Framing ABR as aid and development issue

1. The Global Threat of Antibiotic Resistance:
a development and aid issue
MT Bejarano. MD,PhD
Sida. Unit for Research Cooperation

2. Antimicrobial resistance (AMR)
Antiviral
agents
e.g drugs for
HIV, FLU,
Herpes
Antiparasitic
agents
e.g drugs for
malaria,
leishmaniasis
Antibacterial
agents
=Antibiotics
e.g. drugs for TB
and other
bacterial
infections
Antifungal
agents
e.g drugs for
Candidiasis

3. Bacteria and us
• Babies: sterile in uterus
• colonized with bacteria during the 1st
months
• Adults have 2 Kg bacteria in body
• 10 times more bacteria than human cells
• >1,000 different species of bacteria in
intestine

4. What is Antibiotic resistance?
The ability of bacteria to avoid the harmful
effects of an antibiotic

5. The survival of the fittest

6. ANTIBIOTICS
• Underpin health care
• A non-renewable resource
• Most falsified medicines (28% global falsified
medicines)

7. Antibiotic Resistance is a Global Threat
“If current trends
continue unabated, the
future is easy to predict.
Some experts say we are
moving back to the pre-
antibiotic era. No. This
will be a post-antibiotic
era.”
Dr M Chan. DG WHO; March 2012

8. How did we end up here?
Agri/Aqua/culture- veterinary
Prescription, patient pressure, OTC sales
Water, Soil, Waste
Travel, migration, trade
Patient movement. hosp. cleanliness
Profit, scientific, regulations
Humans
Animals
Medicine
Environment
Globalization
Medical Tourism
R&D failure
ABR
Adapted from The Telegraph, 2014

9. What needs to be addressed

10. Science: 13 FEBRUARY 2015 • VOL 347 ISSUE 6223

11. Primary health care, Paediatric care and
nutrition
• Lack of diagnostic tools in
PHC and hospital settings
- Differential diagnosis of
fever (bacterial vs viral)
- Access to culture and drug
sensitivity tests
- Syndromic approach
=
Systematic and irrational
use of antibiotics

12. China: Intravenous antibiotics
for common colds
Yearly antibiotic use per capita
Sweden :7 grams China :138 grams
Prescription, patient pressure, OTC sales

14. Larsson DGJ, de Pedro C, Paxeus N. 2007. Effluent from
drug manufactures contains extremely high levels of
pharmaceuticals. J Haz Mat. 148 (3), 751-755
Water, Soil, Waste

15. 24 % of Swedish tourists carry multiresistant (ESBL E.coli)
in the gut after coming home from holiday outside the
Nordic countres
Resistant bacteria travel with us at an
unprecedented speed
Tängden et al Antimicrob. Agents Chemother. doi:10.1128/AAC.00220-10
Travel, migration, trade

16. The antibiotic discovery void

17. Children with Acute Lower Respiratory Infections in
Africa, Asia, Latin America:
404 Million antibiotic prescriptions could be
avoided with a rapid test for bacterial infections
.
Lim et al. Reducing the global burden of acute lower respiratory infections in children: the contribution of new diagnostics. Nature,
2006.
NO DIAGNOSTIC TOOLS

18. GBD 2010 study. The Lancet 2012.
WHO
And 1/10 of all global deaths
Bacterial infections account for
≈ 1/3 of all child deaths globally
630.000 children died of pneumonia in 2013

19. Sepsis in newborns in five countries in South Asia
(India, Pakistan, Afghanistan, Nepal, Bangladesh)
One child dies every five minutes because the
antibiotics given are not effective due to
bacterial resistance
Zulfiqar Bhutta presentation at ReAct
conference Sep. 2010

21. “It is anticipated to be only a
matter of time before
gonococci with full
resistance to the third-
generation extended
spectrum cephalosporins
emerge and spread
internationally.
Consequently, gonorrhoea
may become untreatable
unless new drugs become
available.”
WHO AMR surveillance report 2014

22. Multi-drug resistant Tuberculosis

23. Adapted from Källander 2005
The inequitable and non-sustainable
use of a scarce global resource

24. Across developing countries only 1/3 children with suspected
pneumonia receive ABs
Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest
children. New York, NY: United Nations Children’s Fund (UNICEF): June 2012.

26. Impact of ABR

27. ABR threatens disease treatments and medical
procedures

29. Why the global complacency ?
• ABR has no disease or economic face
• Scarce data on global antibiotic use
global resistance levels and trends
• Inadequate data on the global health and
economic burden
• The global self-deception: There will always be new
antibiotics

32. Knowledge gaps
• Burden of ABR
• Global surveillance, standarization
• Health & economic burden
• Assess economic impact in health system
and society

33. Minimize morbidity and mortality from bacterial
infection
implementation of interventions to reduce spread of bacterial infections e.g.
clean water , basic hygienic rules soap and alcoholic hand rub

34. Secure access to effective and
affordable antibiotics
• Make access to effective Abs
an aid issue ≈ to TB, malaria,
HIV.
• address local realities of
difficult access, poor quality of
medicines
• New Abs part of essential
medicines, subsidized by UHC
schemes

35. Support countries in developing national
coordinated policies and:
• Strengthen surveillance capacity
• Support regulatory authorities
• Support & institutionalize data collection of AB prescribing,
dispensing and sales
• Educational and regulatory interventions in the health care
system for rational prescribing of antibiotics
• Major changes in knowledge, understanding and
perception of antibiotics to reduce demand.

36. Reframing the issue
• Health and global security
• Access to effective antibiotics
• Antibiotics are lifesaving global public good not a
commercial commodity
• Essential for any health system
• Universal health coverage
• Sustainable development
• Ecology/environment/Onehealth

38. Restoring
balance
Antibiotic resistance will not go away……

39. Antibiotic Resistance
Caused by human activity and by over- consumption of a global
resource
A failure of public policy & global governance, health systems,
research prioritization and the current market system
It is a collective responsibility by governments, supranational
organizations and individuals to take action
Nasa 1969: Earthrise over the moon from Apollo II