According to researchers, 50 percent of antibiotics globally are prescribed and sold inappropriately. About 2,000,000 people become sick every year because of antibiotic resistant bacteria and about 95 percent of people carry bacteria that are resistant to antibiotics, increasing their chances of death from bacterial infection by 64 percent. According to the World Health Organisation (WHO), which hosted its first Global Antibiotic Awareness Week in November, antibiotic resistance is one of the largest health issues that humanity will have to soon face.
There is no doubt that in Pakistan, a developing country with a relatively weak medical infrastructure and doctors that get a percentage from every antibiotic prescription, that rate is significantly higher. It may not seem like a problem on the surface but allow me to explain how antibiotics could start the next plague.
It is the start of November and I have the common cold. It is probably a viral infection that is spreading around and could also be the result of my immune system being less resistant to disease because of the changing temperature. I decide to visit the doctor’s office and complain of a headache, sore throat, fever and all the other symptoms that this type of illness brings. I should be prescribed a regular cold medicine and told that it will fly over in a few days. Instead, this is what happens.
A few weeks ago, a medical representative entered the doctor’s office. He had a presentation with him — memorised — and some literature with a contact number. He was advertising for a company, lets say Pharm Corp., dealing in mainly antibiotics. The medical representative makes his pitch and leaves. The doctor reviews the literature and, of course, understands how high the margin of a business like Pharm Corp. has. He decides to call the number on the literature and meet with someone who is in a position to make a deal, unlike the representative. The doctor sets up a time with the area manager. He asks how much he will be compensated for prescribing the medicine. He gets a sweet deal: a percentage cut (20-25 percent) and an all-expenses paid vacation once a year shown as a medical conference to everyone on the outside. He accepts and relentlessly begins to jot down the medicine for anyone who will listen. He writes it down for me on a slip and guides me to the nearest pharmacy. I go and buy it because I am an unknowing customer. I do not have a pharmacy degree.
I go home and eat the antibiotic. The bacteria that are naturally in my system, which do not cause me harm, are affected. Most die. But the ones that have mutated to resist the antibiotic I have eaten survive and multiply, both inside my body and outside of it. The next time they affect me or someone else, an antibiotic will not cure me instantly. The antibiotics had no effect on the cold. It got resolved by itself, and would have so without the prescription.
Obviously, one dose of antibiotics is not going to create super bacteria that are untreatable. But constant abuse of antibiotics by customers and constant abuse of unknowing customers by doctors will. A few unknowing doctors need to be shown the ramifications of their short-termed thinking. This starts with doctors themselves, many of whom have taken the good fight up to push for ethical behaviour. Doctors should self-regulate their industry and colleagues, along with establishing best practices for antibiotic prescription. They are the strongest line of defence against antibiotic resistance.
Pharmaceutical companies should be rewarded for ethical behaviour and penalised heavily for unethical behaviour, like was done with restaurants by the Punjab Food Authority (PFA) in recent memory. This oversight should be set up by local, provincial and federal governments along with within the pharmaceutical industry itself. The triple bottom line should not be overlooked for increasing monetary profits and a strong social responsibility mindset should be adopted. Pharmaceutical corporations should also invest in creating the next generation of antibiotics.
Customers should be educated about their antibiotic use and misuse. This should be done through non-profits in the healthcare space, hospitals and clinics, doctors’ offices and pharmaceutical companies themselves. The government should take on an active role in spreading awareness by partnering with nonprofits and companies, making the whole process more efficient. This looming issue should not be overlooked, or we might all die from antibiotics instead of being saved by them.
The writer is an entrepreneur working on www.aceso.care, a healthcare startup in Lahore