Launched this week is a major report on tackling the growing resistance to antibiotics by the UK Government and the Wellcome Trust. We fully support its call for the G20 and the UN to take the lead in building a global coalition for action to address this urgent issue. However, we urge world leaders to consider the unmet needs of the poorest as central to a solution.
As the World Health Assembly and the G7 Summit meet next week, their recommendations must recognise that very large numbers of people still do not have access to antibiotic treatment when they have an infection. Action on antibiotic resistance should not undermine the continuing need to ensure everyone has access to the medicines they require to live full and healthy lives – a goal which has not yet been consistently reached outside of richer countries.
Why do poor communities matter when it comes to fighting antibiotic resistance?
In many countries large numbers of people are poor, and live in circumstances which put them at a much higher chance of contracting an infectious disease, for example through contaminated water or exposure to others who are sick. Many people die from infectious diseases for which effective treatments are known. This is often because health services are not available or they cannot afford to buy the appropriate treatment.
Many people seek healthcare in large unregulated, informal and less expensive markets, which have emerged to fill access gaps. A case in point, in Bangladesh and India, people living in rural areas rely heavily on so-called “village doctors” or “rural medical practitioners” for dealing with common health problems. These are people with some basic medical knowledge, who sell drugs for a living, often antibiotics.
While there is evidence that the easy access to antibiotics has contributed to falls in rates of death from childhood pneumonia and infections after childbirth, there is also evidence of widespread inappropriate use, including treatment without a reliable diagnosis or the use of partial doses. These practices may increase the risk of drug resistance. In many countries, there is also a big problem with sub-standard products. Leaders need to address the inequity of access to quality health services, to ensure that people are not forced to make alternative and detrimental choices when it comes to their healthcare.
A global strategy for addressing drug-resistant infections must ensure access
At its core it needs to recognise that very large numbers of people still do not have access to antibiotic treatment when they have an infection. As the report recognised, basic public health and disease prevention is still not a feature of many health systems and is part of the solution along with raised awareness, new drugs and diagnostics, and more conservative use. However, action on resistance will only be just and sustainable if it includes support, where needed, to extend and improve access to treatment. This means:
- informing people about appropriate treatment of common illnesses through intensive information campaigns
- ensuring that the available drugs are effective by removing sub-standard and counterfeit products from the market
- supporting effective treatment by improving the performance of informal health markets and by making low cost diagnostic technologies widely available
- reducing the cost of antibiotic treatment for common infections Securing a meaningful and coherent agreement on how to address these issues will not be easy but it is not impossible.
Countries with pharmaceutical industries will need to prevent them from producing copies of new antibiotics, despite the inevitable commercial demand. Other countries will need to prevent the wide distribution of antibiotics used as a second or third line of treatment. This requires substantial government support because any new drugs will need to be withheld from the market to delay the emergence of resistance. They will need to secure political support for these actions.
The report is right to highlight the need for a “global coalition for real action’ and we urge leaders to pick it up and run with it. In doing so, they would do well to recognise the synergies between providing universal access to the benefits of antibiotics while, at the same time, delaying the emergence of resistance to them.