Bitter pills to swallow

  • Antibiotic resistance requires immediate attention in Nepal and beyond

Dec 16, 2018-

As the world continues its aim to fulfill the United Nations’ Global Sustainable Development Goals 2030, roadblocks and challenges have appeared in our paths. Though some of these challenges have been around for several hundred years, some have developed over time, as a result of our actions. Included in one of the latter described hurdles is a growing and often overlooked threat: antimicrobial resistance (AMR). Alarmingly, most people are unaware about the phenomenon as it has often been distorted purposively to suit vested interests.

There is a saying among biologists: ‘In a natural evolutionary competition between bacteria and us, there is no certainty that we will find ourselves the survivor.’ The comment can not be ignored in the present context. To understand the phenomena, it is useful to draw comparisons. Just as humans have leveraged science and technology to achieve growth at rapid rates, bacteria have been improving, learning and innovating overtime as well. Prokaryotes have advanced by developing their resistance and virulence over centuries. In turn, threatening microbes have inflicted human systems with many potentially untreatable diseases.

Antibiotic resistance is an emerging threat to food security, yet the alarms have not been raised among the public. Some perceive the phenomenon as scaremongering propaganda, while others view it as a product of organisational tantrums. These misconceptions need to be corrected before it is too late. The issue needs to be addressed with a clear roadmap for prevention.

Until 1928, the havoc caused by microbial diseases was inevitable as diseases—like anthrax, plague, cholera, smallpox, among others—had decimated a significant portion of human population. March 7, 1929 marks an important date in the crusade against microbial diseases. After extensive research, Sir Alexander Fleming discovered some magical ‘mould culture,’ which he later named Penicillin. That culture could produce a substance which checked and killed many common bacteria. This significant discovery was followed by pharmaceutical production and dissemination efforts to ensure that the effective drugs reached the people. At the time, the discovery was anticipated to bring an end to infectious diseases.

However, the evolution of microbes and their genetic maneuverings have taken a lethal turn. The growing appearance of resistance strains—which have the ability to circumvent existing drugs—have traumatised all concerned parties. This has been made possible by the combination of mutations and horizontal gene transfers (HGT). And according to scientists, the evolution is so significant that phylogenetic relationships in prokaryotes have been considerably altered.

This ceaseless uphill battle with microbes has caused plenty of economic distress for some in the medical industry. For others, it has led to virtual resignation. New initiatives like metagenomic techniques to access the antibiotic potentials of complex bacterial colonies have brought some promises. But the success rate of these discoveries is discouraging, especially as the number of infections that are multi-drug resistant are rising. The World Health Organisation (WHO) describes the situation as ‘one of the biggest threats’ to global health, food security and development today.

Amidst this dangerous development, global food security is in serious peril. Although the Malthus theory (which theorised the ominous prediction that global population levels would surpass the threshold of food availability) is long refuted, global leaders have warned of a looming food security crisis for nearly a decade.

In this context, the United Nations Food and Agriculture Organisation (FAO) has predicted that by 2050, the world population will reach 9.1 billion—which means by then, we would need to increase food production by 70 percent. Given this prediction, many other scientists and organisations have taken the year 2050 as a serious deadline. For example, Sara Menker, founder and chief executive of Gro Intelligence, predicts that we will face a 214 trillion calorie deficit by 2027.

Scientists have correlated these risks to one ongoing practice: growing rates of antibiotic prescription. In today’s health sector—especially in Nepal—practitioners very commonly prescribe antibiotics to treat even the most minor conditions. This has especially been the case in the agricultural sector, as antibiotics reportedly increase the weight of crops by 15 to 20 percent. The persistent use of antibiotics to promote growth in crops has been highly criticised in Nepal. It is also apparent in livestock farming. According to Basnyat et al. (2015), the volume of veterinary antibiotic sales rose more than 50 percent from 2008-2012, and among them, 71 percent of veterinary drugs were sold without prescriptions from veterinary professionals.

By overusing non-therapeutic antibiotics, we have intentionally developed powerful genes that are resistant to deadly bacteria and, consequently, we have made treatment incredibly difficult. Resistant bacteria not only poses threats to our available stock of food, but can also be transmitted from agricultural systems to humans through various avenues including consumption of undercooked meat and exposure to animal manure. This issue, especially in Nepal, can not continue to be left unaddressed. It is prudent to recognise the true costs of antibiotic use in our agriculture system and to mitigate our actions accordingly.

An effective monitoring system of antibiotic use is urgently required not just in Nepal but around the world. A ban on unauthorised trade and prescription of antibiotics must also be implemented, especially in Nepal where the practice is common. Stakeholders from various backgrounds should also engage the public through robust community awareness programs. Similarly, demonstrating Nepal’s commitment to counter this issue is urgently needed at the policy level. However, while antibiotic prescriptions should be monitored, these policies should not interfere with its accessibility to people with conditions that genuinely require it.

Antibiotic resistance can be compared to climate change on a global scale. Just as the Intergovernmental Panel on Climate Change (IPCC) has been marshaling scientific evidence and channeling policy-making, countering AMR also warrants equal attention and energy. This should come, not only from veterinarians, pharmacists and microbiologists but also from actors from different sectors—especially as this is an issue that affects everyone.

Speaking in the Nobel Prize acceptance speech in 1945, Alexander Fleming had warned about the dangers of his discovery when he said, ‘There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug, [man may] make them resistant.’ Today, the implications of Flemming’s words have come true: we have proved our ignorance.  It is harder to react in hindsight; the threats of AMR requires urgent attention.

Bajagain holds a Bachelors of Science in agriculture and is currently employed at the ‘Climate Change Adaptation in Agriculture Project.’

Published: 16-12-2018 09:10

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