Tack­ling drug-re­sis­tant in­fec­tions a pri­or­ity

To meet the AMR chal­lenge, we have to tackle short­falls in reg­u­la­tion of an­timi­cro­bial drugs that have re­sulted in their over-pro­duc­tion, over-pre­scrip­tion and over-use while of­ten be­ing of sus­pect qual­ity.

China Daily (USA) - - VIEWS -

While the last half cen­tury has seen ma­jor ad­vances in global health, new chal­lenges are now threat­en­ing these hard-won health gains. One of these is an­timi­cro­bial re­sis­tance (AMR), or drug-re­sis­tant in­fec­tions which can no longer be treated by an­tibi­otics and other an­timi­cro­bial drugs. AMRis on the in­crease glob­ally both in hu­mans and an­i­mals.

As a physi­cian I’mcon­cerned that if this trend con­tin­ues unchecked, many­common­in­fec­tions will again be­come un­treat­able. As a de­vel­op­ment pro­fes­sional, I’mwor­ried that the im­pact ofAMR­could also re­verse decades of hard-earned de­vel­op­ment gains.

Newre­search by the­World Bank, en­ti­tled Drug-Re­sis­tant In­fec­tions: A Threat to Our Eco­nomic Fu­ture, shows that by 2050, the cost of con­tin­ued in­ac­tion on AMR­would be higher than that of the dev­as­tat­ing fi­nan­cial cri­sis in 2008-09. Un­der a worst-case sce­nario, low-in­come coun­tries could lose more than 5 per­cent of their GDP. AMRunchecked could also cause 28 mil­lion peo­ple, mostly in de­vel­op­ing coun­tries, to fall into poverty by 2050. It could also di­min­ish ex­ports by as much as 3.8 per­cent, thereby re­duc­ing global trade. And health­care costs glob­ally could in­crease by $300 bil­lion to more than $1 tril­lion a year by 2050.

Live­stock, which are cru­cial to the diet and in­comes of the poor­est in de­vel­op­ing coun­tries, would also suf­fer as an­timi­cro­bial drugs cease to be ef­fec­tive and more an­i­mals will fall sick or die. The de­cline in global live­stock pro­duc­tion could range from 2.5 per­cent to 7.5 per­cent a year, with up to 11 per­cent de­cline in low-in­come coun­tries, ac­cord­ing to the re­port.

To meet theAMRchal­lenge, we have to tackle short­falls in reg­u­la­tion of an­timi­cro­bial drugs that have re­sulted in their over-pro­duc­tion, over-pre­scrip­tion and over-use while of­ten be­ing of sus­pect qual­ity. Ac­tion must ex­tend to the agri­cul­ture sec­tor to curb the wide­spread use of an­tibi­otics as growth pro­mot­ers for live­stock.

Too many of the poor— es­pe­cially chil­dren— in de­vel­op­ing coun­tries still lack ac­cess to life­sav­ing an­tibi­otics for con­di­tions such as pneu­mo­nia and di­ar­rhea. But this ac­cess agenda is be­ing threat­ened byAMRthat is re­mov­ing ef­fec­tive, low cost drugs to treat wide­spread in­fec­tions. For ex­am­ple, malaria deaths among chil­dren have plum­meted in re­cent years due in part to the artemisinin-based drugs dis­cov­ered by theNo­bel Prize win­ning Chi­nese sci­en­tist Tu Youyou, but re­sis­tance to artemisinin is grow- ing in theMekong sub-re­gion close to the bor­der with China. Strong stew­ard­ship is needed now to en­sure we do not lose one of the world’s most ef­fec­tive malaria drugs.

Clean wa­ter and san­i­ta­tion, as well as uni­ver­sal child im­mu­niza­tion that pre­vents com­mon in­fec­tions that would oth­er­wise re­quire an­tibi­otics, are top pri­or­i­ties in tack­lingAMR. En­hanced ef­forts are also re­quired to es­tab­lish surveillance ca­pac­ity for early de­tec­tion of re­sis­tant bugs in both hu­mans and live­stock. .

There is also an im­por­tant role for reg­u­la­tions and fi­nan­cial mea­sures. One pos­si­bil­ity is to in­cen­tivize farm­ers to use fewer an­tibi­otics in the meat in­dus­try and to pro­mote in­sur­ance cov­er­age against loss of live­stock to dis­ease out­breaks. An­other pos­si­bil­ity is to en­cour­age con­sumers to switch to an­tibi­otics-free meat or dairy prod­ucts, for in­stance by low­er­ing their rel­a­tive prices. China has a key role to play in these ef­forts. Its pork in­dus­try, for ex­am­ple, ac­counts for half of all global con­sump­tion, and con­tain­ing AMR do­mes­ti­cally would not only im­prove public health in China, but also make a ma­jor dif­fer­ence glob­ally.

In­vest­ing in pre­pared­ness for ma­jor in­fec­tious dis­ease out­breaks and im­prov­ing public and vet­eri­nary health sys­tems are some of the best ways to con­tainAMR. The World Bank is in­creas­ingly fi­nanc­ing these ca­pac­i­ties. For ex­am­ple, we have in­vested $1.3 bil­lion in the Global Avian andHu­man In­fluenza Pre­pared­ness Pro­gram, which helped 60 de­vel­op­ing coun­tries to im­prove their an­i­mal and public health sys­tems.

The good news is that we do not need a new magic cure, and we are not start­ing from scratch. The new re­port is a wake-up call. It makes abun­dantly clear that the cost of in­ac­tion is not af­ford­able — es­pe­cially for the poor­est coun­tries. We need to ur­gently change course to avert the com­ing cri­sis, and as a key eco­nomic power China has a spe­cial lead­er­ship role to play in this ef­fort. The au­thor is se­nior direc­tor, Health, Nu­tri­tion and Pop­u­la­tion, the­World Bank Group.


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