The third question

In late January 2022, the journal Lancet published a landmark study providing one of the most detailed estimates of global mortality due to antimicrobial resistance (AMR). AMR is the emergence of resistance to antimicrobials (including antibiotics), meaning that the antibiotics remain no longer effective in killing the disease causing bacteria. So an antibiotic that may have been effective some time ago in clearing the infection is no longer potent.

The global study estimated that more than 1.3 million people died in 2019 alone from AMR. There is no reason to assume that it would be any less in 2020 or 2021 (most likely it would be worse due to a host of other factors). To put it in context, AMR led to more deaths than Malaria or HIV/AIDS in that year. Or we can get a sense of perspective when we compare them to the fact that in 2020 (the first full year of the pandemic) about the same number of people died globally from Covid-19. The study is important for us to reflect, not only because it is the most detailed estimate to date about deaths from AMR, but also because the factors that contribute to these deaths are all flourishing among our midst. Lack of awareness, over-prescription of antibiotics, sale of antibiotics without prescription, unregulated use of antibiotics in the animal sector and a high animal protein demand, wastewater and sewage in our towns that breed drug resistant germs and dubious quality of drugs are the main drivers of AMR. It is no secret that every single one of them is present and thriving in Pakistan. Just because we do not hear about it, or are unwilling to change our behaviour, or choose not to count, does not mean that this is not an issue. Ask any infectious disease doctor about the problem and you may get an earful about our apathy, neglect or statements with less polite words.

At this juncture, two questions are worth asking. First, what should we do about it? Second, do we have the capacity to do something about it? Contrary to what one may think, the answer to both the questions is actually not that hard. The roadmap of what to do has to start with a recognition that this is not a problem down the road, it is a problem that is here. AMR is not a pandemic in a typical sense, nor is it a single disease, which makes it a more complex problem. But that does not mean that public health professionals, scientists or infectious disease experts do not know what to do. In fact, we know exactly what to do. A good starting point would be surveillance and figuring out the scope of the problem in both urban and rural areas. Again, we do not need to invent new tools of surveillance, or reinvent the wheel. Rest of the policies are all well known to experts as well.

The second question is: do we have the capacity to do something about it? The answer to this is also easy. We do have the capacity — though that can be expanded. But infectious disease doctors and public health professionals in our institutions have both the knowledge and the commitment to change the course. As a matter of fact, some of the recent and comprehensive studies on most serious forms of AMR (including typhoid outbreak that started in Hyderabad) were led by our own scholars.

The hardest question is perhaps the third one in addition to the two mentioned above. That is: are we willing to do something about it? This question is not just for those who get infected and find none of the drugs working for them; or the doctors and nurses in the wards trying to find that one combination that may work; or public health professionals who have been screaming at the top of their lungs to tackle urban sewage. It is for all of us.

Published in The Express Tribune, February 15^th, 2022.

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