Menace of drug resistance growing
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Menace of drug resistance growing

This year's Mahidol Awards put the spotlight on antimicrobial resistance - only the fourth global health issue ever to receive this level of attention.
This year's Mahidol Awards put the spotlight on antimicrobial resistance - only the fourth global health issue ever to receive this level of attention.

This week the Prince Mahidol Awards conference will bring a global spotlight to the threat of emerging infectious diseases. The growing challenge of antimicrobial resistance (AMR) will feature prominently in these discussions. The timing could not be better, but we urgently need to see more action on the part of the UN Interagency Coordination Group on AMR and key intergovernmental agencies gathering in Bangkok.

If unchecked, the toll from drug-resistant infections could mount to 10 million deaths annually by 2050. This is more than the number who die from cancer each year today. The World Bank projects the economic losses could be worse than the 2008-2009 global financial crisis and could push as many as 24 million people into extreme poverty by 2030, mostly in low-income countries.

A couple months ago, the World Health Organisation (WHO) took a significant step when it issued guidelines on how the routine use of medically important antimicrobials should be curbed in food production. Antibiotics should not be used for growth promotion, and much work remains to be done to restrict routine preventative use of these drugs in raising livestock. By volume, more antibiotics are used in food animal production than in human medicine. But superbugs can cross over from animals to humans, do not seek visas to cross political borders, and can end up on our dinner plates.

Certainly the Food and Agriculture Organisation and the World Organisation for Animal Health face challenges in supporting the WHO's actions. In some countries, vets are too often in short supply, those raising livestock may need assistance to move to husbandry practices less reliant on antibiotics, and the public disclosure of industry's use of antibiotics in food production is seriously lacking. Still, policymakers and the public should urge these agencies to step up their efforts to meet the threat of antibiotic resistance. Globally antimicrobial use in livestock production will climb by an estimated two-thirds between 2010 and 2030.

We need to make rapid strides to protect especially last-line antibiotics critical to human medicine. In November 2015, resistance to colistin -- one of the antibiotics of last resort for treating drug-resistant infections in human medicine -- was discovered in food animals, in retail meats, and in humans in China. Colistin is used as an antibiotic of last resort in treating patients because of its known toxicity in humans. However, it has been used in raising livestock. Up to a few years ago, it was the fifth most widely sold veterinary antibiotic in the European Union. Today thirty countries have reported such resistance to colistin. This finding has sent shock waves across the global medical community, and at least 10 countries have reported continued use of colistin in livestock production.

Markets may move faster than governments to respond. Consumer groups have targeted restaurant chains and retail outlets to source food animal products raised without the routine use of antibiotics. An alliance of consumer groups has called upon the top 25 restaurant chains in the United States to make commitments in their procurement practices in this direction. Over the past three years, 14 of these companies have stepped forward to do so, particularly in sourcing poultry. However, much still needs to be done.

The US Public Interest Research Group has just launched a petition drive calling upon McDonald's to extend its commitment beyond poultry and to set a timeline to phase out routine use of medically important antibiotics in beef and pork products it sources for its franchises. Alongside the Prince Mahidol Awards Conference, the UN Interagency Coordination Group (IACG) on Antimicrobial Resistance meets for the fifth time. At the group's meeting this past October in Paris, the IACG held its first public consultation, and it was on animal use of antibiotics. The group heard from six industry people and the US Department of Agriculture, but not a single public interest, civil society voice.

Recently civil society members of the Antibiotic Resistance Coalition and its partners urged the IACG to include the WHO guidelines on antimicrobials in food-producing animals in its report, engage in a more open process of policy deliberation, and host a civil society panel focused on antimicrobial use in animal health and agriculture. Antimicrobial resistance is only the fourth global health issue ever to receive this level of attention at the UN General Assembly. Halfway to finishing its charge, the IACG on AMR has a huge task ahead of it if it is to realise the promise of the UN Political Declaration on AMR. Taking action to curb the routine use of antibiotics in producing our food provides one such opportunity.

Anthony D So, MD, MPA, is Professor of the Practice of the IDEA (Innovation + Design Enabling Access) Initiative, Johns Hopkins Bloomberg School of Public Health.

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