Last year, a 30-year-old teacher suffering from a severe bloodstream infection arrived in my emergency room for treatment. The woman had been in and out of local clinics with a stubborn chest infection and fever, and by the time I examined her, she was receiving chemotherapy for blood cancer.
Instinctively, I treated her infection with an antibiotic from a group of drugs known as “carbapenems,” strong medicines commonly prescribed to people who are hospitalized, but after further tests, I discovered that she was carrying a strain of bacteria that is resistant to most antibiotics in our therapeutic arsenal. There was no option but to treat her with drugs that I knew would be largely ineffective; she was lucky to recover.
UNRESPONSIVE
Illustration: Yusha
Sadly, many patients are not so fortunate. Around the world, people are being admitted to hospitals with infections that do not respond to antibiotics, and relatively benign germs — like Klebsiella and Escherichia coli — have become potent killers, shrugging off medicines that in the past easily contained them.
Antibiotics are different from almost every other class of drug in one important and dangerous respect: The more they are used, the less effective they become. When microbes are repeatedly exposed to antibiotics, the bacteria eventually win.
Each year, an estimated 750,000 people die from antimicrobial-resistant (AMR) infections, and the death toll will climb unless the global health community acts decisively.
‘SUPERBUGS’
In the absence of detailed and reliable reporting from all countries, the British government commissioned a series of reports on AMR, estimating that by 2050, as many as 10 million people could die annually from AMR complications. Moreover, the economic impact of “superbug” outbreaks could top US$100 trillion; low-income countries would suffer disproportionately.
Uneven and unregulated antibiotic usage is one of the most important reasons behind the AMR crisis. In developed countries, doctors prescribe antibiotics for even the most basic maladies, like the common cold. Stronger regulations of antibiotics prescriptions in these countries, like those implemented in Finland several decades ago, could help to mitigate resistance.
Yet such rules alone will not be enough, because in much of the developing world, antibiotics can be obtained without a prescription. Inequalities in access to medicine, excessive use and poor sanitation services complicate the problem further. And when farmers use antibiotics to speed the growth of chickens and other livestock, drug-resistant germs find new ways to enter the environment.
GUIDANCE
In an effort to address these challenges, the WHO last year classified antibiotics into three groups and issued guidance for how each class of drugs should be used to treat 21 of the most common infections.
For example, the first of these groups consists of medicines that should always be available to patients, preferably by prescription. Amoxicillin, the preferred medicine for respiratory-tract infections in children, is in this group. The second tier includes carbapenems, which, as my patient last year discovered, are increasingly ineffective. And the third group, including colistin and other “last resort” antibiotics, are drugs that must be used sparingly and only for medical emergencies.
Clearly, guidelines are an important first step in addressing the global AMR challenge, but governments, medical associations and hospitals must also commit to tackling the antibiotic crisis together. That is what the healthcare community in India is doing.
STEWARDSHIP
In 2012, India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship. Last year, Indian Prime Minister Narendra Modi used his monthly radio address to urge doctors to join the effort.
Still, the AMR threat remains real; containing it will require concerted effort. In India, for example, we must implement the regulation, formulated by the Indian Ministry of Health, controlling over-the-counter sales of antibiotics. The WHO’s advice should strengthen support for this move.
India’s “Red Line” campaign — which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics — is a step forward.
Meanwhile, healthcare communities in advanced economies must find the political will to reduce unnecessary antibiotic use by people and in agriculture. “Last resort” antibiotics should never be used as growth promoters in livestock farming, but achieving this will require significant changes to current practices.
Superbugs should strike fear in doctors and patients everywhere, but fear cannot lead to paralysis. The next time a patient arrives in my ward with a treatable infection, I need to be certain that the medicine I prescribe will be effective. Luck should never play a role in a patient’s recovery.
Abdul Ghafur, an infectious disease consultant based in Chennai, India, is the coordinator of the Chennai Declaration.
Copyright: Project Syndicate
Recently, China launched another diplomatic offensive against Taiwan, improperly linking its “one China principle” with UN General Assembly Resolution 2758 to constrain Taiwan’s diplomatic space. After Taiwan’s presidential election on Jan. 13, China persuaded Nauru to sever diplomatic ties with Taiwan. Nauru cited Resolution 2758 in its declaration of the diplomatic break. Subsequently, during the WHO Executive Board meeting that month, Beijing rallied countries including Venezuela, Zimbabwe, Belarus, Egypt, Nicaragua, Sri Lanka, Laos, Russia, Syria and Pakistan to reiterate the “one China principle” in their statements, and assert that “Resolution 2758 has settled the status of Taiwan” to hinder Taiwan’s
Singaporean Prime Minister Lee Hsien Loong’s (李顯龍) decision to step down after 19 years and hand power to his deputy, Lawrence Wong (黃循財), on May 15 was expected — though, perhaps, not so soon. Most political analysts had been eyeing an end-of-year handover, to ensure more time for Wong to study and shadow the role, ahead of general elections that must be called by November next year. Wong — who is currently both deputy prime minister and minister of finance — would need a combination of fresh ideas, wisdom and experience as he writes the nation’s next chapter. The world that
Can US dialogue and cooperation with the communist dictatorship in Beijing help avert a Taiwan Strait crisis? Or is US President Joe Biden playing into Chinese President Xi Jinping’s (習近平) hands? With America preoccupied with the wars in Europe and the Middle East, Biden is seeking better relations with Xi’s regime. The goal is to responsibly manage US-China competition and prevent unintended conflict, thereby hoping to create greater space for the two countries to work together in areas where their interests align. The existing wars have already stretched US military resources thin, and the last thing Biden wants is yet another war.
As Maldivian President Mohamed Muizzu’s party won by a landslide in Sunday’s parliamentary election, it is a good time to take another look at recent developments in the Maldivian foreign policy. While Muizzu has been promoting his “Maldives First” policy, the agenda seems to have lost sight of a number of factors. Contemporary Maldivian policy serves as a stark illustration of how a blend of missteps in public posturing, populist agendas and inattentive leadership can lead to diplomatic setbacks and damage a country’s long-term foreign policy priorities. Over the past few months, Maldivian foreign policy has entangled itself in playing