On an afternoon of January 31st in Lahore, dozens of academics, physicians, public health professionals, hospital administrators and even government professionals took the time out to come to the Lahore University of Management Sciences to discuss the sharp cliff of infectious diseases in the country. A cliff, from where every year, we tend to throw the people down, mostly the poor and the vulnerable, into death, doom and financial destruction. Of the topics that were discussed, none were scarier than the growing threat of antibiotic resistance. The situation where the arsenal of our best drugs to control and cure infection is rendered useless. The scenario which in many situations is already playing out in our urban and rural areas, means that routine procedures in surgery that require infection control are becoming challenging. From the birth to post-natal care, from getting treatment for typhoid to controlling the spread of TB, every procedure and treatment is becoming more difficult, more expensive and less likely to succeed.
While the discussion at times was heated, and people expressed frustration with the government and the ill-executed 18th amendment, there was agreement that the best solutions are right in front of us. Whereas there is a whole list of things that can and should be done, there are two straight forward acts, present squarely within the government’s mandate, that can save us billions in cost and improve the lives of millions of our citizens.
The first is having a prescription drug law that separates over-the-counter drugs from those that require prescriptions from bonafide doctors. This is urgently needed and well within the scope and mandate of the government. Not a single group of physicians or public health experts would disagree with such a law. We need to protect the drugs, and the people. Similar laws exist around the world to protect citizens and their health. Widespread sale, use and abuse of antibiotics are responsible for our antibiotic resistance apocalypse. People are able to buy any antibiotic of their choice, without any understanding of care or caution. Pharmacists are equally to blame, for they are glad that their sales continue to scale new heights. Unaware public uses antibiotics as an ordinary pain killer, using them with every sneeze and every time someone has a headache. This is putting all of us at risk, and must stop immediately.
The second act is controlling the use of antibiotics for animal growth. Pakistani animal farmers, like their counterparts in other countries, have figured that antibiotics are a powerful growth promoter in animals. Antibiotics help fatten the chicken and the cattle, thereby helping farmers achieve slaughter weight in a much smaller time period, which helps them significantly increase their productivity and requiring less feed. Farmers in Pakistan are using antibiotics with a free hand, with no law to stop them. This is not a zero sum game. The cost of this is unhealthy animals, widespread use of antibiotics and the resistance that passes from animals to humans. This passing of antibiotics from animals to humans means that even without actually getting a prescription of antibiotics, we are consuming a high dose and that too without our knowledge or consent. This act, once again squarely within the control of the government, is just as essential as the first one on prescription to safeguard our health.
New antibiotics are not coming to the market and there is a broad agreement that without better awareness and better laws, new drugs wouldn’t be particularly useful. The real solution will come from control of what we already have. This governance, called antibiotic stewardship, is not just better health policy, it is also better fiscal policy. It will save billions spent in treatment of preventable infections and save the valuable labour and effort lost due to prolonged health challenges of antibiotic resistance.
Published in The Express Tribune, February 6th, 2018.