IN light of the race towards vaccines to combat Covid-19, emerging and re-emerging infections continue to confound medical scientists who are striving to arrive at some form of compromise.
However, the race continues. What is evident is, we need to recognise that the development of new diagnostic kits, methods of producing vaccines and recasting of treatment protocols are needed.
There is a lurking pandemic, however, which is by no means to be taken lightly, as it is not submissive. It can be seen from the mutations that are continuing to emerge. On the World Health Organisation's (WHO) top 10 priority diseases for a few years now, a particular health concern termed antimicrobial resistance (AMR) is a "silent tsunami" that accounts for significant morbidity and mortality globally.
What is AMR and how do we manage it? AMR occurs when microorganisms, such as bacteria, viruses, fungi and parasites, evolve and exhibit genotypic and/or phenotypic changes that enable them to resist the effects of antimicrobial drugs.
The detrimental effects of AMR extend beyond the health sector and affect other industries, including agriculture and animal husbandry. Antibiotics (a term used for antibacterial drugs) are lifesaving drugs that were considered "magic bullets" when they were first used in clinical medicine.
Antibiotics act specifically against organisms that cause disease and are relatively safe for humans. However, misuse and over exposure has resulted in microorganisms developing resistance against the drugs.
The pipeline of potential new antibiotics has dried up. A new antibiotic requires huge monetary investments, with years of clinical trials until safety and efficacy is confirmed. Human disease-causing microorganisms have been known to develop resistance to antibiotics within a year of exposure to those drugs.
AMR has a negative impact on the budget of healthcare systems. Longer hospital stays, caused by slower recovery from infection and a higher risk of complications, will be one of the key drivers behind an increase in healthcare expenditure.
Seventy five per cent of the health burden of AMR is due to healthcare-associated infections. Adequate infection prevention and control measures, as well as antibiotic stewardship in hospitals and other healthcare settings, are therefore essential to reduce the burden of AMR. WHO and the Health Ministry (MoH) have established guidelines and ensured continuous lifelong learning on effective antibiotic use.
Antibiotic policies have been established, and its stewardship programme is conducted by every hospital infectious disease control team. This has ensured that appropriate antibiotics are used only when necessary in the appropriate clinical setting.
AMR can be successfully tackled in several ways. First is primordial prevention requiring the creation of antibiotic awareness among the public. WHO has designated November 18 to 24 as the World Antimicrobial Awareness Week.
People should be educated about the "double-edged sword" nature of antibiotics and why they should be used judiciously. What works for one patient may not work for another, and people should never use antibiotics that are prescribed for someone else.
Moreover, a drug that was successful in one situation may not succeed in the future. Therefore, it might not be prudent to repeat an earlier course of action if the same symptoms returned. Most importantly, patients should not stop their course of antibiotics when they start to feel better. If stopped early, dormant bacteria could flare up, this time with resistance against the antibiotics to which they have been treated with.
The greater danger is that once organisms gained resistance, they can spread from one person to another. For example, "multidrug resistant tuberculosis" and "extensively drug-resistant tuberculosis" may spread from person to person by a cough or by being in close contact.
Second is strengthening existing surveillance and monitoring in both the community and hospital setting. Following WHO and MoH's guidelines and antibiotic policies, as well as getting updated information via the antibiotic stewardship programme, would be the major steps in reducing the incidence of AMR.
Patients in hospitals should be counselled and informed about antibiotic policies and their prescription. Over-the-counter access to antibiotics, in any form, without prescription should be banned across the world. Third is adopting a globally agreed set of measurable targets for reducing AMR incidence among humans and livestock.
Fourth is fostering the research and development of new antimicrobial therapies, including improved biosecurity measures in agriculture.
Finally, enhance coordination between countries to develop an effective global action plan to tackle AMR. This plan should adopt a broader "one-health" approach covering human health, agriculture and the environment.
The writer is the deputy vice-chancellor for academic and international affairs, AIMST University Malaysia