Antimicrobial resistance: no action today, no cure tomorrow
Dr Margaret Chan
Director-General of the World Health Organization
Distinguished guests, colleagues in public health, ladies and gentlemen,
No action today means no cure tomorrow.
This is the stark reality the world faces as we focus this year’s World Health Day on the need to combat antimicrobial resistance.
Our behaviours are largely responsible for this situation. I am referring to the demands of patients, the prescribing practices of doctors and pharmacists, poor infection control in hospitals, the weakness of many drug regulatory authorities, and practices used in the industrialized production of food.
We have taken antibiotics and other antimicrobials for granted. And we have failed to handle these precious, yet fragile medicines with appropriate care.
When the first antibiotics were introduced in the 1940s, they were hailed as “wonder drugs”, the miracles of modern medicine. And rightly so. Widespread infections that killed many millions of people every year could now be cured.
Major diseases, like syphilis, gonorrhoea, leprosy, and tuberculosis, lost much of their sting. The risk of death from something so common as strep throat or a child’s scratched knee virtually vanished.
The powerful impact of these medicines sparked a revolution in the discovery of new drugs. The human condition took a dramatic turn for the better, with significant jumps in life expectancy.
The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures.
The emergence and spread of drug-resistant pathogens has accelerated. More and more essential medicines are failing. The therapeutic arsenal is shrinking.
The speed with which these drugs are being lost far outpaces the development of replacement drugs. In fact, the R&D pipeline for new antimicrobials has practically run dry. In other words, resistance is moving faster than research.
The implications are equally clear. In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.
The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions. I am referring to interventions like cancer treatments, sophisticated surgical operations, and organ transplantations. With hospitals now the hotbeds for highly-resistant pathogens, such procedures can themselves be life-threatening.
Hospital “superbugs” make the biggest headlines, but these especially deadly pathogens are just the extreme expression of a much broader, and more disturbing picture.
The development of resistance is a natural biological process that will occur, sooner or later, with every drug. But faulty practices and flawed assumptions have clearly made the inevitable development of drug resistance happen much sooner, rather than later.
As I said, the world has failed to handle these fragile cures with appropriate care. We have assumed that miracle cures will last forever, with older drugs eventually failing only to be replaced by newer, better, and more powerful ones. This is not at all the trend we are seeing.
You have just seen and heard about the threat to cures for malaria and TB. Similarly, gains in reducing child deaths due to diarrhoea and respiratory infections are at risk. These are just a few of the stark warning that must be heeded.
Since the start of this century, the world has made great progress in scaling up the delivery of medicines for AIDS, TB, malaria, and conditions that claim the lives of young children and mothers. We must not let these gains be jeopardized by the further spread of drug-resistant pathogens.
Ladies and gentlemen,
The responsibility for turning this situation around is entirely in our hands. Irrational and inappropriate use of antimicrobials is by far the biggest driver of drug resistance.
This includes overuse, when drugs are dispensed too liberally. Sometimes this occurs because doctors want “to be on the safe side”. Sometimes this occurs in response to patients demands. They want a powerful pill or shot. Often this occurs because doctors and pharmacists want to make more money.
The problem includes underuse, especially when economic hardship encourages patients to stop treatment as soon as they feel better. When this happens, they do not complete the treatment course needed to fully kill the pathogens, allowing the toughest, most resistant microbes to survive.
The problem includes misuse, when drugs are given for the wrong disease, usually in the absence of a diagnostic test. In many countries, the problem includes a failure to keep substandard products off the market, to ensure that antimicrobials are dispensed only by a licensed prescriber, and to stop over-the-counter sales of individual pills instead of full treatment courses.
The problem also includes the massive routine use of antimicrobials, to promote growth and for prophylaxis, in the industrialized production of food. In several parts of the world, more than 50% in tonnage of all antimicrobial production is used in food-producing animals.
The problem arises when drugs used for food production are medically important for human health. Evidence shows that pathogens that have developed resistant to drugs in animals can be transmitted to humans.
Drug resistance costs vast amounts of money, and affects vast numbers of lives. The trends are clear and ominous.
No action today means no cure tomorrow.
At a time of multiple calamities in the world, we cannot allow the loss of essential medicines, essential cures for many millions of people, to become the next global crisis.