October 02, 2011
Dr Ramanan Laxminarayan is Director of the Center for Disease Dynamics, Economics & Policy and Vice President for Research & Policy at the Public Health Foundation of India. He is speaking at the Global Forum during Reflections from GARP Phase 1: India, Kenya, South Africa and Vietnam as well as Agenda for Moving Forward, Achievements and Goals. The following post originally appeared on CNN-IBN.
Limiting the spread of antibiotic resistance in India
Earlier this month, a meeting of health ministers representing the member states of the World Health Organization’s South-East Asia Region recognized antimicrobial resistance as a major global health issue. The Jaipur Declaration issued on 6 September 2011 is an important step forward in coordinating a global response to the problem of antibiotic resistance, or the ability of bacteria to withstand antibiotic treatments. Importantly, it sets the tone and serves a model for other countries to follow.
We already have evidence of the effects of antibiotic resistance in India. A 2009 World Health Organization study found that 58.7 percent of pathogenic E.coli samples in Delhi were resistant to the common antibiotic ciprofloxacin1. In intensive care units in India, the rate of vancomycin-resistant enterococcus (VRE), a hospital acquired infection, is five times the world average.
Why does it matter? When treatment with first-line antibiotics fails, patients have to turn to more powerful, more expensive drugs. In addition, sometimes these drugs fail, too. Antibiotic resistance leads to higher treatment costs, longer hospital stays, and in some cases, death. For example, our rough estimate is that 119,000 of the one million children who die each year in India within the first four weeks of life die from sepsis, or a bacterial infection that overwhelms the blood stream. Of these sepsis deaths, over 30% are attributable to antibiotic resistance.
Resistance is driven by antibiotic use, and antibiotic overuse speeds its development. In India, we see numerous examples of such overuse. India is behind many other countries in regulating the use of antibiotics in livestock, as there are currently no laws prohibiting the use of antibiotics in food animals. Additionally, people often take antibiotics when they are not needed. Between 45 and 80 percent (depending on where they live and the type of practitioner they visit) of patients in India with symptoms of acute respiratory infections and diarrhoea are likely to receive an antibiotic, even though it will not be effective if they have a viral illness.
But, it is important to recognize that India is not only facing a situation of antibiotic overuse – there is also, paradoxically, evidence of underuse, or lack of access to life-saving drugs. In India, bacterial pneumonia is responsible for an estimated 410,000 deaths each year and is the number one killer of children. In developing countries, antibiotic resistance restricts access to treatment, as more expensive, second-line drugs may be out of reach for the poorest of the population. In a country where eighty percent of healthcare expenditures are borne out-of-pocket and a large proportion of these costs are related to pharmaceutical purchases, higher antibiotic costs are a serious problem.
The kinds of challenges facing the developing world inspired the creation of the Global Antibiotic Resistance Partnership (GARP), hosted at the Center for Disease Dynamics, Economics & Policy (CDDEP). GARP working groups develop actionable policy solutions in low-resource settings to address antibiotic resistance while expanding access to treatment to those who currently are not reached.
Research conducted by the GARP-India working group shows that there is much that India can do to address antibiotic resistance. Recommendations include limiting the use of antibiotics in livestock, strengthening hospital infection control, and educating health practitioners and the public about the dangers of antibiotic misuse. The findings of GARP working groups from India, Kenya, South Africa, and Vietnam will be presented at the 1st Global Forum on Bacterial Infections, 3-5 October, at the India Habitat Centre, New Delhi.
The Jaipur Declaration is a promising acknowledgment of antimicrobial resistance as a serious public health issue. But the problem will continue to grow, rapidly, if we don’t build on this first step. Now is the time to adopt meaningful policies within India to preserve life-saving drugs and reduce the burden of bacterial illnesses.
