THERE is a threat to the future of humanity so silent that few people notice it, so pervasive that many families have suffered from it and so dangerous that it may soon be the leading cause of premature deaths worldwide.
If climate change has now become more obvious and visible as the No.1 risk to our civilisation, antibiotic resistance will soon rival it as the gravest threat to human life and health.
Many friends have told me of how their relatives have contracted infections while staying in hospitals and could not be cured with a normal dose of antibiotics. Some of them have died.
For example, the mother of a close friend of mine died from MRSA (methicillin-resistant Staphylococcus aureus) after a visit to the hospital for an unrelated minor ailment.
MRSA is an antibiotic-resistant pathogen that causes a variety of serious infections. It is well known for being spread in hospitals, but it is also a problem elsewhere in the community.
Resistance of bacteria to many antibiotics is growing. The genes of some bacteria that survive an antibiotic attack change and adapt to better defend themselves, and tougher new generations of these bacteria have become increasingly immune to the same or other antibiotics that are stronger.
Unfortunately, in the never-ending race between stronger bacteria and stronger medicines, the bacteria are winning.
The war zone is our bodies. The bacteria that survive, widely called “superbugs”, are growing and becoming more immune to antibiotics treating the same disease.
Their resistance genes can also spread to bacteria that cause other diseases, thus jumping species barriers and resulting in that resistance moving quickly to threaten our ability to treat many diseases.
In fact, there are specific genes that specialise in resisting antibiotics and jumping species barriers to enter other pathogens. These “jumping genes” are accelerating the problem.
In 2013, there were about 480,000 new cases of multidrug-resistant tuberculosis. There are high proportions of antibiotic resistance in bacteria that cause common infections like urinary tract infections, pneumonia and bloodstream infections in all regions of the world. Gonorrhoea is now almost untreatable in many countries.
The problem is not confined to antibiotics and resistant bacteria. Besides bacteria, there are other pathogens such as viruses that cause AIDS and hepatitis, and parasites which cause malaria that are treated by other anti-microbials.
These other microbes are also becoming resistant to medicines. For example, malaria is becoming more resistant to artemisinin-based therapy in some South-East Asian countries, and AIDS patients are increasingly not responding to first-line anti-AIDS medicines.
So, the problem of antibiotic resistance has now broadened to anti-microbial resistance (AMR) and the crisis now covers more people and more diseases.
At present, an estimated 700,000 people worldwide die annually from anti-microbial resistance. This number is projected to swell to 10 million deaths a year by 2050, according to a 2015 review on AMR commisioned by the British government.
The report also estimates that 300 million people will die prematurely because of drug resistance in the 35 years from 2016 to 2050 and that between now and 2050, the world could lose US$60 trillion to US$100 trillion (RM234 trillion to RM391 trillion) of economic output if AMR is not tackled. Most of the deaths and economic losses will be in developing countries.
Health leaders are finally sounding the alarm bell. Britain’s chief medical officer Dame Sally Davies has warned of a “catastrophe”.
Before her term as head of the World Health Organisation ended last year, Dr Margaret Chan spoke of the end of modern medicine in a post-antibiotics era, in which common infections such as strep throat or a child’s scratched knee could once again kill.
These warnings have come very late, but it is better late than never. In the 1980s, the Consumers’ Association of Penang (CAP), where I used to work, published studies on unethical marketing by drug companies of almost 20 medicines, which led to their inappropriate use and contributed to resistance. The health authorities took action by banning or restricting the sales of most of those medicines.
CAP also published a book in the mid-1990s titled Revenge of the Killer Germs, warning of the looming AMR crisis and calling for urgent action.
CAP was ahead of the curve and its warnings have been vindicated.
A recent international action is the 2015 Global Action Plan on AMR adopted by the World Health Assembly, which has spurred most countries to formulate their own national plans. Malaysia launched its AMR plan earlier this month.
Another action is the United Nations summit-level event on AMR in 2016, where heads of governments pledged to take action to address the crisis. This led to an inter-agency coordinating group that will come up with recommended actions in 2019.
At the national level, a lot more can be done, including surveillance and data collection, infection control, better diagnosis aided by diagnostic tools, introduction of many new regulations and guidelines on drug marketing, proper prescription and dispensing, and a policy ensuring that new antibiotics are freely or cheaply available to the public.
The recognition of AMR as a crisis is only at the beginning stage. Much needs to be done. Every day of delay will allow the bugs to become super-bugs and super-superbugs with dire consequences for all of us.
Martin Khor is executive director of the South Centre. The views expressed here are entirely his own.
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