Is now the time for urgent action on the misuse of antibiotics?
Total antimicrobial resistance is knocking on Europe's door. Is it time now for urgent and decisive action on the misuse of antibiotics?
Total antimicrobial resistance is knocking on Europe's door | Photo credit: Fotolia
In August 2016, researchers in China reported the occurrence of E. coli bacteria carrying the antibiotic resistant genes MCR-1 and NDM-1 in several locations across China. Later that month, a senior WHO expert revealed that similar bacteria had been found in the United States and Venezuela.
In November 2016, it was reported that comparable bacteria were recorded in Thailand. In each of these cases these last-resort antibiotics resistant bacteria were found in humans.
People infected with pathogenic bacteria carrying this combination of genes are virtually untreatable. This was confirmed by WHO Global Director for AMR Dr Marc Sprenger.
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- Glenis Willmott: AMR is a global problem requiring a global response
- Cristian-Silviu Bușoi: How can we make medicines work again?
Both an outbreak and a steady growth scenario of AMR are realistic. In June 2017, it was reported that a quarter of patients in a Guangzhou hospital had MCR-1, while several carried the NMD-5 gene as well. In China it is estimated that an outbreak would cost 467bn Yuan (€61bn) with an unknown number of victims.
The World Bank estimates that AMR could cost the global economy $120 trillion by 2050. They predict that the annual financial costs of AMR could be as large as the losses incurred during the 2008 global financial crisis.
England's Chief Medical Officer, Dame Sally Davies, warned that if we return to the pre-antibiotic era, "40 per cent of people will die of infections".
The UK Review on AMR estimates that by 2050, 300 million people will have died of AMR unless policies change now. Action is thus urgently needed to prevent such a catastrophic yet preventable man-made disaster.
German Chancellor Angela Merkel recently confirmed that the overuse of antibiotics in agriculture and aquaculture is the leading cause of AMR. Globally, it is estimated that livestock consume nearly two thirds of all antibiotics produced.
In Europe and the United States, 75 per cent of antimicrobials are used for agriculture. Most concerning is that compared to 2010, antibiotics use in agriculture is expected to further increase by 67 per cent by 2030. In the socially vulnerable BRIC countries, an increase of 99 per cent is expected.
The recently released WHO Essential Medicines List classifies colistin as a drug which can only be used for human health when nothing else works.
However, colistin is still widely used in animal husbandry, in Europe and globally. In 2013, 495 tonnes of lifesaving drugs were used in European agriculture, of which a majority was added to animal feed or water.
The low price of veterinary antibiotics, and frequent discounts, promote their continued overuse and the sale of antibiotics at prices far below the social and economic cost that wrongly-used antibiotics will wreck on society.
In anticipation of new laws and regulations, industries have started to offer discounts of up to 88 per cent on antibiotics for vets and up to 50 per cent for farmers. A recent Chinese report on the economic implications of AMR proposed levying a tax on veterinary antibiotics.
The UK Review on AMR and the World Bank have also proposed veterinary antibiotics taxes, as already implemented in Denmark and Belgium.
EU member states levy taxes on products with health risks such as tobacco, sugar, alcohol, and briefly even ice-cream to discourage overconsumption. All of these have a much lower impact on human health than antibiotics.
Total antibacterial Resistance is knocking on Europe's doors. The number of Europeans dying from AMR is growing, with the European Commission reporting that it currently accounts for an estimated 25,000 deaths per year across the EU.
Current worldwide mortality from AMR is estimated at 700,000. Inaction is projected to cause millions of deaths globally and by 2050 AMR has the potential to become a more common cause of death than cancer.
The time to stem the tide of AMR and prevent the proliferation of pan-resistant bacteria is now. The genie should not be out the bottle just to serve industrial interests.
Extensive surveillance programmes, production and distribution limits and/or taxes on antibiotics for any other use than to save lives, border controls, are needed now: if you cannot measure antibiotics use, you cannot manage it.
Presenting farmers with alternatives to antibiotics for health and growth promotion is paramount and the pharmaceutical industry must be encouraged to develop and sell new molecules for antibiotics unburdened by resistance.
Public funding can be made available if these industries stop selling antibiotics to vets and farmers for any other reason than to combat a disease. But substantial funding must be made available at the same time, for the development, production and introduction of feed additives for both land animals and fish farming that promote animal health and growth.
During the May 2017 G20 Health Ministers Summit in Berlin, German Health Minister Hermann Gröhe warned we are unprepared to deal with a health pandemic. AMR may be the challenge which proves him right.
TIME TO ACT:
WHO global director for AMR Dr Marc Sprenger, European health and food safety Commissioner Vytenis Andriukaitis and a range of high level speakers, including experts on ethics and morality, are set to debate what actions are required to tackle the scourge of antimicrobial resistance at an event in the European Parliament on 28 June.
Co-hosted by MEPs Adina-Ioana Vălean, Pavel Poc and Fredrick Federley, the event, “Scientific, human health, husbandry and Socio-economic aspects of antibacterial resistance: Time to act”, will hear from speakers from around the world on the challenges facing health authorities as they attempt to address the constantly increasing rate of antimicrobial resistance.
The event, co-organised by the PA International Foundation, will hear keynote addresses from renowned experts in the field of AMR, including Sarah Cahill, Food Safety Officer of the FAO, the Director and Deputy Director of the institute of animal sciences at the Chinese academy of agricultural sciences, Zhang Junmin, and Chen Jilan, Ramanan Laxminarayan, director of the center for disease dynamics, economics and policy and Diederik Standaert, head of management office, DG animal, plant and nutrition, Belgian Health Ministry, and Former Belgian national representative to the standing committee on plants, animals, food and feed and many more.
Venue: European Parliament A3E-2 28 June 2017 14.00-18.00 hours Click here for further information
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