Antibiotic Resistance as a development and aid issue

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

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