated with development of healthcare-associated infection, comorbidities, or antimicrobial usage. The remaining 12% had incomplete information.

The multi-year, multi-country study was carried out by the Mapping Antimicrobial Resistance and Antimicrobial use Partnership (MAAP), a consortium spearheaded by the African Society for Laboratory Medicine (ASLM), with partners including the Africa Centre for Disease Control and Prevention (Africa CDC), the One Health Trust, the West African Health Organization (WAHO), the East, Central, and Southern Africa Health Community (ECSA-HC), Innovative Support to Emergencies, Diseases, and Disasters, and IQVIA. It provides stark insights into the under-reported depth of the AMR crisis across Africa and lays out urgent policy recommendations to address the emergency.

MAAP reviewed 819,584 AMR records from 2016 to 2019 from 205 laboratories across Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon, and Cameroon. MAAP also reviewed data from 327 hospital and community pharmacies and 16 national-level AMC datasets.

The researchers found that most African laboratories are not ready for AMR testing. Only 1.3% of the 50,000 medical laboratories forming the laboratory networks of the 14 participating countries conduct bacteriology testing. And of those, only a fraction can handle the scientific processes needed to evaluate AMR. Researchers also found that in eight of the 14 countries, more than half of the population is out of reach of any bacteriology laboratory.

The study results provide insights into the AMR burden and antimicrobial consumption in the 14 countries where most available AMR data is based only on statistical modeling. The effort by MAAP is the first of its kind to systematically collect, process, and evaluate large quantities of AMR and antimicrobial consumption (AMC) data in Africa.

The WHO has repeatedly stated that AMR is a global health priority—and is, in fact, one of the leading public health threats of the 21st century. A recent study estimated that, in 2019, nearly 1.3 million deaths globally were attributed to antimicrobial-resistant bacterial infections. Africa was found to have the highest mortality rate from AMR infections in the world, with 24 deaths per 100,000 attributable to AMR.

ASLM’s director of science and new initiatives, Pascale Ondoa, said, “Africa is struggling to fight drug-resistant pathogens, just like the rest of the world, but our struggle is compounded by the fact that we don’t have an accurate picture of how antimicrobial resistance is impacting our citizens and health systems.”

The research also found that only four drugs comprised more than two-thirds (67%) of all the antibiotics used in healthcare settings. Stronger medicines to treat more resistant infections (such as severe pneumonia, sepsis, and complicated intra-abdominal infections) were unavailable, suggesting limited access to some groups of antibiotics.

ASLM’s chief executive Nqobile Ndlovu said, “Across Africa, even where data on antimicrobial resistance is collected, it is not always accessible, often recorded by hand, and rarely consolidated or shared with policymakers; as a result, health experts are flying blind and cannot develop and deploy policies that would limit or curtail antimicrobial resistance.”

“The disconnect between patient data and antimicrobial resistance results, coupled with the extreme antimicrobial resistance burden, makes it incredibly difficult to provide accurate guidelines for patient care and wider public health policies,” said Dr Yewande Alimi, Africa CDC AMR programme coordinator. “Hence, collecting and connecting laboratory, pharmacy, and clinical data will be essential to provide a baseline and a reference for public health actions.”

“Collectively, the data highlights a dual problem of limited access to antibiotics and irrational use of those that are available,” said IQVIA’s head of Public Health (Africa and Middle East) and Real-World Evidence (Middle East), Deepak Batra.

“As a result, people don’t get the right treatment for severe infections, and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options. Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use,” he added.

Based on the findings, MAAP calls for a drastic increase in the quality and quantity of AMR and AMC data being collected across the continent, along with revised AMR control strategies and research priorities.

For Shumba, Ghana, like the rest of Africa, can fight AMR by including critical interventions in revised versions of the national AMR Action plans, essential medicine Lists, laboratory strategies, and standard treatment guidelines.

“This heavy toll on the health systems poses a major threat to progress made in health and in the attainment of Universal Health Coverage, the African Union’s Agenda 2063: The Africa We Want and the United Nation’s Sustainable Development Goals,” he added.

Shumba said the AMR coordinating committee of Ghana could assist other policymakers in using the evidence gathered by the MAAP project to refine their strategies for AMR containment. In addition, they can plan to increase the number and capacity of medical laboratories to conduct bacteriology testing in the country.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

By Lina Taing and Rachel Kaiser
HAMILTON, Canada, Nov 23 2021 (IPS)

The overuse and misuse of antimicrobial medicines and chemicals has become the main driver of antimicrobial resistance (AMR) and drug-resistant infections that threaten human health and the global economy.

Given that development, the UN designated November 18-24 as World Antimicrobial Awareness Week, to remind us all to handle antimicrobials with greater care.

Antimicrobials – which range from antibiotic and antiviral medicines to disinfectant and antiseptic chemicals – help prevent or treat human, animal and plant infections and have contributed immensely to health and progress worldwide.

Now, however, common antibiotics, as well as first-line antimicrobials for infectious diseases such as HIV and malaria, are becoming less effective.

The World Health Organization reports that 700,000 people die from drug-resistant diseases every year. If this threat continues unchecked, 10 million people are predicted to die every year and the world will lose USD $100 trillion by 2050.

Most worrying, an estimated 90% of the world’s urban growth is anticipated in Africa and Asia, where populations are most vulnerable to drug-resistant bacteria. Increasingly, multilateral organizations and national governments are adopting measures to reduce unnecessary antimicrobial use by humans, including in our food chain.

From 2000 to 2015, human consumption of antibiotics increased 65%, led by low- and middle-income countries (LMICs) where GDP has risen in parallel with antibiotic use, overuse and misuse.

Meanwhile, antimicrobial use in animal farming is nearly triple that of human consumption and is on track to reach 200,235 tons in animals and 13,600 tons in aquaculture by 2030 as producers work to reduce infection and increase animal growth.

Data on antimicrobial use in plants is limited, but the presence of resistant bacteria has been detected on 25% of plant-based foods from all world regions, indicating that food likely is contributing to greater AMR.

The excessive use of antimicrobials in humans, animals, and plants also puts environmental health at risk. But environmental transmission via soil, air, or water receives relatively little attention as an AMR driver.

Depending on the drug, humans and animals can excrete waste with up to 90% of antimicrobial compounds or metabolites still active, which can end up untreated in the environment.

Unsafe disposal of antimicrobials and wastewater from hospitals, pharmaceutical manufacturers, municipal treatment plants, and farms are recognized as hotspots for the introduction and evolution of more resistant strains (i.e., superbugs).

This pollution can consequently compound human AMR exposure through contaminated soils and water supplies that sustain our environment, or are used to produce food, for drinking, cleansing and recreation.

Increasing access to safe water, sanitation and hygiene (WASH) and raising capacity for wastewater treatment are the primary environmental interventions to reduce the spread of AMR.

However, current statistics paint an alarming picture of whether these efforts are enough to address environmental risks, as a quarter of humanity does not have access to safe water and just over half of the world’s wastewater is treated. Of particular concern are large swathes of Africa, Asia, Latin America, the Middle East, and Eastern Europe, which report limited treatment of, or have no data on, domestic and industrial wastewater flows.

At current rates of progress, universal WASH and wastewater treatment is unlikely to be achieved soon, which highlights the need to put into place now additional measures that protect environmental waters from these AMR exposure pathways.

Environmental waters are aquatic environments that can function as both AMR reservoirs and pathways and their protection, therefore, is critical in AMR stewardship. Environmental waters refers to the world’s diverse natural and man-made water bodies, ranging from wetlands that shelter wildlife and nurture local ecosystems, to groundwater and surface waters from which we draw supplies or discharge wastewater into.

One could argue that environmental water AMR protection is inherent in measures that reduce antimicrobial use upstream, and enhance WASH and municipal and industrial wastewater treatment strategies downstream.

But wastewater treatment from a major contributor to environmental pollution – agriculture – tends to be overlooked, despite the facts that this industry uses the largest amount of antimicrobials, 70% of global freshwater, and discharges the majority of its wastewater and runoff untreated into the environment.

The combination of poor WASH coverage and inadequate domestic, industrial, and agricultural wastewater treatment puts half a billion people that rely on unimproved water from polluted environmental waters at greater risk of AMR exposure and infection.

Safeguarding environmental waters represents a major void in current AMR stewardship efforts, despite water protection being recognized in 2018 as the “first step” to reducing environmental AMR pollution.

The UN should support surveillance, regulation and enforcement of water and land protection legislation and development of AMR-related water quality standards – to prevent and mitigate environmental AMR risks, as well as equitably address human, animal, and environmental AMR threats.

Lina Taing is a Water and Health Researcher, and Rachel Kaiser is an Intern at the UN University Institute for Water, Environment and Health (UNU-INWEH), a Canadian-based think tank supported by the Government of Canada and hosted at McMaster University, Hamilton, Ontario. The Institute marks its 25th anniversary in 2021.

Follow @IPSNewsUNBureau
  

Antimicrobial resistance is a consequence of overusing and misusing antimicrobials. This is a worldwide problem. But in developing countries antibiotics are easily available without prescription. Credit: Adil Siddiqi/IPS

By External Source
Nov 17 2021 (IPS)

The cost of infectious diseases is somewhere between staggering and incalculable. Around $8 trillion and 156 million life years were lost in 2016 alone. Throughout human history, pestilences have wiped out more lives than famine and violence.

Then, in 1941, the antibiotic age was born when doctors at the Radcliffe Infirmary and the Dunn School of Pathology in Oxford first tested penicillin in a patient. When I was a medical student there in the late 1970s, we felt a reverence for this world-changing achievement. Penicillin and its successors have saved millions of lives.

It can take 15 years and a billion dollars to develop a new antibiotic. And then, either the poor can’t afford them or consumption must be restricted to stave off future resistance. Meanwhile, companies that have monopoly rights over niche antimicrobials profit with abandon
So, 50 years later, as a doctor visiting Uganda’s Gulu Hospital, I was heartbroken to see patients die despite treatment with antibiotics. Sara, for example, a young Sudanese refugee, died from puerperal sepsis because she was resistant to first-line antibiotics. And modern, expensive versions were unavailable.

Antibiotics are part of a group of drugs called antimicrobials – including antivirals, anti-fungals and anti-parasitics – that prevent and treat infections in humans, animals and plants. But, as coronavirus has reminded us, all living organisms mutate. When that leads to resistant “superbugs”, we get antimicrobial resistance – the drugs are no longer effective.

Antimicrobial resistance is a consequence of overusing and misusing antimicrobials. This is a worldwide problem. But in developing countries antibiotics are easily available without prescription. The residents of Kibera, a low income settlement in Kenya, for example, consume more antibiotics than typical American families. When a poor patient cannot afford the full course, however, they make do with a few pills. That may be harmful if an infection is not fully treated, and antimicrobial resistance may follow.

Meanwhile, the parallel lack of hygiene, water and sanitation in crowded, deprived communities means more sickness. That pushes up the need for antimicrobials.

Antimicrobial resistance also compromises human health via food. Two-thirds of all antibiotics are used in farm animals. Intensive use to fatten up animals and hide poor animal husbandry is a potent source of resistance. Powerful drugs leached into soil and water recycle into us via the food chain. Antimicrobial residues in milk, eggs, meat and fish are worrisome for our health.

Antimicrobial resistance kills around 700,000 people worldwide annually. This could increase to 10 million annually by 2050, at a cost of $100 trillion. It is a top-ten global health threat.

It’s now time for a bold effort on antimicrobial resistance. That requires a dedicated organisation with the universal legitimacy of a UN body, political clout of a G20, deep pockets of a global fund, brainpower of a space agency, campaigning zeal of an NGO, mould-breaking power of a social movement, and leveraging capacity of a public-private partnership.

Drug resistance and health

Antimicrobial resistance has devastating consequences. For the ill, it means getting sicker for longer, wasting money they cannot afford, and impoverishing desperate families. Or succumbing to ordinary chest and urinary infections that were easily treatable earlier. Traditional public health threats such as tuberculosis, malaria and HIV are also returning as serious conditions resist first-line drugs.

Drug resistance is especially bad news for seriously ill patients with diseases ranging from COVID-19 to chronic bronchitis who are prone to secondary infections. It also becomes riskier to do organ transplants or give cancer therapy because immune-suppressed patients need antimicrobial cover.

A broken market

Drug resistance satisfies the definition of a pandemic and comparison with other pandemics is instructive. Investing massively in coronavirus research was worth it because there are billions of permanent customers for COVID-19 vaccines and treatments. In contrast, nothing new has entered the antibiotics cupboard since the 1980s.

It can take 15 years and a billion dollars to develop a new antibiotic. And then, either the poor can’t afford them or consumption must be restricted to stave off future resistance. Meanwhile, companies that have monopoly rights over niche antimicrobials profit with abandon.

In contrast, 20 preventable and treatable tropical diseases that debilitate 1.7 billion poor people – mostly in Africa and South Asia – are neglected. This is because the remedies are often too cheap for sufficient profit to be extracted. They include river blindness, guinea worm, leprosy, and elephantiasis.

The particular circumstances around antimicrobial supply and demand mean that inequity prevails, as with COVID-19 vaccines where developing countries are denied the intellectual property rights to make them.

An earlier generation struggled similarly at the height of the AIDS epidemic. South Africa and India led the fight to waive restrictive trade rules on generic medicine production, when public health emergencies warrant. That saved thousands of lives as cheap antiretrovirals became available.

A comparable approach is now urgent to help all countries get effective, affordable antimicrobials. But prospects are not good, if the current battle over increasing COVID-19 vaccine supplies – led again by South Africa and India – is a pointer. Polarised geopolitics is not helpful to fix the broken market for essential medicines.

One health

The painful lesson from pandemics such as Ebola, HIV, and COVID-19 is that human, animal, and planetary health are intertwined. That is because animals are getting closer to humans. Their habitats get compromised by development practices that create wide scale deforestation. Thus, their microbes jump to us more easily. This is exacerbated by environmental shifts due to climate change. The trend necessitates new antimicrobials to be found for diseases yet to come.

Siloed approaches won’t work in inter-connected contexts. Integrated working is needed to tackle the multi-dimensional causes and consequences of our sickening humanity, ecosystem, and planet. This “one health” approach could tackle antimicrobial resistance. But the concept remains nebulous. Society and institutions don’t have incentives to work across sectoral and disciplinary boundaries.

A technocratic approach is not enough

The World Health Organisation has joined up with the World Organisation for Animal Health and the Food and Agriculture Organisation to sound the alarm on antimicrobial resistance with a global action plan, several resolutions of the World Health Assembly, and a high-level global leaders group. Technical tools and guidance are available to national action plans: 89 countries have them but only 18 in Africa and 23 in Asia-Pacific. They include strengthening surveillance, promoting antimicrobial stewardship, training and capacity building.

All this is worthwhile. But there is no time to wait. A technocratic approach and sparse funding have not created the necessary momentum.

The early AIDS activists realised the same in the 1980s when many countries were devastated, especially in Africa. A massive global movement arose to shift social morays, shake up stodgy establishments, galvanise massive funding for research, prevention, and treatment. And it triggered extraordinary innovations in biological and behavioural sciences.

Its legacy has gone well beyond HIV. It also led to the creation of UNAIDS and the Global Fund To Fight AIDS, Tuberculosis and Malaria as specialised institutions to energise and orchestrate an unprecedented global endeavour.

The hugely disruptive COVID-19 crisis has sparked comparable effort with record-time technological breakthroughs, overturned economic orthodoxy, and unprecedented financing. Also innovations in how we work, design social safety nets, re-configure international co-operation, generate solidarity, and hold policy makers accountable. But we also deepened inequalities, and realised that globalisation itself needs a makeover.

There are excellent examples of the elements that could make up a dedicated global organisation to combat antimicrobial resistance. To connect them is the necessary organisational innovation. That means challenging petty institutional turf battles and sectoral boundaries, and overcoming small mindsets.

Mukesh Kapila, Professor Emeritus in Global Health & Humanitarian Affairs, University of Manchester

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation. Credit: Bigstock.

By Baher Kamal
MADRID, Nov 11 2021 (IPS)

Antibiotics, like other antimicrobials, have become a threat to health rather than healing it. Why? Because their misuse and overuse have created such a strong resistance that they no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.
Much so that antimicrobial resistance is now considered among the top 10 global public threats facing humanity.

In fact, an estimated 700 000 people die each year from antimicrobial resistant (AMR) infections, in addition to an untold number of sick animals that may not be responding to treatment.

Antimicrobial Resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death

In short, antimicrobial resistance is a significant global threat to public health, food safety and security, as well as to livelihoods, animal production and economic and agricultural development.

What happens?

According to the World Health Organization (WHO) The misuse and overuse of antibiotics in livestock is meant to prevent contagion from one animal to the rest of the herd, thus increasing milk and meat production, in pursuit of more profits.

A similar case is the misuse and overuse of different antimicrobials in agriculture with the aim of obtaining more production and therefore more commercial benefits.

The point is that human consumption of meat and vegetables and fruits also imply their ingestion of antimicrobials in the daily diet.

What are antimicrobials?

The following information is based on investigations and studies carried out by the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO).

Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants.

What is antimicrobial resistance?

Antimicrobial Resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Why is it a global concern?

The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten our ability to treat common infections.

Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.

Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health-care systems.

Change or loose

In other words, new antibacterials are urgently needed – for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list.

However, if people do not change the way antibiotics are used now, new antibiotics will suffer the same fate as the current ones and become ineffective.

Without effective tools for the prevention and adequate treatment of drug-resistant infections and improved access to existing and new quality-assured antimicrobials, the number of people for whom treatment is failing or who die of infections will increase.

Medical procedures, such as surgery, including caesarean sections or hip replacements, cancer chemotherapy, and organ transplantation, will become more risky.

What accelerates the emergence and spread of antimicrobial resistance?

AMR occurs naturally over time, usually through genetic changes. Antimicrobial resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air).

They can spread from person to person or between people and animals, including from food of animal origin.

The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.

Present situation

For common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhoea, high rates of resistance against antibiotics frequently used to treat these infections have been observed world-wide, indicating that we are running out of effective antibiotics.

Drug resistance in malaria parasites
Another example is the case of the emergence of drug-resistant parasites which poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality.

Drug resistance in fungi
The prevalence of drug-resistant fungal infections is exasperating the already difficult treatment situation. Many fungal infections have existing treatability issues such as toxicity especially for patients with other underlying infections (e.g. HIV).
This is leading to more difficult to treat fungal infections, treatment failures, longer hospital stays and much more expensive treatment options.

A week to raise awareness

This year’s World Antimicrobial Awareness Week (WAAW) marked 18 to 24 November was previously called the World Antibiotic Awareness Week.

But from 2020, it would be called the World Antimicrobial Awareness Week to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals.

The Week is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy makers to slow the development and spread of drug-resistant infections.

Is obtaining more and more commercial benefits a reason enough to transform the healers into killers?

Among the major drivers of the Antimicrobial Resistance crisis is the misuse and overuse of antibiotics in livestock and feed. Credit: Germán Miranda/IPS.

By Tharanga Yakupitiyage
UNITED NATIONS, May 21 2019 (IPS)

Antimicrobial resistance is quickly becoming a global crisis and risks reversing a century of progress in health. Some organisations have already geared up and are tackling the issue from its roots.

In a new report, the United Nations Interagency Coordination Group (IACG) on Antimicrobial Resistance estimates that antibiotic resistance could cause 10 million deaths each year by 2050.

Already, drug-resistant infections cause at least 700,000 deaths annually around the world.

“Antimicrobial resistance is one of the greatest threats we face as a global community,” said UN Deputy Secretary-General and Co-Chair of the IACG Amina Mohammed.

“[The report] rightly emphasises that there is no time to wait and I urge all stakeholders to act on its recommendations and work urgently to protect our people and planet and secure a sustainable future for all,” she added.

In 2017, the World Health Organization (WHO) reported that antibiotic resistance was a “global crisis that we cannot ignore” and that if ignored, “will take us back to a time where people feared common infections and risked their lives from minor surgery.”

According to the IACG report, approximately 35 percent of common human infections are already resistant to currently available medicines in some member countries of the Organization for Economic Cooperation and Development (OECD), while resistance rates are as high as 80 to 90 percent in some low- and middle-income countries (LMICs).

The economic impact of antimicrobial resistance would also be catastrophic as healthcare expenditures will rise and sustainable food and feed production will increasingly be at risk.

The World Bank estimates that up to 24 million people could be forced into extreme poverty particularly in low-income countries, and the economic damage could be comparable to the shocks experienced during the 2008-2009 global financial crisis.

“The world is already feeling the economic and health consequences as crucial medicines become ineffective. Without investment from countries in all income brackets, future generations will face the disastrous impacts of uncontrolled antimicrobial resistance,” WHO said.

Among the major drivers of the crisis is the misuse and overuse of antibiotics in livestock and feed.

Though WHO has recommended that the food industry stop using antibiotics to promote growth and prevent disease, nearly three-quarters of the total use of antibiotics worldwide is still used on animals, greatly impacting the health of consumers.

According to the Alliance to Save our Antibiotics, livestock raised for food in the United States are given five times more antibiotics as farm animals in the United Kingdom. In the case of cattle, the difference in dosage rates may be as high as 16 times the rate of dosage per cow in the UK.

As a result, Europe banned the import of American hormone-treated beef.

In Bangladesh, a study found a range of antibiotics in almost 50 percent of poultry feed samples across 14 brands from four districts. The Bangladesh Agricultural Research Council also noted that the levels of antibiotics were far above the levels acceptable to human health.

Among such antibiotics was Oxytetracycline, which is often used to treat chest infections such as bronchitis and pneumonia.

Another review found a high prevalence of antimicrobial resistance in Bangladesh, partially due to the misuse and overuse of antibiotics, including in the livestock sector.

As Bangladesh’s livestock sector is only expected to grow, with plans to export poultry in coming years, sustainable livestock management is necessary in managing growing antibiotic resistance regionally and globally.

One organisation hopes to do just that.

After graduating from Chittagong Veterinary and Animal Sciences University, Salma Sultana saw a shortage of trained veterinarians and farmers resorting to untrained doctors who are most often behind the widespread misuse of antibiotics and thus the frequent death of livestock and rise in antimicrobial resistance.

In 2015, she founded the Model Livestock Advancement Foundation (MLAF) near Dhaka whose vision includes “to have a livestock sector that is sustainable, commercial, and contributing to livelihood, employment, national income, and food security.”

This includes the training and provision of modern and evidence-based animal health services as well as the prevention of antimicrobial resistance.

MLAF is the only educational, research, and animal healthcare voluntary organisation in Bangladesh and has since produced 45 veterinary service providers and 500 livestock entrepreneurs while providing health support to over 5,000 livestock herders.

The organisation has been recognised for its work as it was most recently awarded with the International Arch of Europe Award for Quality and Technology in 2018 and the Joy Bangla Youth Award in 2017 for its contribution to youth training and development.

As the Lancet Planetary Health found that interventions that restrict antibiotic use in food-producing animals reduce antibiotic-resistant bacteria in such animals by up to 39 percent, the work of organisations like MLAF is therefore crucial in the fight to keep the planet and its populations healthy and safe.

Community health worker Urmila Kasdekar performs a health check on a new born baby in Berdaball village of western India. In India, for example, where it is thought that as many as 120,000 babies alone die every year from sepsis caused by antimicrobial-resistant infections, doctors say two of the key factors behind rising AMR are pharmacies selling antibiotics without a prescription and poor infection control in overcrowded healthcare facilities. Credit: Stella Paul/IPS

By Ed Holt
BRUSSELS, Dec 4 2018 (IPS)

European Union officials and global health bodies have called for help for poorer countries as growing resistance to antibiotics threatens to become a ‘global health tragedy’ and jeopardises Sustainable Development Goals in some parts of the world.

Antimicrobial resistance (AMR) has risen by as much as two thirds in the last two decades, according to some studies, and is now responsible for an estimated 700,000 deaths annually worldwide.

But this is projected to rise to 10 million per year by 2050 and cost up to 100 trillion dollars unless governments ramp up efforts to tackle it.

The growing problem with AMR has been put down largely to inappropriate use of antibiotics for both humans and animals.

As antibiotics have been used more widely and more frequently in both humans and animals, bacteria have built up resistance to them, rendering them effectively useless in some cases. Doctors say this would make routine operations more dangerous and certain medical treatments, such as for some cancers, would disappear completely.

When antibiotic resistance emerges in one place it also quickly spreads to other locations, meaning it must be tackled on a global scale.

While all World Health Organization (WHO) member states signed up to a multi-sectoral Global Action Plan on AMR in 2015, progress on its implementation has been mixed.

Some countries, notably in Europe, have made good progress, in other parts of the world things have moved much more slowly, if at all, raising fears that in poorer countries the problem is worsening and SDGs may not be reached.

EU Commissioner for Health and Food Safety, Dr Vytenis Andriukalitis, told IPS: “We need a global framework for tackling AMR in all regions, not just Europe. It needs to be dealt with because otherwise some countries won’t be reaching the SDGs.”

The size of the challenge presented by AMR in developing countries has been underlined in a slew of data and studies released during the World Antibiotic Awareness week last month (November).

An Organisation for Economic Co-operation and Development (OECD) study showed that while AMR rates averaged 17 percent in OECD countries in 2015, rates in India, China and Russia averaged 42 percent and were as high as 90 percent for some antibiotic-bacteria combinations.

Meanwhile, it said, AMR is forecast to grow up to four to seven time faster in some low and middle-income countries than in OECD states and in countries where healthcare systems are financially constrained, AMR is likely to cause ‘an enormous’ death toll, mainly among new-borns, infants and the elderly.

Another study earlier this year by researchers at ETH Zurich, the University of Antwerp and Princeton University showed that while global use of antibiotics in humans was estimated to have risen 65 percent between 2000 – 2015, use in low- and middle-income countries increased 114 percent.

Developing new antibiotics is complex – it has been decades since new classes of antibiotics were invented – and much of the focus in fighting AMR is being put on prevention.

The Global Action Plan is based on a multi-sectoral approach to AMR and charges governments with adopting national action plans involving improved awareness, understanding, surveillance, stewardship and prevention and control measures.

But in many developing countries, lack of funds in both healthcare and animal industries as well as weak legislation and enforcement are major barriers to those measures being effectively implemented.

In India, for example, where it is thought that as many as 120,000 babies alone die every year from sepsis caused by antimicrobial-resistant infections, doctors say two of the key factors behind rising AMR are pharmacies selling antibiotics without a prescription and poor infection control in overcrowded healthcare facilities.

Supporters of over the counter antibiotic sales in India argue that it is vital that antibiotics are available without prescription as there is a severe shortage of qualified doctors in many areas.

The government has tried to limit the sale of at least so-called ‘last resort’ antibiotics which are used when all others fail. However, the measure – putting a red line on boxes of the medicines in pharmacies to alert people – has been largely ineffective.

There are also concerns over the use of antibiotics in livestock.

According to the European Commission, in Europe, 70 percent of antimicrobials are consumed in food-producing animals. The figure is similar in the U.S. and is over 50 percent in China.

But monitoring antibiotic use in the animal industry in poorer countries is often more difficult.

“[Use of antibiotics in animal farming] is extremely difficult to enforce unless you have very good legislation and a system for monitoring,” Dr Nedret Emiroglu, Director Programme Manager, WHO Europe, told IPS.

While legislation on animal antibiotic use exists and is closely checked in developed states, particularly in the EU, in poorer countries it is sometimes absent or adherence is impossible to monitor effectively because of a lack of resources.

Despite the Indian government’s approval of a national action plan on AMR a year a half ago, critics point out that legislation and networks to control use of antibiotics for animal growth and tracking the sale and use of antibiotics in food production are, in reality, non-existent or ineffective.

The WHO has said that many middle- and low-income countries may need long-term development assistance to implement their AMR plans effectively and sustainably.

“We need financial support for low and middle-income countries,” Emiroglu told IPS.

She added this was crucial to ensure progress in one region of the world was not undermined by a lack of progress elsewhere.

“AMR knows no boundaries. What happens in one part of the world affects people in another,” she told IPS.

But many experts on healthcare in developing countries say a one-size fits all approach for all developing states will not work.

“Measures need to be different for different countries, especially when we are talking about poorer states. You cannot compare somewhere like India and Liberia,” Andriukalitis told IPS.

“In some countries they have problems with access to simple antibiotics, but in others there are problems because people are self-treating with no proper controls. In some places there is a lack of any basic understanding of hygiene and sanitation. We need long-term local strategies for [different] countries,” he added.

Meanwhile, AMR is putting SDGs in jeopardy in some places. Although AMR alone is unlikely to stop an SDG being achieved, left unchecked it could contribute to health, poverty and sustainable economic growth SDG targets being missed.

Longer hospital stays because of slower patient recovery and greater risk of treatment complications would put a massive extra strain on already struggling healthcare systems and worsen mortality rates and quality of life. Economies would be hit hard with the cost of not dealing with AMR forecast to cause a drop of as much as 3.8 percent in global GDP by 2050.

Meanwhile, AMR makes illnesses more expensive to treat and, as universal health coverage is limited in many poor countries and people have to pay out of their own pockets for treatment, these increased costs – as well as potential loss of income from morbidity and mortality – could drive individuals and families with limited resources into even greater poverty.

Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control (ECDC) which has been involved in monitoring AMR in Europe, told IPS: “​To achieve SDG3 [on health], AMR is not the only issue that needs to be addressed, but it is a crucial component.

“A high rate of AMR indicates that various elements in a health system may not be working satisfactorily because of a mix of factors. The factors causing high AMR rates could be cultural values, behaviour of healthcare providers and patients, regulatory issues such as OTC availability, or infection control. These factors may also prevent other targets included within SDG3 being achieved.”

A doctor examines the x-ray of a TB patient in New Delhi. Credit: Bijoyeta Das/IPS.

By Lyndal Rowlands
UNITED NATIONS, Mar 24 2017 (IPS)

New antibiotics that could treat tuberculosis may rapidly become ineffective, according to new research published by the Lancet ahead of World Tuberculosis Day.

The rise in multi-drug resistant tuberculosis, which affected 480,000 people in 2015, could mean that even newly discovered drugs will soon be useless, the study found.

In total both drug resistant and non-drug resistant Tuberculosis (TB) killed an estimated 1.8 million people in 2015, making it the world’s deadliest infectious disease. The five countries where TB is most predominant are India, Indonesia, China, Nigeria, Pakistan and South Africa.

Multi-drug resistant tuberculosis reflects the meeting of an ancient and under-addressed disease – tuberculosis – with an emerging modern threat – antimicrobial resistance. The inappropriate use of antibiotics, including taking them without prescription or not following doctor’s orders closely is slowly rendering many antibiotics useless.

“Resistance to anti-tuberculosis drugs is a global problem that threatens to derail efforts to eradicate the disease,” said lead author of the Lancet report Professor Keertan Dheda from the University of Cape Town, South Africa.

“Even when the drugs work, TB is difficult to cure and requires months of treatment with a cocktail of drugs. When resistance occurs the treatment can take years and the drugs used have unpleasant and sometimes serious side effects,” said Dheda.

Dheda added that it is important for improved diagnostic tests, which are currently being developed, to be made available in low-income countries “so as to inform treatment decisions and preserve the efficacy of any new antibiotic drugs for TB.”

The report was published in the Lancet Respiratory Medicine on World TB Day – 24 March.

Meanwhile, according to Medecins Sans Frontieres (MSF) Access Campaign fewer than five percent of people with multi-drug resistant Tuberculosis have access to new medicines, four years after these medications were released.

“It’s downright disheartening that, with hundreds of thousands of people living with deadly drug-resistant tuberculosis, only 4,800 people last year received the two new drugs that could dramatically increase the number of lives saved,” said Dr. Isaac Chikwanha, TB advisor for MSF’s Access Campaign.

“Our first major problem is that pharmaceutical corporations are not even registering important new drugs in some of the countries hardest hit by TB; The next major problem is their high price,” said Dr. Chikwanha.

“People with drug resistant TB who don’t have access to the two new drugs continue to be treated with older, more toxic regimens that cure only 50 percent of people treated and cause severe side effects ranging from severe nausea to deafness to psychosis,” said MSF Access.

Dr Margaret Chan, Director General of the World Health Organization recently told IPS at a press conference on antimicrobial resistance that “there is no denying the fact that TB is a top priority for the world.”

She says that there are two high level meetings planned in 2017 and 2018 to “shine a light on TB” and give it “the political attention and the investment in research and development that it deserves.”

However according to both MSF Access and the new Lancet study, research and development alone, though needed, is not enough to address the shortcomings in the global response to TB and Antimicrobial Resistance without a matching political response.

In a comment article published alongside the new Lancet study David W Dowdy from Johns Hopkins Bloomberg School of Public Health said that the difference between “a drug-resistant tuberculosis epidemic of unprecedented global scale” or “an unprecedented reversal of the global drug-resistant tuberculosis burden,” falls largely to whether there is “political will to prioritise a specific response to the disease.”

By Martin Khor
GENEVA, Apr 10 2014 (IPS)

The growing crisis of antibiotic resistance is catching the attention of policy-makers, but not at a fast enough rate to tackle it. More diseases are affected by resistance, meaning the bacteria cannot be killed even if different drugs are used on some patients, who then succumb.

We are staring at a future in which antibiotics don’t work, and many of us or our children will not be saved from TB, cholera, deadly forms of dysentery, and germs contracted during surgery.

Martin Khor

The World Health Organisation (WHO) will discuss, at its annual assembly of health ministers in May, a resolution on microbial resistance, including a global action plan. There have been such resolutions before but little action.

This year may be different, because powerful countries like the United Kingdom are now convinced that years of inaction have cause the problem to fester, until it has grown to mind-boggling proportions.

The UK-based Chatham House (together with the Geneva Graduate Institute) held two meetings on the issue, in October and last month, both presided over by the Chief Medical Officer for England, Dame Sally Davies.

This remarkable woman has taken on antibiotic resistance as a professional and personal campaign. In a recent book, “The Drugs Don’t Work”, she revealed that for her annual health report in 2012, she had decided to focus on infectious diseases.

“I am not easily rattled, but what I learnt scared me, not just as a doctor, but as a mother, a wife and a friend. Our findings were simple: We are losing the battle against infectious diseases. Bacteria are fighting back and are becoming resistant to modern medicine. In short, the drugs don’t work.”

Davies told the meetings that antibiotics add on average 20 years to our lives and that for over 70 years they have enabled us to survive life-threatening infections and operations.

“The truth is, we have been abusing them as patients, as doctors, as travellers, and in our food,” she says in her book.

“No new class of antibacterial has been discovered for 26 years and the bugs are fighting back. In a few decades, we may start dying from the most commonplace of operations and ailments that can today be treated easily.”

At the two Chatham House meetings, which I attended, different aspects of the crisis and possible actions were discussed. In one of the sessions, I made a summary of the actions needed, including:

– More scientific research on how resistance is caused and spread, including the emergence of antibiotic-resistance genes as in the NDM-1 enzyme, whose speciality is to accelerate and spread resistance within and among bacteria.

– Surveys in every country to determine the prevalence of resistance to antibiotics in bacteria causing various diseases.

– Health guidelines and regulations in every country to guide doctors on when (and when not) to prescribe antibiotics, and on instructing patients how to properly use them.

– Regulations for drug companies on ethical marketing of their medicines, and on avoiding sales promotion to doctors or the public, that leads to over-use.

– Educating the public on using antibiotics properly, including when they should not be used.

– A ban on the use of antibiotics in animals and animal feed for the purpose of inducing growth of the animals (for commercial profit), and restrictions on the use in animals to the treatment of ailments.

– Promoting the development of new antibiotics and in ways (including financing) that do not make the new drugs the exclusive property of drug companies.

– Ensuring that ordinary and poor people in developing countries also have access to the new medicines, which would otherwise be very expensive, and thus only the very rich can afford to use them.

On the first point, a new and alarming development has been the discovery of a gene, known as NDM-1, that has the ability to alter bacteria and make them highly resistant to all known drugs.

In 2010, only two types of bacteria were found to be hosting the NDM-1 gene – E Coli and Klebsiella pneumonia.

It was found that the gene can easily jump from one type of bacteria to another. In May 2011, scientists from Cardiff University who had first reported on NDM-1’s existence found that the NDM-1 gene has been jumping among various species of bacteria at a “superfast speed” and that it “has a special quality to jump between species without much of a problem”.

While the gene was found only in E Coli when it was initially detected in 2006, now the scientists had found NDM-1 in more than 20 different species of bacteria. NDM-1 can move at an unprecedented speed, making more and more species of bacteria drug-resistant.

Also in May 2011, there was an outbreak of a deadly disease caused by a new strain of the E Coli bacteria that killed more than 20 people and affected another 2,000 in Germany.

Although the “normal” E Coli usually produces mild sickness in the stomach, the new strain of E Coli 0104 causes bloody diarrhoea and severe stomach cramps, and in more serious cases damages blood cells and the kidneys. A major problem is that the bacterium is resistant to antibiotics.

Tuberculosis is a disease making a comeback. In 2011, the WHO found there were half a million new cases of TB in the world that were multi-drug resistant (known as MDR-TB), meaning that they could not be treated using most medicines.

And about nine percent of multi-drug resistant TB cases also have resistance to two other classes of drugs and are known as extensively drug-resistant TB (XDR-TB). Patients having XDR-TB cannot be treated successfully.

Research has also found that in Southeast Asia, strains of malaria are also becoming resistant to treatment.

In 2012, WHO Director General Margaret Chan warned that every antibiotic ever developed was at risk of becoming useless.

“A post-antibiotic era means in effect an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”

The World Health Assembly in May is an opportunity not to be missed, to finally launch a global action plan to address this crisis.
(END/COPYRIGHT IPS)

Excerpt: