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United Nations sounds alarm bell on drug-resistant infections

United Nations sounds alarm bell on drug-resistant infections

According to a new report from a United Nations Committee, antibiotic resistance levels are at an all time high and are the reason behind common infections becoming difficult to treat. The report adds that simple life-saving surgeries are increasingly becoming risky and life threatening because of lack of post operative effective antibiotic coverage. The authors write that the resistance shown against antibiotics, anti-virals, anti-fungals and anti-protozoal drugs has become a global phenomenon and could be called a “global crisis”.

A One Health response to address the drivers and impact of antimicrobial resistance

The committee called the Ad hoc Interagency Coordination Group on Antimicrobial Resistance comprised on scientific experts and representatives of major UN scientific agencies. They gathered in March 2017 and were asked to prepare guidelines to tackle the global problem of antibiotic resistance. The team writes in their report published this week (29th April 2019)  that antibiotic and other drug resistance is directly responsible for around 700,000 deaths annually per year. Of these 230,000 deaths occur due to multidrug-resistant tuberculosis. They speculate that if action is not taken, by 2030, drug resistant illnesses could lead to around 10 million deaths each year. The US Centers for Disease Control and Prevention (CDC) also adds that antibiotic resistant infections affect around 2 million Americans each year and of these 23,000 deaths are seen.

The report emphasizes on steps to prevent resistance not only among humans but also among animals and plants by preventing misuse and overuse of the existing antimicrobial agents. This is the first step to reducing resistance they write. They add that risk factors for spread of antimicrobial resistant pathogens include poor infection control, poor hygiene, poor sanitation, lack of access to clean water, lack of disease and infection prevention, lack of adequate and timely healthcare, inadequate vaccination, lack of diagnostic facilities, malnutrition, food safety and lack of good waste management systems etc.

The Interagency Coordination Group writes that to address antimicrobial resistance the united efforts should be clean water, food safety, good sanitation, sustainable production and consumption and improved health. The report emphasized on “One Health”. According to the World Health Organization (WHO), to combat antimicrobial resistance more antimicrobial drugs should be developed. The agency says that there are several drugs that are being developed but of these only around 14 percent would actually be deemed safe and effective to be used in humans.

This present report recommends five steps to combat antimicrobial resistance. These steps include;

  • Implementation of One Health National Antimicrobial Resistance Action Plans on a more aggressive and prioritized mode
  • Development of new antimicrobials
  • Collaboration for more effective joint global action. Global awareness
  • Investment for sustainable response to antimicrobial resistance and phasing out indicrimate use of antibiotics in agriculture
  • Global governance, regulatory actions and improving accountability

Tedros Adhanom Ghebreyesus, WHO Director-General and Co-Chair of the IACG, on the report made a statement saying, “We are at a critical point in the fight to protect some of our most essential medicines. This report makes concrete recommendations that could save thousands of lives every year.”

Amina Mohammed, UN Deputy Secretary-General and Co-Chair of the IACG, in a statement said, “Antimicrobial resistance is one of the greatest threats we face as a global community. This report reflects the depth and scope of the response needed to curb its rise and protect a century of progress in health. It rightly emphasizes 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.”

José Graziano da Silva, Director-General of the Food and Agriculture Organization of the United Nations (FAO) added, “The report’s recommendations recognize that antimicrobials are critical to safeguard food production, safety and trade, as well as human and animal health, and it clearly promotes responsible use across sectors. Countries can foster sustainable food systems and farming practices that reduce the risk of antimicrobial resistance by working together to promote viable alternatives to antimicrobial use, as laid out in the report’s recommendations.” Dr. Monique Eloit, Director General of the World Organisation for Animal Health (OIE) in her statement added, “Antimicrobial resistance must be addressed urgently, through a One Health approach involving bold, long-term commitments from governments and other stakeholders, supported by the international organisations. This report demonstrates the level of commitment and coordination that will be required as we face this global challenge to public health, animal health and welfare, and food security. We must all play our part in ensuring future access to and efficacy of these essential medicines.”

Antimicrobial resistance anecdotes

At present the CDC says that the United States is facing three urgent threats from antimicrobial resistance. These include;

  • Clostridium difficile or C. Diff that can cause life threatening diarrhea and colitis. This infects around 50,000 patients annually and kills around 15000.
  • Carbapenem-resistant Enterobacteriaceae (CRE) – also called “nightmare bacteria” that affects 9000 people each year killing 600
  • Neisseria gonorrhoeae – or drug resistant gonorrhoea infection that affects 246,000 people annually

Recently the WHO has updated the treatment guidelines for gonorrhoea, chlamydia and syphilis to accommodate antimicrobial resistance.

Malaria and tuberculosis too have been increasingly developing resistance against first line drugs. The WHO says that in 2016 resistance to the first-line treatment for P. falciparum malaria (artemisinin-based combination therapies) has been reported from 5 countries of the Greater Mekong sub-region (including Cambodia, Myanmar, the Lao People’s Democratic Republic, Thailand and Viet Nam). A “WHO Strategy for Malaria Elimination in the Greater Mekong subregion (2015-2030)” has begun in all the five nations and in China. Drug resistance against HIV is also becoming a major concern worldwide. The WHO has launched a new “Global Action Plan for HIV Drug Resistance (2017-2021)” to prevent drug resistance against HIV.

Since November 2015 an antibiotic awareness week is being observed, the theme being, “Antibiotics: Handle with care”. The WHO has a support system called the Global Antimicrobial Resistance Surveillance System (GLASS) to collect information regarding analysis of data on antimicrobial resistance and its sharing and global level decision and policy making. The WHO has a Global Antibiotic Research and Development Partnership (GARDP) which is its joint initiative with Drugs for Neglected Diseases initiative (DNDi) which encourages research and development of new drugs to fight antibiotic resistant organisms.

In a study published this week in the journal Science and titled, “The challenge of antimicrobial resistance: What economics can contribute.” Authors Laurence SJ Roope and colleagues wrote that the “accelerating tide of antimicrobial resistance (AMR) is a major worldwide policy concern.” They called AMR a problem of a similar magnitude of climate change calling it a “tragedy of the commons”. They forecast that AMR could cost governments same as a “2 degree rise in global average surface temperature”. The authors in their paper suggest how economic concepts such as “externalities and the principal–agent relationship” could help understand and tackle the problem. They suggest providing incentives for new antibiotic development and improvement of antibiotic stewardship using financial regulations and mechanisms.

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