As we stand over the threshold of the twenty-first century, ground breaking technological advancements and breakthroughs in the medicinal sector can be anticipated justifiably. Conversely there are many products and commodities that we have allowed to become an integral and irreplaceable part of our everyday proceedings. Antibiotics and their widespread consumption serve as indication enough of the mounting demand worldwide that will eventually reach a point where it will be unable to be met. Ironically, we are still using the same antibiotics that were discovered decades ago and little advancement has been made to counter the resultant repercussions. Resistance developed by bacteria on the micro level is proving to be an unprecedented, yet problematic issue. Two million illnesses are caused by antimicrobial resistance per annum, with approximately 23,000 deaths in the US; in Europe its 25,000; the overwhelming statistics of the developed world provide only an insight into the accentuating situation in the third world.
With the medicines that are used to treat and prevent bacterial diseases becoming increasingly ineffective, the prospects of global health, food security, and development are looking very abortive indeed.
An article published on 11 October 2016 by BBC about the approaching “antibiotic apocalypse” spurred rigorous global debate pertaining to the validity of this claim and the possibility of it coming about in reality. Despite wavering doubts regarding the repercussions, dosage only mounted: Saudi Arabia and South Africa top the list of consumption trends with 39,999 doses per 1000 people in 2015 followed by 20,000 in the USA, Egypt and South Korea. Generally, global antibiotic consumption has grown by 30% between 2000 and 2010, according to the Center for Disease Dynamics, Economics and Policy.
On 13 January 2017, the unprecedented was realized, when a 70-year-old woman in Nevada, succumbed to an infection after 26 antibiotics failed to be effective. The woman had repeatedly needed hospital treatment in India after breaking her right leg. An infection got into the bone and then spread to her hip. “She was seriously ill when she arrived in a US hospital – her immune system was going into overdrive in an attempt to fight the infection causing inflammation throughout her body.”
Incidents such as these make us question the advances we have made scientifically. Momentous achievements including the eradication of several fatal diseases highlighted the past decade, but many of these are beginning to resurface with unparalleled intensity. Tuberculosis was largely expelled from the western world, courtesy of the antibiotics Isoniazid, Rifampicin and Mycobacterium. An alarming increase in tuberculosis is noticed, resistant to both these antibiotics, emerging in parts of the world such as Papua New Guinea, India, China and Russia. Nicknamed ‘Ebola with wings,’ it is easily transmitted and chances of survival are 50%.
Up to 95% of adults in India and Pakistan carry bacteria that are resistant to β-lactam antibiotics — which include carbapenems, considered to be antibiotics of last resort according to Timothy Walsh, a medical microbiologist at Cardiff University. In the third word therefore, lack of sanitation can be plastered with the blame. When poorly filtered wastewater from hospitals escapes into waterways, many antibiotics are allowed to thrive. Consumption of contaminated water, in turn, provides an avenue for these to enter into the human body directly.
In China, however, hospitals and clinics receive financial incentives for prescribing, making over usage of antibiotics a result. In other countries pharmacies are allowed to sell antibiotics without prescription and outpatients resort to this source for treating diseases where these are not required, such as malaria.
While these countries believe in a free market capitalist economy where the private sector is given a free ticket to operate, the repercussions of this are sometimes overlooked in the efforts to sustain the public-private cooperation.
In Pakistan and the developing world, the future of antibiotics does not appear to be very promising. Resistance accounts for seventy-one percent of the newborn infections in Pakistan. Dr. Ejaz Khan, infectious diseases consultant at Shifa International Hospital spoke of how in around 50% of usual cases in the country, antibiotics are not optimally prescribed, and often when not needed, and in inappropriate dosage or duration.
According to a report by DAWN in 2015, the problem lies predominantly with acute lack of awareness of the local populace, as well as doctors and pharmacists. The spillover effects of this ignorance include lack of infection control measures at health facilities and increased over-the-counter sale of antibiotics and poor drug quality assurance.
Additionally, as Pakistan is characterized as a predominantly agro-based economy, the problem can be seen brewing in the farms as well. 15000 tons of antibiotics are used in the region, exclusively to boost livestock growth and for other purposes. With the resistance developing in the animals’ immune systems, it is inevitably transferred onto the human consumers’ body as a result.
But there are foreign and external factors contributing behind the scenes as well.
The pharmaceuticals industry is a big foreign exchange earner for first world countries where they are produced. Developing countries, where 70 percent of the world’s population lives, produce only 7 percent of the drugs they consume. This implies that a great amount of antibiotics is shipped into developing countries for the sake of economic benefit, overlooking the resistance that will result. Twenty multi-national companies dominate the particular market in Pakistan, making antibiotics and medicinal drugs very easily available for outpatients.
Living in the third world ourselves, we can relate to the fact that about half of all deaths in such countries are of children less than five years of age. Diarrhea, respiratory infections, and infectious diseases are the major causes of death and can be effectively controlled by inexpensive measures used in developed countries. Instead, the budgets of many people go to the purchase of expensive drugs often of dubious utility for the majority of the people.
So to say that we are in for a rather rude awakening would be quite an understatement. What a blow to twenty first century evolutions indeed.