How bad is AMR?

We all have been there and we all are guilty. Well, at least everyone I know. Guilty of not waiting for a prescription to take an antibiotic, taking one when we were not sure whether the infection was bacterial or not, and of course, not finishing the whole course.

I remember, growing up, we had antibiotics at home and if anything looked suspect, even some cough that did not sound right, we would end up taking one or two doses. Of course, there is the other side of the problem too. You can go to any of your favourite pharmacy, across the street or the one on the other side of the city, and get the antibiotic of your choice. One packet or two, the salesperson would not ask you for a prescription.

This broad set of practices, ranging from self-medication to widespread availability without prescription, and with the added problem of counterfeit and substandard medicines means that there is likely a severe antimicrobial resistance (AMR) amongst most of us. What that means is that it is likely that in case of an infection, one or several front line antibiotics would not work. We do know that from our anecdotal experience, where we have experienced it ourselves, or know of someone who may have an infection, may have tried an antibiotic or two, and it just would not go away. The doctor would then have to try a different one, or a different combination to get the infection under control.

AMR is not some kind of a global conspiracy against our good way of life and is not aimed at imposing western values of regulation and prescription based drugs. It is a real threat, a fundamental problem seen globally and one of the biggest threats against our ability to combat infectious disease and improve our overall chances of survival.

So this gets to the fundamental question — how bad is AMR in Pakistan? The answer: no one knows. We have never done a systematic study, in our hospitals and our cities, to know what is our resistance pattern and what drugs are no longer effective. Part of the reason is complacency. It has never been on the government radar to make it a top priority, despite it being a global challenge. Part of it is the cost. Testing for AMR requires lab tests which are expensive, unavailable at public hospitals and often not recommended by the doctors seeing patients. Part of it is our own relaxed attitude and lack of awareness and part of it is corruption that leads to the widespread presence of counterfeit, fake and substandard medicines.

There is also a deeper underlying issue. Health, biological and biomedical research in Pakistan has not seen the same kind of growth as IT and computer science research has seen in the last two decades. While there are companies, innovation and entrepreneurship activities around apps, mobile devices and computer science, medical and biomedical research has not seen the same kind of vibrancy. A smartphone and a laptop are not going to solve all our problems, particularly in medical science. This issue of creating awareness in medical research and enabling researchers in biomedical sciences and biotechnology to carry out original, innovative research has to become a priority. The changing landscape of global public health demands that internal change.

So while we may not know how bad AMR is but we ought to find out. The bottom line is that AMR is here to stay, and the only way to manage it is through a combination of awareness, systematic analysis so that the doctors know which antibiotics to prescribe and not to prescribe, and a crack down on counterfeit drugs. Above all what we need a tougher set of actions and strict penalties against any pharmacy that gives antibiotics without prescription.

It may be hard, but it is absolutely worth it.

Published in The Express Tribune, November 8^th, 2016.

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