By Rex Clements
This World Health Day, we must turn our attention to one of the most influential discoveries in medical history – antibiotics. Antibiotics are foundational to modern medicine. Before their use, bacterial infections claimed thirty percent of all deaths worldwide. Now, these medicines that seem so familiar to us are still just as crucial as they once were. They are used to treat bacterial infections, such as pneumonia and bronchitis, and prevent infections during operations or for people undergoing cancer treatment. There is a critical need for awareness of antibiotics’ various uses, limitations, and public health concerns, specifically antimicrobial resistance (AMR).
AMR occurs when bacteria change in response to the use of antibiotics; these resistant strains of bacteria are known as “superbugs” and are one of the most significant threats to global health. Antimicrobial resistance is a natural phenomenon in bacteria. Still, this process is accelerated by the frequent use of antibiotics and other human activities. Over-prescription of antibiotics by health professionals is one factor in growing AMR, as antibiotics are readily prescribed for trivial conditions or conditions not caused by bacteria. Antibiotics used for agricultural purposes or given to livestock for growth promotion beyond curing diseases also contribute to increased resistance. If we continue with this over-consumption of antibiotics, we are putting our whole medical system in danger.
This is a call for sustainability and accountability for the production, sale and use of antibiotics, because preserving these medicines means protecting global public health. With a global pandemic bringing to light the fragility of our medical systems, now more than ever we must put in place policies coupled with strong surveillance to keep these medicines working for our future generations.
Pharmaceutical effluent discharge into rivers is another critical factor responsible for increasing drug resistance. The dangers of this pollution on AMR are best seen in pharmaceutical industrial hubs, such as Hyderabad in India. Research conducted on the Musi river into which such discharge is released, found that all the bacterial isolates isolated from the river were resistant to at least one of the 14 antibiotics they were tested against.
As India and China manufacture 80%-90% of the global antibiotics and Active Pharmaceutical Ingredients (APIs), these observations are a timely concern becoming extremely critical in the Indian context.
In a recent initiative, the Indian Government released a draft standard calling for maximum antibiotics levels in manufacturing effluents of bulk drugs and spearheading efforts to release first-of-its-kind guidelines in the world. As one of the two major manufacturers of antibiotics in the world, this legislation would enable India to set a global benchmark on AMR mitigation for the protection of public health. As part of the pharmaceutical manufacturing industry, this makes me particularly happy as this would effectively result in the companies adopting greener manufacturing practices with a lesser impact on the environment and eventually public health.
The fight against drug-resistant infection is so critical due to the lack of new discoveries in antibiotics. The last entirely original class of antibiotics was discovered in the 1980s. One of the reasons for this lack of innovation is that research and development to produce new antibiotics require immense funding and, in most cases, are not viable to carry out. Therefore, policymakers must take specific steps to encourage investment into the research and development of new antibiotics, the necessity of which is becoming ever more apparent.
There is an undeniable need for rapid and decisive measures to arrest antimicrobial resistance growth before it escalates into an even more significant issue. These new measures and standards must be coordinated and comprehensive on a global level. This issue is multi-institutional, and change must come at the individual level, industry level, as well as structural and systemic advancements.
These critical life-saving medicines must be preserved for our modern medical treatments to remain effective. Take your medications only when prescribed, advocate for improved industry-wide sustainability standards, and challenge your local legislation to protect our public health by investing in antibiotics’ development. Like the pandemic has taught us already, as our world becomes more interconnected, we must prioritize safeguarding public health. Creating future-ready, resilient health systems can help humanity and protect economies from unsurmountable crises.
The columnist is CEO, Centrient Pharmaceuticals. Views expressed are the author’s own.