TODAY -

Fork in the road: Will we protect medicines that protect us or deal with incurable diseases?

Shobha Shukla *

 Will we protect medicines that protect us or deal with incurable diseases?



As the world observes the annual World Antimicrobial Awareness Week (WAAW) from November 18 to 24 2022, the spotlight is once again on preventing antimicrobial resistance that is not only devastating human health but also threatening the sustainability of our planet earth. Will we protect the medicines that protect us or lose them, resulting in diseases that become difficult or impossible to treat? "The answer my friend is blowing in the wind" as the legendary lyrics go.

What is antimicrobial resistance?

Antimicrobial resistance occurs when bacteria, viruses, fungi or parasites become resistant to, and hence no longer respond to the antimicrobials or drugs (antibiotics, antivirals, fungicides and parasiticides) used to treat the diseases caused by them. While antimicrobials are the backbone of modern medicine, their misuse and overuse in humans, animals and plants is driving the emergence and spread of antimicrobial resistance, making it difficult or even impossible to treat infections, increasing the risk of disease spread, severe illness and death.

Progress on all SDGs threatened by antimicrobial resistance

Antimicrobial resistance is not only causing a huge loss of human life (contributing to over 6 million deaths every year directly and indirectly) but also posing a crippling mountainous economic burden, said Dr Haileyesus Getahun, who is the Director, Global Coordination and Partnership on antimicrobial resistance, and also the Director, Quadripartite Joint Secretariat on antimicrobial resistance at the World Health Organization (WHO). Dr Getahun was the inaugural speaker at a recently concluded 2nd Annual Global Media Forum in lead up to 2022 World Antimicrobial Awareness Week.

According to a 2017 World Bank report, if no action is taken now, antimicrobial resistance is likely to cause an USD 1.2 trillion additional health expenditure per year by 2050, and push up to 24 million additional people (particularly in low-income countries) into extreme poverty by 2030. Dr Getahun warned that antimicrobial resistance can directly affect progress on at least 6 of the 17 UN Sustainable Development Goals and can be linked indirectly to the remaining 11 as well.

Inequity also ails antimicrobial resistance

As the burden of antimicrobial resistance is greatest in low-resource settings, particularly in sub-Saharan Africa, and South Asia, it is not only a global public health problem, but also an issue of health equity and socioeconomic development, says Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit at the World Health Organization (WHO). Along with ensuring a rational use of antibiotics “having access to clean water, sanitation, and hygiene, as well as good infection prevention and control measures, such as hand washing and vaccination, are vital in the fight against antimicrobial resistance,” he emphasises.

One Health approach is vital to address antimicrobial resistance

Humans, animals, plants and environment are continuously interacting and sharing with each other the microbials that have become resistant to drugs. So curbing antimicrobial resistance to protect human lives is not possible without protecting the health of our plants, animals and environment.

Jacqueline Alvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP), rightly points out that “Antimicrobial resistance is both, a cause and a consequence of the triple planetary crisis of climate change, biodiversity loss and pollution and chemicals.”

Dr Getahun calls for increased financing, political advocacy and coordinated global action to better respond to the converging threats of antimicrobial resistance and the climate crisis before it is too late.

Scott Newman, Senior Animal Health and Production Officer for Asia and the Pacific at the Food and Agriculture Organization of the United Nations (FAO), stresses upon preserving antimicrobial efficacy while we sustain food and agriculture production.

"Loss of biodiversity and ecosystems, as well as of natural habitats for agriculture, has also led to an increase in antimicrobial use, and pathogen spread. We have to ensure that emergence and spread of antimicrobial resistance is slowed down across all food sectors (animal husbandry and agriculture). We need to switch to sustainable food production, by promoting climate-smart agriculture, agro-ecological approaches, nature-based solutions, and efficient and safe production methods biosecurity and disease prevention and control," added Scott Newman.

Antimicrobials cannot compensate animal husbandry practices

"Antimicrobials are also used to prevent infections in animals apart from their use in treating animal diseases. But we must note that antimicrobials used in animals to prevent infections, must not be done to compensate poor animal husbandry practices. Rather antimicrobials should only be used for infection prevention in animals, who are at risk of acquiring a specific infection or in a specific situation where infectious disease is likely to occur, if the drug is not administered," cautioned Delfy Gochez, Data Management Officer, antimicrobial resistance, and Veterinary Products Department, World Organisation for Animal Health (WOAH).

Jane Lwoyero, Technical Officer on antimicrobial resistance at the WOAH shared that in Africa, and globally, WOAH (World Organisation for Animal Health)’s strategy is followed by them to promote prudent use of antimicrobials. "We have also disseminated farm biosecurity guidelines in Kenya and Ethiopia to curb antimicrobial resistance. We also helped pilot the information and alert system for substandard and falsified veterinary products (during October – December 2021)" said Jane. "WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans."

Improve the basics to strengthen antimicrobial stewardship

"To contain antimicrobial resistance, we need better evidence, and evidence-backed actions; we need to improve diagnostic stewardship; we need to have good infection control practices in the hospitals and the community; and without these pillars – we cannot truly practice antimicrobial stewardship," said Dr Kamini Walia, Senior scientist, Indian Council of Medical Research.

"Diagnostic stewardship and infection control – both are significant challenges in our country because we have sub-optimal investment in the healthcare system, and we do not have good diagnostic laboratories in secondary and primary healthcare services (and good laboratories are essentially limited to tertiary care health services). Being a tropical country, we have a significant burden of infectious diseases. This further leads to sanitation and hygiene problems, and most of the antimicrobials which are prescribed are to compensate for poor sanitation and hygiene – both in communities and in hospitals. So, if we really want to make progress on antimicrobial stewardship we have to improve the basics, such as improving diagnostics, infection control, and other necessary actions," rightly added Dr Walia.

"Studies done in India show that almost half of all prescriptions audited in the study, were of antibiotics, and over 55% of antibiotic use was prescribed for uncomplicated respiratory symptoms. More alarmingly, less than 1% of these patients had any microbiological diagnosis done. Many of these prescriptions show the levels of inappropriate use or higher use of antibiotics. Also, over two-third of these drugs are available over the counter. We need to prevent over-the-counter dispensing of antimicrobials," said Dr Prapti Gilada-Toshniwal, senior microbiologist and founder head of UniLabs.

"We need stronger and practical antimicrobial stewardship programme for our context and ground realities so that we can effectively promote the appropriate use of antimicrobials (including antibiotics), improve treatment outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms," added Dr Prapti Gilada-Toshniwal. "We need to boost diagnostic capacities at all levels. Access to accurate, rapid, and point-of-care diagnostic facilities for different diseases and conditions, should be scaled up."

Clock is ticking

All this points towards the urgency of tackling antimicrobial resistance through an integrated and comprehensive response involving all the sectors, what is now referred to as the One Health approach. In the words of Dr Getahun, “One Health approach is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.”

Collaborative efforts are needed that involve public health, agriculture, animal husbandry and environment sectors, as well as whole of society approach, to effectively address the challenge of AMR and make economies resilient to its impacts.


* Shobha Shukla wrote this article for e-pao.net
The writer is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service)
and is a feminist, health and development justice advocate.
She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media).
Follow her on Twitter @shobha1shukla
This article was webcasted on November 26 2022.



* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • My Memories of Imphal #9 : Download
  • World Cancer Day at Imphal
  • COVID-19 Status 04 Feb : Govt of Manipur
  • 'Bihari parties' in Nagaland election
  • Love for Unity :: Poem
  • Mental Health & Social Policy at Meghalaya
  • Couch surfing !
  • COVID-19 : Impact in Manipur :: News Timeline
  • Manipur Fashion Extravaganza #5 :: Gallery
  • World Wetland Day @Keibul Lamjao: Gallery
  • COVID-19 Status 03 Feb : Govt of Manipur
  • Wild Edible Fleshy Fungi :: Book Review
  • World Wetlands Day at Keibul Lamjao
  • Cramps in legs and feet: What to do ?
  • Challenge for state in meeting JMM objective
  • Drug menace & the HIV reality
  • 74th Republic Day @ Kangla #2 :: Gallery
  • Chinese New Year @Bangkok 2023 :: Gallery
  • It's time for Wetlands restoration
  • Popularization of Science at Chandel
  • Aqua-based IFS model : Options
  • Want fabulous skin this Winter ?
  • Local contractor paying high price for past
  • Take the War on Drugs beyond
  • Sangai Fest: Anal Dance :: Gallery
  • COVID-19 Status 01 Feb : Govt of Manipur
  • International Bioresource Conclave
  • Chanchui Khayi wins Mega Miss NE 2022
  • Happiness :: Poem
  • Indispensable e-Governance but
  • Mass movement must to preserve forests
  • Reaching out to the interiors
  • Singcha Wuya Won @ Kamjong :: Gallery
  • 4 (Manipur) Battalion the Assam Rifles
  • COVID-19 Status 31 Jan : Govt of Manipur
  • Hazardous chemical contaminants in fishes
  • YouTube as a Career Choice
  • Indo-Naga Talks (2012-) :: News Timeline
  • My belated New Year resolution
  • Healthcare inadequacy hallmark of rural area
  • Incursion from across border
  • Puya Awareness / Exhibition :: Gallery
  • February Calendar for Year 2023 : Tools
  • COVID-19 Status 30 Jan : Govt of Manipur
  • Dealing with peer pressure: Tips for student
  • The inspiration to choose right
  • Sholas of Ootacamund
  • Critical analysis of reservation system
  • Manipur favourite destination for refugees
  • Disturbing call from Lamlongei
  • 74th Republic Day @ Kangla #1 :: Gallery
  • Whither women's reproductive health in Asia
  • COVID-19 Status 29 Jan : Govt of Manipur
  • Primary Health Center (PHC) at Tamei
  • Center Manager @ Imphal
  • IT Advance Trainer @ Imphal
  • Mealybugs & their biological control in NE
  • Namesake varsities exploiting education
  • Already 30 days into 2023
  • My Memories of Imphal #8 : Download
  • MaolKeki Foundation celebrates 5th Anniv
  • COVID-19 Status 28 Jan : Govt of Manipur
  • As a war rages...
  • Netaji Subhas Chandra Bose #2
  • Wakhal Eronba (Leela) #2 :: Gallery
  • Echoes of Higher Education in Manipur
  • COVID-19 Status 27 Jan : Govt of Manipur
  • National Tourism Day 2023
  • Multi-State Cooperative Seed Society
  • The Mute Tree :: Poem
  • Artificial Intelligence Weapons, World at risk
  • Axe falls on 5 as anti-drug drive intensifies
  • Imphal-Ukhrul road stretch
  • Barak Festival & Dam Plans: Contradictions
  • Sangai Fest: Thang Ta :: Gallery
  • COVID-19 Status 26 Jan : Govt of Manipur
  • Metamorphosis: 2023, Naga CM not need ...
  • History of Diabetes
  • Green Chemistry, for a sustainable world #2
  • Mr Imphal East Body Building :: Gallery
  • Taibang Keithel (2018) :: Review
  • Seiboi Singsit: Top achiever in Forest Dept
  • A Legal Discussion on "Frontier Nagaland"
  • Netaji & Dattatreya Hosabale
  • Thirukkural, the universal scripture
  • Perennial boundary row
  • Growing traffic congestion in Imphal
  • Support of all essential to win war on drugs
  • NH-102, part of Indo-Burma Road :: Gallery
  • Transforming education for Govt schools
  • COVID-19 Status 24 Jan : Govt of Manipur
  • Crying foul of officials of Forest Dept
  • Netaji Subhas Chandra Bose #1
  • Fish stock manipulation techniques #2
  • Workplace mental health matters
  • Education : Outside Manipur, why ?
  • Hand over case to CBI demand
  • Ibudhou Thangjing Lai Haraoba #7 :: Gallery
  • Swiss Artist in Manipur
  • Deepika Mayanglambam: Netaji Bose Award
  • COVID-19 Status 23 Jan : Govt of Manipur
  • Yes to: "Nagas Are Moving Ahead"
  • 4th Plenary Session of World Meetei Council
  • Tips for preventing cold weather acne
  • No time for verbal spat over drug issue
  • Louroi Festival @ Khurai #2 :: Gallery
  • COVID-19 Status 22 Jan : Govt of Manipur
  • Green Chemistry, for a sustainable world #1
  • Avatar of God :: Poem
  • ABHM appoints President for Northeast
  • A journey towards knowing ourselves
  • Follow up action - dismissal from service
  • More than half a century of Statehood
  • My Memories of Imphal #7 : Download
  • Tanthapolis Cinema at Sanakeithel
  • Nagas are moving ahead : A Commentary
  • COVID-19 Status 21 Jan : Govt of Manipur
  • Vermi with aquaculture for farmer's income
  • The shameful game behind the games
  • Sangai Fest: Basanta Raas #1 :: Gallery
  • My fear for Manipuri Khorirol
  • COVID-19 Status 20 Jan : Govt of Manipur
  • 50 years of NS films to be observed
  • Time to use election to defeat Status quoists
  • Courage Begets Crown :: Poem
  • RSS, Mohan Bhagwat's mind
  • Healthcare sector in hills on Govt radar
  • Bringing home the spirit of the WC
  • Tributes to Oja Naba Wareppa :: Gallery
  • COVID-19 Status 19 Jan : Govt of Manipur
  • Mishti Doi : Kolkata Diary
  • Fish stock manipulation techniques #1
  • Vibrant border villages: A 'game changer'
  • Keep your hands soft and smooth this winter
  • Success tale of Phalee village
  • Drugs and poppy in dry Manipur
  • Fish Fair @Hapta Kangjeibung #2 :: Gallery
  • The Sangai Film Festival, 2022
  • COVID-19 Status 18 Jan : Govt of Manipur
  • Missionaries left enduring righteousness
  • Transaction of budget & financial business
  • Reliance Foundation Youth Sports concluded
  • Improved highways perilous for rule resisters
  • An unlikely ally for ATSUM
  • Nupilan & its impact in Manipuri society
  • Romi Meitei's Eikhoigi Yum :: Review
  • COVID-19 Status 17 Jan : Govt of Manipur
  • Selected Screen Projects for Screen Lab
  • Moirang & Port Blair in freedom struggle #2
  • National Lok Adalat at Lamphelpat
  • 33rd Phek Area Sports Association Meet
  • Indian Army as a career choice
  • Multiple hurdles in battling drug menace
  • A process dating back to 1997
  • Louroi Festival @ Khurai #1 :: Gallery
  • South East Asian in performing art
  • COVID-19 Status 16 Jan : Govt of Manipur
  • BINER 2.0 @Manipur Tech Innovation hub
  • Frontier Nagaland- Marching toward Solution
  • Are our life predetermined by a higher power
  • The 108 Divya Desam Temples
  • Water crisis here to stay
  • Beyond arresting the 5 cops
  • 29th Imphal Book Fair Jan 15 2023 :: Gallery
  • 'Yumpham yaodaba / khudam leitaba wafamni'
  • Capacity Building program at Moreh
  • Health Technology : Can it solve health issues
  • A Sternly Life :: Poem
  • Sukrunye, festival of Chakhesang at Phek
  • Empowering through sex education #2
  • 'War on drugs' campaign winnable...
  • Second edition of the War on Drugs
  • My Memories of Imphal #6 : Download
  • Huidrom Nageshwar: Expedition to Antarctica
  • NNPG and NSCN joint statement
  • COVID-19 Status 14 Jan : Govt of Manipur
  • The Village Playground :: Poem
  • Diabetes treatment beyond medications
  • TN CM Stalin out to prove good politics...
  • Yaoshang Thabal competition #3 :: Gallery
  • 'Champions of Film Heritage Award'
  • COVID-19 Status 13 Jan : Govt of Manipur
  • BIG grant, Ideation to Proof of concept
  • Amit Shah poses teasers for Naga leaders
  • State delimitation & gerrymandering
  • Nail care in Winters
  • Half-hearted upgrade of DM University
  • Prohibition lifted, now what ?
  • Imoinu Erat Thouni #2 :: Gallery
  • Around the famous Loktak Lake!
  • Moirang & Port Blair in freedom struggle #1
  • COVID-19 Status 12 Jan : Govt of Manipur
  • NE India Launchpad 2.0 program
  • L Tonthoi: Best Female Actor @ GIFC
  • World Climate 2022, an overview
  • Drying up of Singda dam water fallout...
  • Shiv Sena: Hitting the right button
  • Nupilal Ningshing Lamjel #4 :: Gallery
  • COVID-19 Status 11 Jan : Govt of Manipur
  • Frontier Nagaland Movement- a better world
  • An introduction to Manipuri Vaishnavism #2
  • Buried Deep :: Poem
  • Empowering through sex education #1
  • Robert Memorial Badminton at Senapati
  • Firearms in the hands of reckless denizen
  • Lessons from the past
  • State Level Gaan Ngai #2 :: Gallery
  • Ima Savitri - Documentary film : Review
  • COVID-19 Status 10 Jan : Govt of Manipur
  • 'Chahi Taret Khuntakpa' at Cachar
  • Emerging Manipur peace, prosperity @growth
  • State of the States 2022: Manipur on top
  • War on Drugs mission far from being over
  • Of Leikhom, Leinang & Uphul, Waiphul
  • New Year picnic @Singda #2 :: Gallery
  • Sangai Festival: Sangai Dance :: Gallery
  • 50th years of Manipuri Cinema celebration !
  • Nations wished to no more have war
  • Emerging career options
  • Spike in vehicle sale: Traffic chaos imminent
  • Cong making the right noises
  • Tupul Landslide site construction :: Gallery
  • Addressing skill aspirations among adolescent
  • Shumang Leela Kumhei #1 :: Gallery
  • State Level Gaan Ngai #1 :: Gallery
  • Imoinu Erat Thouni #1 :: Gallery
  • Featured Front Page Photo 2022 #6: Gallery
  • Manipur Journalist Awards #2 :: Gallery
  • Dr Savitadidi N Mehta Museum :: Gallery
  • Ningol Chakkouba @ Pune :: Gallery
  • Linthoi Chanambam- Judo Player :: Gallery
  • Olympians & National awardees of Manipur
  • Downloadable Manipuri Calendar for 2023