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An invisible threat: tackling drug-resistance in Asia

June 20,2024

Antimicrobial resistance (AMR) is a growing challenge in Asia, with the misuse and overuse of antimicrobials driving the rise of drug-resistant infections. This article by Dr Kamini Walia from India explores the socioeconomic and cultural factors contributing to AMR in Asia, and highlights the need for a coordinated, regional effort to address this invisible threat.

Antimicrobials are the foundation of modern medicine. Their discovery has completely transformed the management of infectious diseases and facilitated advances in transplantation, cancer care, and surgery.

However, the misuse and overuse of antimicrobials − especially antibiotics − in humans, animals and plants are driving the rise of drug-resistant infections. This makes common infections harder to treat, and medical procedures and treatments, such as surgery and chemotherapy, much riskier.

Antibiotic resistance (AMR) first appeared in hospitals in the 1950s and has since become a global public health challenge. Both high- and low- and middle-income countries are facing the mounting pressure of drug resistant infections. The emergence of AMR is threatening to compromise the gains that were collectively made at the global level towards the control of infectious diseases.

In 2019, drug resistant infections directly caused some 1.27 million deaths and are estimated to have been associated with nearly 5 million deaths overall.^ 

The adverse impacts of AMR go beyond the health sector and the well-being of people, it has serious ramifications also for economic well-being. According to a World Bank report, AMR will be responsible for a decrease of up to 3.8% in global exports, and reduce livestock production by 7.5% per cent per year, due to increased disease and related mortality, as well as trade restrictions. It will also result in an increase in healthcare-related costs of USD100 trillion by 2050.

High antimicrobial resistance rates are a function of overuse of antimicrobials. In low-resource settings, the inappropriate use of antibiotics is often driven by poor sanitation and hygiene standards, insufficient regulations and ease of acquisition, scarcity of microbiology laboratory infrastructure, inadequate access to second-line and third-line antibiotics, and counterfeit or substandard antibiotics.  

Out of the total world population of approximately 8.1 billion people, as of 2023, 4.57 billion were living in Asian continent which consists of 48 countries. It is also the wealthiest continent, with a total wealth at around USD177.82 trillion, and is home to 10 of the richest countries and growing economies such as India and China.

This growing prosperity further reinforce the trend of AMR, as growth in wealth has been linked to an increase in access to antibiotics and demand for animal protein. To meet this demand, countries such as India and China have introduced large-scale farming, and the use of antimicrobials in livestock and agriculture means that antibiotic consumption is projected to double by 2030.

Their improper disposal, non-existent antibiotic stewardship for animal health, and the lack of wastewater management further adds to high antimicrobial loads in the environment.

While a 2023 Lancet article noted heightened awareness and actions against AMR in the WHO South-East Asia Region, drug resistance continues to increase.

Of course, misuse of antimicrobials is, of course, not limited to Asia. A survey of 14 countries in the WHO European Region found that one-third of respondents consumed antibiotics without a medical prescription; in some countries, over 40% of antibiotics were obtained without medical advice.

AMR is often called the “invisible threat”. At the population level, the public health risks of drug-resistant infections is not readily perceived by individuals, physicians, and policy-makers. At the individual level, the longer-term risk of misusing antibiotics in the short term is often overlooked with the hope of recovering more quickly from an illness, even when antibiotics may not the appropriate treatment, as for a viral infection.

Given the socioeconomic and cultural diversity of Asian countries and the multifaceted nature of the challenges of AMR, there is no single solution or path to AMR control in the continent.

First, healthcare systems need to be strengthened overall. There is also a need to invest in surveillance and research to inform evidence-based strategies and policies, and support innovation through investments and improved regulatory frameworks.

There is also an urgent need for a coordinated effort across multiple sectors and regions, using a One Health approach, to combine and enhance efforts, expertise, and experiences in areas such as surveillance, socio-behavioral research, economics, and innovation to address AMR.. Although many countries have attempted to implement a national AMR action plans, there is need to escalate the issue of AMR control beyond just national agendas to a regional level so that the progress achieved in one country is not off-set by failures in another country.

Now is the opportune time to put together a regionally coordinated effort, which that is target-driven, sustainable, and builds on a framework that facilitates communication and consistent governance to strengthen the fight against AMR. 

Source: UICC

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