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Antimicrobial resistanceAntimicrobial resistance, or AMR, is a growing trend among newly discovered viruses. The World Health Organization (WHO) identifies 30 new diseases that threaten half the world’s population, which are particularly prevalent in developing nations.

Background of Antimicrobial Resistance

Drug-resistant diseases (AMR) have grown in prevalence over the past 40 years. Many of the medicines used to treat common infections like the flu and pneumonia have been around for decades. Eventually, viruses and bacteria develop their own microbial methods of fighting back against these drugs and inevitably become fully resistant to treatments.

Perhaps the most well-known example is the virus known as pneumococcus, or streptococcus pneumoniae. Penicillin has been used to treat pneumococcus since the early 1950s, giving it plenty of time to develop a strong resistance to the drug. Now, pneumococcus is practically untreatable, killing over 300,000 children below the age of 5 annually.

The CDC explains that germs that grow resistant to medications can be almost impossible to treat, often resulting in severe illness or death. This problem is only getting worse, as the U.N. finds that while 700,000 people die every year due to AMR diseases now, by 2050 that number will skyrocket to 10 million people.

The AMR crisis has severe economic implications as well. Antimicrobial diseases affect livestock as well as humans, leaving our international agricultural sector to collapse if not dealt with. All in all, the AMR crisis is projected to cause $100 trillion worth of global economic damage by 2050, only pushing people further into poverty.

Three organizations have stepped up to address the issue of antimicrobial resistance.

The AMR Action Fund

The AMR Action Fund is a financial project created by an international group of pharmaceutical companies. It aims to bring four new antibiotics that combat AMR to the consumer market by 2030. The fund expects to invest over $1 billion into late-stage antibiotic research by the end of 2025.

The AMR Alliance

The AMR Alliance is a massive coalition of more than 100 of the most powerful pharmaceutical companies, dedicated to fighting AMR. In 2016, the AMR Alliance signed the Industry Declaration, an agreement promising the development of anti-AMR medicines.

In 2018, the AMR Alliance spent a record $1.8 billion in the war against AMR. In 2020, the  AMR Alliance released its second progress report, detailing the progress made so far. The results are promising: 84% of relevant biotechnology companies are in the late stages of research and development for AMR cures and more than 80% of them have strategies in place for releasing the drugs.

UN Food and Agriculture Organization (FAO)

The FAO is taking serious steps to battle antimicrobial resistance. These dangerous antimicrobial superbugs threaten livestock in farms throughout the world. The FAO explains that two-thirds of future antimicrobial usage will be in livestock. These AMR superbugs will only increase in danger over time, as they develop stronger resistance to medicines.

The FAO has worked to improve agricultural practices across the world, specifically in developing nations. The FAO is raising awareness about this issue with rural farmers and is providing millions of dollars in funds to combat AMR.

World Antimicrobial Awareness Week (WAAW) is an annual campaign designed to increase awareness of the issue and encourage best practices among the general public, health workers, and policymakers to avoid the further emergence and spread of drug-resistant diseases. Over the week of November 18, millions of posts are made around the globe in support of antimicrobial resistance awareness. Expanding awareness is key, as the WAAW campaign website explains that less general use of antibiotics could help to mitigate the effects of this issue.

– Abhay Acharya
Photo: Flickr

self-medication
The connection between health and poverty is not a new one. The lack of access to healthcare, overcrowded healthcare facilities and the sometimes high costs of medications are major barriers for the poor to take appropriate steps to treat any health problems. Often, people turn to self-medication as an alternative to the expense of consulting a physician.

Paul J. Gertler, professor at the University of California Berkeley’s School of Public Health, said for the Washington Post, “Delaying medical care is a characteristic of poverty. For people living close to the edge, taking off a day to visit a doctor or staying home sick is literally taking food out of their mouths.”

It is no wonder that people facing such circumstances seek healthcare where they can get it cheaply. Sometimes this means going to a spiritual or traditional healer or taking the advice of family or friends. However, it can mean sharing medication, self-medicating or not completing a full-dose of a prescription so that it can be saved for another rainy day. These practices can be more dangerous than they seem.

Self-medicating can of course lead to using an incorrect medication, unsuitable for the medical condition, but it can also lead to overuse or underuse of the correct medication. A study based in a Nigerian community hospital concludes that a whopping 85 percent of the patients practiced self-medication and used an array of analgesics and anti-malarials either alone or in combination. According to Leadership, a local Nigerian newspaper, 75 percent of the populace rely on self-medication. This allows the market to flood with counterfeit drugs, low quality alternatives and charlatans selling ineffective herbal remedies.

From a public health point of view, incorrect usage of medication is a major cause of the rise in drug resistant infections. When patients do not complete a full dosage of antibiotics or use anti-malarials to treat unrelated infections, the disease-causing organisms have the chance to evolve to become resistant to these medications. Such resistant organisms then become untreatable and the resistant infection spreads among the population. Furthermore, the longer it takes to cure an infection due to use of incorrect medication, the higher the chances of an infection spreading.

The incorrect use of anti-malarials led to treatment failure and resistance to mainstay drugs like Chloroquine. This led to a shift in treatment policies worldwide and treatment with Artemisin Combination Therapy (ACT) began. Now, malarial infections resistant to ACT are spreading across Southeast Asia much faster than expected and can soon spread rapidly across the world if not contained. This story is frighteningly similar for a whole range of infections.

As science struggles to keep up with the evolution of drug resistance, policy can do its part. Increasing awareness and education about the disease causing organisms and the dangers of self-medicating is one approach. Improving infrastructure, the accessibility of healthcare facilities, resources at existing healthcare facilities and subsidies for medications will go a long way toward weaning the population away from self-medication.

There is another angle to this problem. In a survey in a district of Bangladesh, 100,000 doses of antibiotics were dispensed without a prescription. In Manila, Philippines, 66 percent of antibiotics were dispensed without a prescription. Heavily regulating pharmacies and preventing the sale of medication without a prescription can cut off one of the sources of self-medication.

More avenues will have to be explored to provide adequate healthcare and make good health a fulfilled right for each individual person so that the global population benefits.

Mithila Rajagopal

Sources: Annals of Ibadan Post-Graduate Medicine, Devex, Journal of the American Board of Family Medicine, Leadership, Malaria Journal, Washington Post
Photo: Flickr