The Global Threat of Antibiotic Resistance: a development and aid issue
MT Bejarano. MD,PhD Sida. Unit for Research Cooperation
Antimicrobial resistance (AMR)
Antiviral agents
e.g drugs for HIV, FLU, Herpes
Antiparasitic agents
e.g drugs for malaria, leishmaniasis
Antibacterial agents =Antibiotics e.g. drugs for TB and other bacterial infections
Antifungal agents
e.g drugs for Candidiasis
Bacteria and us • Babies: sterile in uterus
• colonized with bacteria during the 1st months
• Adults have 2 Kg bacteria in body
• 10 times more bacteria than human cells
• >1,000 different species of bacteria in intestine
What is Antibiotic resistance?
The ability of bacteria to avoid the harmful
effects of an antibiotic
The survival of the fittest
ANTIBIOTICS
• Underpin health care
• A non-renewable resource
• Most falsified medicines (28% global falsified medicines)
Antibiotic Resistance is a Global Threat
“If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era.” Dr M Chan. DG WHO; March 2012
How did we end up here?
Agri/Aqua/culture- veterinary
Prescription, patient pressure, OTC sales
Water, Soil, Waste
Travel, migration, trade
Patient movement. hosp. cleanliness
Profit, scientific, regulations
Hu
man
s
Animals
Medicine
Environment
Globalization
Medical Tourism
R&D failure
ABR
Adapted from The Telegraph, 2014
What needs to be addressed
Science: 13 FEBRUARY 2015 • VOL 347 ISSUE 6223
Primary health care, Paediatric care and nutrition
• Lack of diagnostic tools in PHC and hospital settings
- Differential diagnosis of fever (bacterial vs viral)
- Access to culture and drug sensitivity tests
- Syndromic approach
=
Systematic and irrational use of antibiotics
China: Intravenous antibiotics for common colds
Yearly antibiotic use per capita Sweden :7 grams China :138 grams
Prescription, patient pressure, OTC sales
Larsson DGJ, de Pedro C, Paxeus N. 2007. Effluent from drug manufactures contains extremely high levels of pharmaceuticals. J Haz Mat. 148 (3), 751-755
Water, Soil, Waste
24 % of Swedish tourists carry multiresistant (ESBL E.coli) in the gut after coming home from holiday outside the Nordic countres
Resistant bacteria travel with us at an unprecedented speed
Tängden et al Antimicrob. Agents Chemother. doi:10.1128/AAC.00220-10
Travel, migration, trade
The antibiotic discovery void
Children with Acute Lower Respiratory Infections in Africa, Asia, Latin America: 404 Million antibiotic prescriptions could be avoided with a rapid test for bacterial infections
.
Lim et al. Reducing the global burden of acute lower respiratory infections in children: the contribution of new diagnostics. Nature, 2006.
NO DIAGNOSTIC TOOLS
GBD 2010 study. The Lancet 2012. WHO
And 1/10 of all global deaths
Bacterial infections account for ≈ 1/3 of all child deaths globally
630.000 children died of pneumonia in 2013
Sepsis in newborns in five countries in South Asia
(India, Pakistan, Afghanistan, Nepal, Bangladesh)
One child dies every five minutes because the
antibiotics given are not effective due to
bacterial resistance
Zulfiqar Bhutta presentation at ReAct conference Sep. 2010
“It is anticipated to be only a matter of time before gonococci with full resistance to the third-generation extended spectrum cephalosporins emerge and spread internationally. Consequently, gonorrhoea may become untreatable unless new drugs become available.” WHO AMR surveillance report 2014
Multi-drug resistant Tuberculosis
Adapted from Källander 2005
The inequitable and non-sustainable
use of a scarce global resource
Across developing countries only 1/3 children with suspected pneumonia receive ABs
Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children. New York, NY: United Nations Children’s Fund (UNICEF): June 2012.
Impact of ABR
ABR threatens disease treatments and medical
procedures
Why the global complacency ? • ABR has no disease or economic face • Scarce data on global antibiotic use global resistance levels and trends • Inadequate data on the global health and economic burden
• The global self-deception: There will always be new
antibiotics
Knowledge gaps
• Burden of ABR
• Global surveillance, standarization
• Health & economic burden
• Assess economic impact in health system and society
Minimize morbidity and mortality from bacterial infection implementation of interventions to reduce spread of bacterial infections e.g.
clean water , basic hygienic rules soap and alcoholic hand rub
Secure access to effective and affordable antibiotics • Make access to effective Abs
an aid issue ≈ to TB, malaria, HIV.
• address local realities of difficult access, poor quality of medicines
• New Abs part of essential medicines, subsidized by UHC schemes
Support countries in developing national coordinated policies and:
• Strengthen surveillance capacity
• Support regulatory authorities
• Support & institutionalize data collection of AB prescribing, dispensing and sales
• Educational and regulatory interventions in the health care system for rational prescribing of antibiotics
• Major changes in knowledge, understanding and
perception of antibiotics to reduce demand.
Reframing the issue
• Health and global security
• Access to effective antibiotics
• Antibiotics are lifesaving global public good not a commercial commodity
• Essential for any health system
• Universal health coverage
• Sustainable development
• Ecology/environment/Onehealth
Restoring balance
Antibiotic resistance will not go away……
Antibiotic Resistance
Caused by human activity and by over- consumption of a global resource A failure of public policy & global governance, health systems, research prioritization and the current market system It is a collective responsibility by governments, supranational organizations and individuals to take action
Nasa 1969: Earthrise over the moon from Apollo II