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UN Week – 4/4/2011

April 6, 2011

John and Douglas Carey, Editors,

Contents of this issue: concern over antibiotics.

          Thursday, April 7th, will be World Health Day. The World Health Organization (WHO) has issued the following warning:

“World Health Day 2011 is dedicated to antimicrobial resistance, a major threat to patient care and disease control throughout the world.    Antimicrobial resistance is a significant obstacle to success in controlling HIV, malaria and tuberculosis—three of the world’s leading infectious killers. This serious problem also makes it more difficult to treat hospital-acquired infections, facilitates the emergence of “superbugs” that are resistant to major antibiotics, and creates the need for new, more expensive and more complex treatments. 

“World Health Day 2011 seeks to raise awareness of factors that contribute to antimicrobial resistance, to build commitment to common solutions across diseases, and to encourage the implementation of policies and practices that can prevent and contain antimicrobial resistance.”

Antimicrobial resistance is a global problem that affects all countries. This year’s World Health Day on April 7th aims to make governments more aware of the problem and to encourage them to take measures to combat this global threat.

“[Antimicrobial resistance] is a real public health problem and it is emerging globally and in Europe. We have to do much more about it – both in the World Health Organization (WHO) and also in Member States,” says Zsuzsanna Jakab, WHO Regional Director for Europe. Jakab is well aware that the struggle against antimicrobial resistance in Europe requires continuous vigilance if problems such as drug-resistant tuberculosis are not to get worse. “This is the start of a process; we can and have to raise awareness among policy-makers and the public, and follow up with strategies after World Health Day,” Jakab says.

It is not the first time WHO has tackled the issue. In 2001, WHO released the Global Strategy for Containment of Antimicrobial Resistance, containing recommendations that countries could customize for their own use. But the launch in Washington DC coincided with the attacks of September 11th 2001 in the United States, and any momentum was lost in the subsequent turmoil.

For Dr Gerald Dziekan, from WHO’s Patient Safety Program, the 2001 initiative nevertheless provided a start for some countries in tackling the problem. “It certainly triggered the development of national plans in some countries, but all in all the response was quite weak in the sense of global awareness and coordinated action,” Dziekan says. One of the challenges governments face in Dziekan’s view is enforcing laws banning over-the-counter sales of antibiotics. “This is particularly difficult in [low- to middle-income] countries where there are often no doctors to prescribe medicines but people need to get the drugs somehow.”

But it is also in these countries where the problem is increasingly being felt. “Antibiotic resistance is not confined to the emergency rooms of rich countries in Europe and North America,” according to Anthony So, professor at the Sanford School of Public Policy at Duke University in the USA.

“It is a growing, global health problem that severely affects disadvan-taged populations in low-income countries,” So says, adding: “Children in Africa, Asia and Latin America suffering from pneumonia, meningitis or blood stream infections are often given old drugs rendered ineffective by resistance since they are the only available treatment options.”

A concerted effort on the part of regulatory authorities can have an impact, as shown in Chile, for example, where the mandatory prescription of antibiotics and the ban of over-the-counter sales has made a difference. Dr Luis Bavestrello, medical director of Clinica Reñaca in Viña del Mar in Chile, says that highlighting the risks of antimicrobial resistance in the media has paid off.

“Even if antimicrobial resistance is not considered a priority problem by the government, some suggestions are discussed and important measures have been taken,” says Bavestrello, who is also coordinator of the Anti-microbial Commission of the Chilean Infectious Diseases Society. He gives the examples of a nationwide surveillance program of antimicrobial resist-ance in hospitals and a national committee of representatives from medical communities and government ministries responsible for health and for agriculture.

As in Chile and India, medical communities in Kenya, for example, are also at the forefront of efforts to tackle the problem. “Doctors, pharmacists, other professionals and academics are aware of the antimicrobial resistance problem,” says Eric Mitema, professor of pharmacology and toxicology at the faculty of Veterinary Medicine at the University of Nairobi, adding: “These professionals make efforts to make the government aware of antimicrobial resistance.”

Even in western Europe, where countries such as Belgium and France have reduced the use of antibiotics, misuse continues. A few of these countries have policies on containing and preventing antimicrobial resistance. Campaigners praise Scandinavian countries such as Norway and Sweden for having done a lot to tackle the problem. They also cite the Netherlands as an example of a country with low prescribing of antibiotics and excellent guidelines on their use.

One of the most powerful measures globally to prevent antimicrobial resistance has been the ban of the use of antibiotics as growth promoters in livestock in the 27 European Union countries since 2006. The ban underlines the complex nature of the problem. “Antimicrobial resistance is a problem that goes beyond the health sector, so it is important to involve all sectors,” says Jakab. “Every government should have a national intersectoral plan on how to address the issue and respond to it.”

Clinicians agree that one of the biggest challenges is finding out the true size of the problem of resistant infections in each country. “We need better microbiology labs to test antibiotic resistance to infections but above all we need better data to inform policies,” says Professor Nirmal Ganguly, Chair of the Global Antibiotic Resistance Partnership – India National Working Group.

For some, simply restricting over-the-counter sales of antimicrobials does not go far enough, and they suggest that more is needed to curb the use of second-line antibiotics, which should be used to treat infections when first-line antibiotics fail and may be the last resort.

I hope this material will be found useful. For me, it is a worrisome revelation. All I know of the subject is that in our house we buy antibiotic-free roast chickens. Apparently that is only the beginning of the precautions we should be taking. There is much more to learn.

That’s all for this April 4th issue of United Nations Week: News and Views. We’ll be back with the next issue. Meantime do send along your own views on these or other UN-related issues, to

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