Squash­ing the su­per­bugs

Financial Mirror (Cyprus) - - FRONT PAGE -

Cur­rent an­tibi­otics are be­com­ing in­creas­ingly in­ef­fec­tive, not only at fight­ing com­mon ill­nesses like pneu­mo­nia and uri­nary tract in­fec­tions, but also at treat­ing a range of in­fec­tions, such as tu­ber­cu­lo­sis and malaria, which now risk again be­com­ing in­cur­able. With the G-7 lead­ers hav­ing com­mit­ted, in a re­cent joint dec­la­ra­tion, to tackle ìan­timi­cro­bial re­sis­tanceî (AMR), it is time for the more in­clu­sive G-20 – and China, as it chairs the group for the first time – to take the fight to the next level.

Fail­ure to ad­dress AMR will af­fect ev­ery­one, re­gard­less of their na­tion­al­ity or their coun­try’s level of de­vel­op­ment. In­deed, by 2050, ten mil­lion peo­ple could be dy­ing as a re­sult of AMR, up from around 700,000 to­day, with China and In­dia each hous­ing about 1 mln suf­fer­ers. At that point, an es­ti­mated $100 trln in global GDP will al­ready have been lost.

No G-7 strat­egy, how­ever well crafted, can suc­ceed with­out the in­volve­ment of the rest of the in­ter­na­tional com­mu­nity. Af­ter all, if in­fec­tions travel with the peo­ple who carry them, so does re­sis­tance, mean­ing that the only so­lu­tion to AMR is a shared one. That is why mem­bers of the World Health Or­gan­i­sa­tion have agreed to im­ple­ment a ìglobal ac­tion plan on AMR,î and have called upon the United Na­tions to con­vene a high­level meet­ing of po­lit­i­cal lead­ers in 2016.

In this ef­fort, the emerg­ing economies – with their large pop­u­la­tions, ris­ing wealth, and grow­ing in­ter­na­tional clout – have a par­tic­u­larly im­por­tant role to play, with China lead­ing the way. We at the Re­view on An­timi­cro­bial Re­sis­tance (which I chair) have al­ready rec­om­mended such a role for China, in­clud­ing in dis­cus­sions with some Chi­nese pol­i­cy­mak­ers.

Be­tween now and 2016, the stage must be set for China to act. The G-7 coun­tries should drive this ef­fort for­ward by tak­ing con­crete steps to ful­fill the com­mit­ments they made in their joint dec­la­ra­tion.

One such com­mit­ment is to re­duce the use of an­tibi­otics in an­i­mal hus­bandry. Some Euro­pean gov­ern­ments have al­ready made sig­nif­i­cant progress in reg­u­lat­ing this prac­tice. The United States has been slower to act, but has lately made some im­por­tant pol­icy moves.

But per­haps the best way to change the way live­stock are raised is by putting pres­sure on ma­jor food com­pa­nies – a feat that con­sumers could achieve most ef­fec­tively. In­deed, ris­ing de­mand for health­ier foods, in­clud­ing an­tibi­otic-free meat, has al­ready com­pelled ma­jor foodindustry play­ers like McDon­ald’s, Costco, and KFC to de­clare their in­ten­tion to phase out an­tibi­otic-laden meat.

A sec­ond com­mit­ment in­cluded in the joint dec­la­ra­tion – to help en­sure that medicines are used only when they are needed – may seem ob­vi­ous, but in fact rep­re­sents a ma­jor prob­lem driv­ing AMR. The key to ad­dress­ing this prob­lem is to de­velop and im­prove ac­cess to rapid point- of-care di­ag­nos­tic tools.

Im­proved di­ag­nos­tic tech­nolo­gies are un­doubt­edly within the reach of the world’s top tech­nol­ogy firms. But they will in­vest only if they are con­fi­dent that health sys­tems will use their in­no­va­tions. If gov­ern­ments, say, man­dated that par­tic­u­lar di­ag­nos­tic tests must be con­ducted be­fore an­tibi­otics could be pre­scribed, com­pa­nies would have the nec­es­sary in­cen­tive.

Con­sider one of the most com­mon in­fec­tions: sore throats. Though they are of­ten vi­ral, rather than bac­te­rial, they are fre­quently treated with an­tibi­otics – an ap­proach that not only is in­ef­fec­tive, but also fu­els AMR.

A quick and easy swab test could solve this prob­lem – and, in­deed, one al­ready ex­ists. In a trial by a Bri­tish phar­macy chain (which, ad­mit­tedly, used a small sam­ple), the test re­duced the num­ber of an­tibi­otics con­sumed by nearly 60%. In­vest­ment in the de­vel­op­ment and de­ploy­ment of this tech­nol­ogy could lead to a sub­stan­tial de­cline in un­nec­es­sary an­tibi­otic treat­ments for sore throats, not to men­tion ease pres­sure on health sys­tems and save doc­tors’ time.

A third im­per­a­tive, rec­om­mended by the Re­view and recog­nised by the G-7, is im­proved sur­veil­lance of the spread of dru­gre­sis­tant in­fec­tions, par­tic­u­larly in de­vel­op­ing coun­tries, where such data is most sparse. On this front, our own gov­ern­ment is lead­ing the way, with Chan­cel­lor Ge­orge Os­borne pledg­ing in March to al­lo­cate £195 mln ($307 mln) to help emerg­ing coun­tries fi­nance the fight against AMR. Foun­da­tions are likely to pledge their own funds to this ini­tia­tive.

The world faces many chal­lenges and crises, vir­tu­ally all of which will de­mand strong po­lit­i­cal com­mit­ment and sig­nif­i­cant in­vest­ment to re­solve. But the fact is that, when it comes to AMR, gov­ern­ments have a rare op­por­tu­nity to pre­empt a ma­jor cri­sis, at a frac­tion of the cost of re­spond­ing to the cri­sis once it has es­ca­lated. In the scram­ble to ad­dress the re­cent Ebola out­break in West Africa, for ex­am­ple, the US alone had to con­trib­ute $5.4 bln in public funds. Add to that the sav­ings to health sys­tems and even em­ploy­ers, and con­certed ac­tion to com­bat AMR be­comes even more cost-ef­fec­tive.

That is why the G-7 gov­ern­ments should in­ten­sify their ef­forts to ad­dress AMR. And it is why China and the other emerg­ing economies should join the fight. To­gether, we can safe­guard the cu­ra­tive pow­ers of our medicines.

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