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.”