CAP: Treat antibiotics with respect and care

The World Health Organization (WHO) has chosen “Antibiotics: Handle With Care” as its theme for this year’s World Antibiotic Awareness Week.  Held annually from 14 – 20 November, Antibiotic Awareness Week is a reminder to all – health care providers, patients and users of antibiotics – that antibiotics are life saving and preserving and deserve utmost care in handling, use, preservation and conservation.

“We must treat antibiotics with respect and care as they are a precious public good,” states CAP President, Mr Mohamed Idris.

According to WHO, new resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death. Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk.

Globally, 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria, as well.  It is clear that Antimicrobial Resistance (AMR) is an increasingly serious threat to global public health that requires action across all government sectors and society.

To combat this global threat, WHO endorsed a Global Action Plan (GAP) in 2015 during the 68th World Health Assembly (WHA) in Geneva.  The goal of  GAP is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.   The Assembly also urged Member States to develop and have in place by 2017, national action plans on antimicrobial resistance, aligned with the objectives of GAP.

At the UN High-Level Meeting on AMR held on 21 September 2016 in New York, world leaders committed to taking a broad, coordinated approach to address the root causes of AMR across multiple sectors, especially human health, animal health and agriculture.  [This was only the fourth time a health issue has been taken up by the UN General Assembly ( the others were HIV, non-communicable diseases and Ebola)].   This strong Political Declaration by Heads of State has set the stage for action by the total international community.

At this meeting, countries reaffirmed their commitment to develop national action plans on AMR, based on WHO’s GAP, in coordination with the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE).

National Action Plans are essential to understand the full scale of the problem and stop the misuse of antimicrobial medicines in human health, animal health and agriculture.  Leaders pledged to strengthen regulation on antimicrobials, improve knowledge and awareness and promote best practices as well as put in place stronger systems to monitor drug-resistant infections and the volume of antimicrobials used in humans, animals and agriculture.

To assist countries in preparing or refining their national action plans, WHO, FAO and OIE have collaborated on a manual aimed to facilitate the participation of all relevant sectors.  It outlines an incremental approach that can be adapted by countries to their specific needs, circumstances and available resources. A number of supporting documents and tools accompany the manual.

WHO has also compiled a library of existing, publicly available national action plans on antimicrobial resistance for countries to consult. To date, the national action plans of 26 countries are in this library; Malaysia is not yet on this list.

Over the years, the Consumers Association of Penang (CAP) has raised concerns on the use of antibiotics in animal husbandry and agriculture in Malaysia, with particular reference to animal feeds and prophylaxis.  A CAP and Third World Network Penang (TWN) Memorandum on Antibiotics in Animal Feeds – The Case for Malaysia 2013, highlighted shortfalls in the animal farm certification scheme as well as food production sectors with recommendations for action by the Ministry of Agriculture.  The memo had urged the government to treat antibiotic resistance as a matter of national priority and policy and to strengthen regulations on the use of antimicrobials in both the human and animal health sectors.

During this week of Antibiotics Awareness, CAP strongly urges the government to consider the adoption of the recommendations in the memorandum.  These recommendations are reflective of the commitments made in the Political Declaration of the UN High-Level Meeting held in September 2016 in New York

CAP’s recommendations include:

• The existing National Surveillance on Antibiotic Resistance (NSAR) programme must be strengthened nationwide.  Hospital Information Systems that are outdated pose considerable challenges for data collection, analysis and retrieval.  Systems-support guidelines provide information on appropriate indicators (ie scientific, population, and systems data) for development of antibiotic resistance information databases.
• The MOH must invest further in and increase allocations for systems upgrading and data collection: it must provide software programmes to all hospitals throughout the country so that nosocomial and community pathogens can be identified and resistant clones tracked at district, provincial and national levels.  Currently only government and 2 university hospitals participate in the NSAR programme.  This means that the actual status of antimicrobial resistance in the country is unknown.  The lack of private health sector participation in the NSAR programme is a major drawback which can compromise the national antimicrobial resistance strategy.
• The NSAR Programme under the Ministry of Health cannot work alone. There is a need to create a national intersectoral body or task force comprising healthcare professionals, veterinarians, academics, agricultural scientists, consumers, the media, to raise awareness about AMR, prioritise research, collect data, recommend policy measures to contain AMR eg formulating principles for a new Animal Health Law
• In order to create awareness of the seriousness of the antibiotic resistance problem, information and public education campaigns involving multisector collaboration must be carried out.  Engagement with Civil Society Organizations (CSO) will be vital for this in view of their strong grass-roots and community links.   Development and dissemination of educational material for practitioners and patients on rational use of antibiotics must be a vital part of the Campaign.
• The use of antibiotics in food animal/livestock production, agriculture, aquaculture and horticulture must be banned.
• Introduce and or enforce laws on the use of antibiotics in animals ie approval of veterinary drugs and restrictions on their use; promote animal health; strengthen hygiene in the food chain.
• Introduce and strengthen laws on prescriptions for all antibiotics used for disease control in food animals.
• Reduce the use of specific classes of antibiotics especially those used in human health. WHO has classified 3rd and 4th generation cephalosporins and fluoroquinolones as critically important antibiotics for humans. Prohibit for animal use any new drug developed for human medicine and of those that are used only in human health.
• Improve animal health to reduce the need of antibiotics through measures like immunisation against prevalent infections. In 1987 Norway introduced effective vaccines in farmed salmon and trout and improved health management which reduced the annual use of antibiotics in farmed fish by 98% between 1987 and 2004. Many countries and the EU have regulations to enforce and promote vaccinations as a method of reducing infections in food animals.
• Develop guidelines for veterinarians to reduce the overuse and misuse of antibiotics in food animals.
Letter to Editor, 17 November 2016