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The campaign for global antibiotic awareness

Recognition of the problem of antibiotic resistance — where antibiotics lose their efficacy against the bacteria that cause infections in humans and animals — has never been greater among policy makers, scientists and physicians.

Antibiotics are used to prevent infection and treat diseases in livestock and fish. Often an entire batch of animals/fish is treated if a single member is found to be ill. Photo: Reuters

Antibiotics are used to prevent infection and treat diseases in livestock and fish. Often an entire batch of animals/fish is treated if a single member is found to be ill. Photo: Reuters

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Recognition of the problem of antibiotic resistance — where antibiotics lose their efficacy against the bacteria that cause infections in humans and animals — has never been greater among policy makers, scientists and physicians.

The World Bank published a report in September that stated that drug-resistant infections could cause economic damage similar to or worse than the 2008 global financial crisis by 2050, estimating — among other things — that annual global GDP would fall between 1.1 per cent to 3.8 per cent, and that global healthcare costs could increase between US$300 billion (S$415 billion) to more than US$1 trillion per year.

These estimates matched a 2014 independent report from the Review on Antimicrobial Resistance commissioned by then British Prime Minister David Cameron, which in addition had predicted that by 2050, 10 million people a year would die due to infections caused by drug-resistant bacteria (the review estimates the current death toll at 700,000 a year).

At the recently concluded United Nations General Assembly in September, world leaders unanimously pledged to combat this issue and to develop national action plans that will monitor the extent of antibiotic resistance and misuse, as well as provide stronger regulatory systems to reduce antibiotic misuse in human health and agriculture.

Yet, the way forward is by no means straightforward or smooth. Government action alone is insufficient to alter a culture where antibiotics have become just another commodity, prescribed (or requested) incautiously for viral infections.

Because of the increasing global demand for cheap animal protein, livestock and fish are commonly raised in crowded, confined spaces, resulting in intense pressure on agricultural workers to prevent infection. Antibiotics are used in multiple ways in these livestock and fish, including prevention of infection (prophylaxis), treatment of disease — often an entire batch of animals/fish is treated if a single member is found to be ill (metaphylaxis), and in small sub-therapeutic doses that function as growth promoters. The bulk of antibiotics used in livestock fall into this last category.

Antibiotic use in agriculture is difficult to measure but has been estimated to exceed human prescription by far. In the United States, for instance, up to 80 per cent of all antibiotics sold are used in livestock.

A substantial proportion of antibiotics used in food animals and fish are also used in humans (the so called “medically important antibiotics”), and the resulting drug-resistant bacteria generated in livestock can and have been transferred to humans via various routes.

Only the European Union has succeeded in passing laws that ban the use of all antibiotics as growth promoters since 2006. A powerful agricultural lobby has blocked similar legislation from being passed in the US since 2007. The issue is complicated by the belief that antibiotic use in agriculture can only be safely reduced in high-income countries, whereas attempts to do so in farms in low- and middle-income countries would compromise output. Hence the governments of low- and middle-income countries are reluctant to pass such laws at present.

Crucially, there is now a global campaign to heighten the public appreciation of antibiotics as a finite and valuable resource: World Antibiotic Awareness Week, an annual event supported by the World Health Organisation (WHO) will be held from Nov 14 to 20.

The weeklong observation “aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers and policymakers to avoid the further emergence and spread of antibiotic resistance”.

It arose as a merger of several inter-related campaigns in different parts of the world over the past decade, including the Get Smart About Antibiotics Week in the US, European Antibiotic Awareness Day, Canadian Antibiotic Awareness Week and Australian Antibiotic Awareness Week. Each of these campaigns had received strong support from the respective governments, with reams of material developed for the education of both the public and healthcare workers, as well as good media coverage and publicity.

CULTURE CHANGE NEEDED

Singapore has never had an independent antibiotic awareness campaign, although healthcare workers and academics in several local institutions had previously organised small-scale observances in their institutions.

This year, besides the many events in local hospitals, researchers from the NUS Saw Swee Hock School of Public Health will also be carrying out a series of public awareness and education activities such as teaching children about antibiotics, hand hygiene and bacteria at the Jurong Regional Library between Nov 12 and Nov 18.

For the next and subsequent years, more public activities can be organised during World Antibiotic Awareness Week as public support and recognition increases.

Ultimately, however, the key is culture change. There is a need for more public education for a mindset change on the use and misuse of antibiotic resistance. This will lead to more innovative solutions to various aspects of the problem.

What can an individual do today? Besides obvious actions such as maintaining good health and hygiene, avoid asking for antibiotics for common coughs and colds, question physicians who liberally prescribe antibiotics to oneself or one’s family members, get vaccinated annually against influenza, and get educated about the various issues surrounding antibiotics.

Currently, “antibiotic-free” meat in Singapore is priced at a premium (although, as with most food labels, it is difficult to ascertain the veracity) and is beyond the means of most to buy on a regular basis. However, increased demand, as with organic foodstuff, will inevitably spur more suppliers to enter the market and drive prices down.

ABOUT THE AUTHOR:

Associate Professor Hsu Li Yang leads the Antimicrobial Resistance Programme at the NUS Saw Swee Hock School of Public Health

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