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Healthcare system needs an overhaul

Absence of adequate regulatory controls, treatment guidelines, and patient awareness have led to a global surge in antibiotic resistance, says a team of experts; two of them are from India.

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Leading medical researchers have called for a total overhaul of the global healthcare system. The entire structure of health-care delivery for effective antibiotics – from research and development, to distribution and rational use – needs to be re-engineered to address the looming global threat of antibiotic resistance, a global team of 26 scientists asserted in a report in The Lancet Infectious Diseases journal on Sunday.

The report presents a global overview of the growing problem of antibiotic resistance, its major causes and consequences, and identifies key areas in which action is urgently needed. The findings were published ahead of European Antibiotic Awareness Day, and the US Centers for Disease Control and Prevention (CDC) ‘Get Smart About Antibiotics Week’ on Monday. The team included Prof Ramanan Laxminarayan of the Public Health Foundation of India and Dr Chand Wattal of the department of clinical microbiology, Sir Ganga Ram Hospital.

Lead author Professor Otto Cars, of Uppsala University in Sweden, said, “The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Within just a few years, we might be faced with unimaginable setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions to improve surveillance and transform the way antibiotics are regulated and developed are taken immediately.”

The problem is more at the political level, since the decisions have to be taken there. “Only now has the awareness and urgency of the problem of antibiotic resistance reached a level that a new sustainable global system to counteract these problems can be built,” said Cars. “Addressing these problems will require nothing less than a fundamental shift in how antibiotics are developed, financed, and prescribed.”

There have been initiatives to tackle the malaise, but the researchers noted that these programmes need time and patience to be set up and need to be backed by visionary governments with adequate funding. “A stepwise approach to a national strategy according to a contextualised and prioritised road map might be the best way forward for most settings,” they said In this context, a special mention was made of the ‘Channai Declaration’ that was issued last year by Indian professional societies. They put together an implementable road map for resistance containment in the country that pushed for central coordination and implementation support from the government.

Comprehensive research itself is an issue. The professionals called for availability of clear information on the health and economic burden of antibiotic resistance so as to make this complex problem tangible to policymakers. “A global surveillance system for antibiotic resistance, including outbreak reporting and an early warning system to detect new resistance mechanisms and their global spread, is still lacking, despite the obvious need of such a system and several proposals for potential models, they wrote.

At the end of the day, it would have to be the governments’ call. “The ultimate responsibility for the provision of equitable and affordable access to effective antibiotics for those in need lies with national governments. The consequences of antibiotic resistance reach far beyond the human health sector and thus no one governmental ministry or agency can be held solely responsible,” they warned.

It’s now up to governments, and UN bodies too, to pick up the gauntlet, or let the antibiotic menace consume humanity.

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