We are facing a global health crisis, unlike anything in the last 75 years. COVID-19 is killing people, causing innumerable sufferings, and is turning lives upside-down. The coronavirus disease (COVID-19) has shaken the society to its core.
Earlier, people stated that the flu causes tens of thousands of deaths each year. So, why make COVID-19 such a big concern?
Globally, the World Health Organization (WHO) estimates that the flu kills 290,000 to 650,000 people each year.But till date, 560,000 people have lost their lives due to COVID-19 in a brief span of around 6 months since the very first death in early February.
Are you horrified by these figures? Wait, we have a more deadly problem in front of us.
So, let me introduce the greatest threat to Human-kind.
It’s Not Cancer.
And It’s Not AIDS
What about Tuberculosis? Nah, it’s not the deadliest disease.
The biggest threat to Human-kind is Antibiotic Resistance.
What is Antibiotic Resistance?
Antibiotic resistance is a condition when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs couldn’t be killed and hence continue to grow.
Why is Antibiotic resistance so Dangerous?
The infections caused by the antibiotic-resistant germs are very difficult, and in some cases even impossible to cure. In most cases, antibiotic-resistant infections require extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives.
Where buying antibiotics for humans or animals is possible without any prescription, the emergence and spread of antibiotic resistance is made worse. In countries without proper health care guidelines, antibiotics are over-prescribed by health workers and veterinarians; this leads to over-exploitation of antibiotics. Owing to this over-exploitation UN, international agencies and experts released a groundbreaking report which states that more than 10 million people will lose their lives each year by 2050 due to antibiotic resistance.
Antibiotic Resistance is a Threat to Everyone.
Antibiotic-resistant has the potential to affect anyone of any age, gender or race. While antibiotic resistance occurs naturally, the healthcare, veterinary and agricultural industries are making things even worse for people.
- Antibiotic resistance kills. Around 214,000 newborns are estimated to die each year due to sepsis (blood infections) caused by antibiotic-resistant bacteria- contributing to 30% of total sepsis-related deaths in newborns.
- Antibiotic resistance spreads rapidly throughout the world. More than 60% of the population in some areas carry multidrug-resistant bacteria in their normal bacterial flora.
- Treatment is expensive. The median overall cost to treat a resistant-bacteria infection is around $700, which is more than the yearly income of a daily wage worker in India. In some cases, the treatment may even amount to tens of thousands of dollars, making it unaffordable to a large population.
- Antibiotic resistance is already here. Resistance has already developed to the last-line treatment of gonorrhoea, which in many cases is untreatable. With around 106 million new cases per year, the consequences of total resistance would be ghastly.
Causes of Antibiotic Resistance
Lack of Surveillance in The Development of Antibiotic Resistance
While it is essential to maintain proper surveillance of antibiotic resistance development, in most of the developing countries, there is little to no such surveillance.
In 2014, the WHO collected national data on nine bacterial infections/antibiotic combinations of greatest concern for global health. The data revealed that out of 194 countries, only 129 provided data, of which only 22 had data on all nine infection-antibiotic resistance combinations deemed to be emerging global threats. The report not only highlighted the high levels of antibiotic resistance globally but also the lack of coordination and significant gaps in surveillance, especially in many of the developing countries with a high burden of antibiotic resistance from where no national data was obtained.
Poor Quality of Available Antibiotics
Many developing countries don’t have proper quality assurance mechanisms to ensure the quality of antibiotics supplied.
Sometimes, due to negligent behaviour of health services the expired antibiotics are also sold to the patients. The expired antibiotics poses an extra risk of 2-6 times causing antibiotic resistance.
While expiration date refers to the shelf life, it doesn’t talk about the active quality of the medication. However, high temperature, humidity and harsh sunlight degrade a large part of the drug. The tropical conditions of some countries cause the degradation of a large part of the drug during transportation. Hence, health-care workers remain unaware that the patient is receiving a subtherapeutic dose.
Many medications also get relabeled near the end of their shelf life and get donated rather than sold. Finally, counterfeit drugs, in which there is little to no active ingredient, are also sold and can lead to an increase in the development of drug resistance.
All of these facts underscore the need to improve quality assurance and enforcement of the antibiotic good manufacturing practice globally.
Clinical Misuse of Antibiotics
Clinical misdiagnosis and antibiotic misuse also contribute to antibiotic resistance. It has been shown that proper diagnostic methods are often not utilized when treating infections and therefore antibiotics are prescribed when not necessary.
As the private practitioners depend on both the patients’ fees and kickbacks that they receive from the pharmaceutical industries, they contribute much for resistant organisms and lead to increasing antibiotic resistance.
Over The Counter Sale
In most developing countries, there is little regulation on the retail of pharmaceuticals. The ease of availability of antibiotics is probably one of the biggest contributors to antibiotic resistance. Antibiotics are available often without a physician’s prescription, contributing to the overuse of antibiotics due to self-medications and prescriptions by unskilled health workers.
In many developing counties, especially rural areas there is a lack of trained medical practitioners. As a result, many unskilled health workers with minimal training as well as traditional healers treat ailments and prescribe antibiotics. Unskilled health workers and healers often have little to no understanding of the consequences of unregulated antibiotic use.
Poor Hospital-Based Antibiotic Use
Antibiotics are used extensively in hospitals to not just treat patients with bacterial infectious diseases but also prophylactically to reduce risk of infections during procedures and surgeries.
The excessive use of antibiotics coupled with close patient to patient interactions and the need for increased hygiene and sanitation within hospitals play a significant role in the development and transmission of drug-resistant bacterial infections.
Excessive Use of Antibiotics in Livestock Industries
The livestock industry has been debated for long enough of being the largest contributor to antibiotic resistance. Antibiotics are not only used to treat diseases in animals but also prophylactically to prevent infections and non-therapeutically to increase animal growth.
According to the FDA, in 2016, 96% of antimicrobials for medical and nonmedical use were sold over-the-counter without needing a veterinary prescription.
Due to the complex web of interactions between animals and humans, the infectious diseases and antibiotic resistance get transmitted from animals to humans. For instance, consumption of meat products contaminated with antibiotic-resistant pathogens can lead to outbreaks of resistant diseases. Even the contamination of animal faeces with drug-resistant species can also lead to eventual transmission to humans through soil and water.
Overall, this complex web of animal-human interactions leads to transmission of drug-resistant bacterial species into humans.
Response from WHO
World Antimicrobial Awareness Week
Held annually since 2015, WAAW is a global campaign that aims at increasing the awareness of antimicrobial resistance worldwide and to encourage best practices among the general public, health workers and policymakers to avoid the further emergence and spread of drug-resistant infections.
Antimicrobials are critical tools in helping to fight diseases in humans, animals and plants. They include antibiotics, antivirals, antifungals and antiprotozoa. WAAW takes place every year from 18 to 24 November. The slogan has previously been, “Antibiotics: Handle with Care” but changed to “Antimicrobials: Handle with Care” in 2020 to reflect the broadening scope of drug-resistant infections.
The Global Antimicrobial Resistance Surveillance System (GLASS)
The WHO-supported system takes a standardized approach to the collection, analysis and sharing of data related to antimicrobial resistance at a global level to inform decision-making, drive local, national and regional action.
Global Antibiotic Research and Development Partnership (GARDP)
A joint initiative of WHO and Drugs for Neglected Diseases initiative (DNDi), GARDP encourages research and development through public-private partnerships. By 2023, the partnership aims at developing and delivering up to four new treatments, through improvement of existing antibiotics and acceleration of the entry of new antibiotic drugs.
Interagency Coordination Group on Antimicrobial Resistance (IACG)
The United Nations Secretary-General has established IACG to improve coordination between international organizations and to ensure effective global action against this threat to health security. The IACG is co-chaired by the UN Deputy Secretary-General and the Director-General of WHO and comprises high-level representatives of relevant UN agencies, other international organizations, and individual experts across different sectors.
The 2019 AWaRe Classification Antibiotics
Improving the use of antibiotics through antibiotic stewardship is one of the key interventions necessary to curb the further emergence and spread of antimicrobial resistance (AMR). It is also important for ensuring appropriate treatment.
For that reason, WHO in 2017 introduced the Access, Watch, Reserve (“AWaRe”) classification of antibiotics in its Essential Medicines List. The classification is a tool for antibiotic stewardship at local, national and global levels to reduce antimicrobial resistance.
To Prevent and Control The Spread of Antibiotic Resistance, Individuals Should:
- Only use antibiotics when prescribed by a certified health professional.
- Never demand antibiotics if your health worker says you don’t need them.
- Always follow your health worker’s advice when using antibiotics.
- Never share or use leftover antibiotics.
- Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
- Prepare food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.
Health-care workers, policy-makers, pharmaceutical companies and individuals should take all the stringent measures in the hope of a better tomorrow; or should I say for a tomorrow at all?
In the end remember,
Time is running out.
Liked this article? Read another one: How Will COVID-19 Change Our Lives Forever?