The United Nations General Assembly is the world’s leading policy making body. Since its foundation in 1945, most of the UNGA discussions focus on subjects like war and economics.
This year in its September meeting, world leaders at the UNGA discussed at length the global problem of antimicrobial resistance and deliberated on a broad, coordinated approach to address the root causes of this menacing healthcare issue. In its long history, this was only the fourth time the UNGA has deliberated on a health issue (previous issues were HIV, non-communicable diseases, and Ebola). In doing so, the UNGA placed the spotlight on one of the most pressing healthcare issues of our generation.
What choices do our doctors face
For many doctors in the clinic or in the emergency room, tackling patients who display clinical signs of infection leads to making some difficult choices. Firstly, identifying the microorganisms responsible for the infection could take a few days, that the patient may not have. Doctors are left one choice – hit the patient with the most potent available antibiotic which might cure the current patient but may cause the microorganism strain to acquire resistance to this antibiotic. For so many doctors around the world, choosing to safeguard the patient in front of them is creating havoc with future patients, many of whom are reporting rising resistance to antibiotics.
How bad is the situation?
A study by America’s Centres for Disease Control (CDC) found that the number of cases of sepsis rose from 621,000 to 1,141,000 between 2000 and 2008, with deaths rising from 154,000 to 207,000. In America, some 40m people are prescribed antibiotics for respiratory problems every year. In 2013, a paper published in the Journal of Antimicrobial Chemotherapy estimated that two-thirds of those people may well not have needed the antibiotics they got. In 2014 nearly 60% of samples of Escherichia coli, a common gut bacterium, collected from patients in the hospital were strains that could not be treated with penicillins. About 25% were resistant to one or both of two other commonly used sorts of antibiotics.
It is expected that ten million people will die each year of drug resistance in illnesses by 2050.Click To Tweet This projection is much more than the 7 million people that die annually from ischemic heart disease, the leading cause of mortality globally. Deaths linked to antimicrobial resistance in 2050 could cause Gross Domestic Product to fall by 2-3.5%, costing the world up to $100 trillion.
Projected global GDP loss linked to antibiotic-resistant infections, Credit Review on Antimicrobial Resistance
This is a problem very much in our front yard and one that will impact all global citizens equally, irrespective of incomes and classes. We won’t have to wait for exotic and complicated infections to hit us. Common and life-threatening infections like pneumonia, gonorrhoea, and post-operative infections, as well as HIV, tuberculosis and malaria will increasingly become untreatable because of AMR. Elective surgery, such as hip replacements, now routine, would come to carry what might be seen as an unacceptable risk. So might Caesarean sections. The risks of procedures which suppress the immune system, such as organ transplants and cancer chemotherapies, would increase.
Left unchecked, anti-microbial resistance is predicted to have significant social, health security, and economic repercussions that will seriously undermine the development of countries.
Solutions to address the challenges
Most solutions focus on the demand and the supply side of addressing rising antimicrobial resistance. There should be an increasing effort to raise awareness amongst the general public. Simple measures like hand-washing, disinfecting surfaces and getting vaccinated go a long way to preventing infections. While doctors make decisions on antibiotic usage, patients must start asking if a prescription of an antibiotic is truly needed.
On the supply side, it is clear that greater intervention is needed in the form of incentives to promote the research and development of new classes of antibiotics, rapid diagnostics tests and other therapies.
There hasn’t been a new class of antibiotics discovered in decades. Some opinions hold that the pharmaceutical industry is increasingly focusing on high-value therapies like cancer and medicines for chronic conditions, that will allow them to sell medicines for a longer duration to patients. As we saw with the global response to HIV and the Ebola virus, its time now for constructing multi-sectoral public-private partnerships comprising the pharmaceutical, diagnostics and vaccine industries, medical experts, population health and policy makers amongst others.
An estimated 2000 people died yesterday of anti-microbial resistance. If we do not act today, up to 27,000 are expected to die daily by 2050. The global community has taken the lead in addressing the scourge of anti-microbial resistance – it is time for all of us to join the fight!
Dr Aakash Ganju is a healthcare consultant and entrepreneur, focused on increasing transparency, access, and convenience to health providers and consumers. He is the CEO of Mirai Health and lives in Mumbai, India.
UN General Assembly Press Release On “High-Level Meeting on Anti-Microbial Resistance”: 21 September 2016
Superbug Explosion Triggers U.N. General Assembly Meeting- Scientific American, Public Health: 7 Sep 2017
Antibiotic Resistance- The grim prospect; The Economist: 21 May 2016
Meet the economist taking on drug-resistant superbugs; Wired Health: 04 Apr 2016
Resistance to antibiotics- The other global drugs problem; The Economist: 24 Sep 2016