Resistance of a different kind

Anti-microbial drug resistance is threatening our public health system in a very real way.

Pakistan is in the midst of various resistances. These include extreme resistance by various political parties to act in the national interest, routine resistance by the people to follow the laws and growing resistance by all of us to listen to opposing points of view. While all of these resistances and their causes are worthy of discussion, my focus is on a resistance of a different kind; a resistance that is not unique to Pakistan, though quite well and thriving here.

Anti-microbial drug resistance may not make the news as much as some of the other resistances do, but it is threatening our public health system in a very real way. For those who may not know, it is the inability of the antibiotics to kill the disease causing bacteria. In a typical case of bacterial infection, treatment by antibiotics results in bacteria dying and the person regaining his or her health. In the case of anti-microbial drug resistance, despite the use of the antibiotics, the bacteria continue to spread and multiply and the drug does little to control infection. The problem is global and growing at an alarming rate, but we in Pakistan may be aiding the spread of this global menace.

To think about this, let us take a hard look at our practices. How often do we get antibiotics without a prescription? How often do we use them when there is no basis for any infection? And how often do we not follow the whole course? The answer to any, and perhaps sadly all of these questions, would be ‘all too often’. Furthermore, in the case of Pakistan, poor quality drug manufacturing and lack of oversight and regulation in maintaining drug quality exacerbates the problem of drug resistance even further. The exact impact of anti-microbial drug resistance in Pakistan has never been estimated. Drugs that were once potent are now worthless and diseases that were once controllable can make a much stronger and lethal comeback.

The reason I am bringing this up today is that among the few things highlighted and emphasised at the World Health Assembly, that concluded a couple of days ago, one was the urgency with which we all need to tackle this problem. There are three major things that we individually and collectively need to think about. First, following the Eighteenth Amendment, with a deregulated health sector, there is an urgent need to have a national plan on improving medicine quality and regulation. Unregulated sales, poor manufacturing, improper storage and counterfeit drugs have previously affected our fragile health system and they will continue to fracture it further if immediate steps are not taken. The solution to this is more than just SMS-based systems that track the drug lineage. While the bandwagon of ‘e-governance’ is all well and good, it is not a solution to every problem. SMS-based methods do little to test poor manufacturing and post-manufacturing degradation. They also do little to control unregulated sales. Let us not put the burden on the poor consumer here. Let us, for a change, create better national policy.

Second, we need to prioritise this at the national level and encourage both public research and the private sector to tackle this problem. If the government is serious about improving Pakistan’s health sector in the long term, it will have to make investments in innovation and research to address this problem. The last thing Pakistan needs is pandemics combined with an inability to cure or manage them.

Finally, national awareness needs to be a high priority. A lot of people really do not know how their self-medication practices are putting them, their family members and everyone else at high risk. A media and public outreach campaign may stem the growth of this problem.

As the media looks for its next target to put in its crosshairs, this may be as good a target as we have had in a long time.

Published in The Express Tribune, May 27^th, 2014.

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