• Overcoming the ‘super bug’ crisis in Asean



    IMAGINE a time in which small scrapes and stomach bugs could kill you; when your likelihood of dying from hospital-borne infections was higher than dying from complications from the actual surgery; when you were more likely to die from an infection than from cancer. No, this is not the 1920s. This could be our future if we don’t stop “super bugs,” or the antibiotic-resistant microbes, today.

    Antimicrobial resistance (AMR) is caused by the improper use of antimicrobial medicines, like antibiotics. When antibiotics are taken in too low a dosage, some harmful bacteria will be killed but some will also continue to grow and multiply. The bacteria that survives is more likely to survive when the drug is used again, becoming a “super bug,” and reducing the ability of the medicine to cure illness caused by that bacteria. The patient can spread this tougher strain of bacteria to other people and when they become infected, the antibiotic used against the super bug will be ineffective.

    Take, for example, the spread of tuberculosis (TB) super bugs in the Philippines. TB is a bacterial disease that infects 410,000 Filipinos every year; it is the seventh leading cause of death in the country. Its treatment requires patients to take strong antibiotics daily for a period of six months. mClinica, a public health technology group dedicated to strengthening pharmacy systems in Asean, has found that the average number of TB pills sold to patients in Mega Manila was just 2.4 tablets per purchase. This is a far cry from the 130 to 182 tablets required for the normal treatment and contributes to the rise of resistant or even multi-drug resistant (MDR) – an aggressive form of AMR –strains of TB. Patients in the mClinica study said that they bought small quantities of pills because they could not afford more. However, treating MDR-TB costs 10 times more than treating nonresistant TB. It’s also much deadlier.

    Modern fears around chronic diseases like cancer, diabetes and heart disease are increasing along with the rise of incomes and unhealthy foods. And while the double burden of disease—the situation in which chronic diseases rise while infectious diseases like TB continue to be significant killers nationally—is well along its way in Asean. It is predicted that more people will die from antibiotic resistance than will die from cancer in 2050. AMR makes cancer treatments and surgeries much more dangerous because of the risk of becoming infected with super bugs. Organ transplants could become impossible. Dr. Margaret Chan, former director general of the WHO, said that antibiotic resistance could cause “the end of modern medicine as we know it.”

    Asia has been described as the “epicenter of AMR globally,” and has the most antibiotic-resistant strains of bacteria in the world. It is possible in many Asean countries to buy antibiotics over the counter without a prescription, leading to improper use and increased AMR. mClinica found that one in every three medicines purchased in Manila were antibiotics, suggesting mass over-prescription. When antibiotics were dispensed, more than two-thirds were in insufficient doses. This crisis must be addressed immediately. Countries must strengthen their surveillance systems for AMR as well as enforce proper prescribing and dispensing behavior among doctors, pharmacists, and drug sellers in order to prevent a public health catastrophe caused by super bugs.

    A specific focus should be placed on pharmacies. They are often the first point of access to modern medical advice and treatment for many people in Southeast Asia, especially in rural areas and among the poor. The international public health community has largely neglected their critical role in the health system for decades. Pharmacists should be trained and empowered to comply with guidelines on proper antibiotic use, even if it means having to overcome cultural hierarchies in the medical field and confront doctors who write improper prescriptions for antibiotics. Governments should increase the surveillance of the pharmacy system as well as improve education for both formal pharmacists and informal drug sellers to protect patients and fight AMR.

    As a part of their “Health 2020” initiative, Asean has affirmed its commitment to combatting AMR. The Philippines has made strides in developing a national action plan against AMR and should continue to strengthen and expand its drug surveillance system in the country. As social and economic integration in the region increases, so will the spread of diseases between countries. As donor countries reduce aid and the West becomes increasingly unpredictable, governments should look inward and promote their own public-private partnerships in the fight against AMR and other public health threats. A rising health and technology sector in Asean can drive this growth forward and protect hundreds of millions of lives in this region. It’s up to governments and the public health community to drive it home.

    Beth Ann Lopez is a Master of Public Health candidate in health policy at the Harvard T.H. Chan School of Public Health. She has worked in health and development in the Asean region since 2012 and is a health policy associate at mClinica.



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