AMR
Antimicrobial Resistance in Bangladesh: Growing Threat and Urgent Solutions
“Stop referring to a coming post-antibiotic era — it’s already here.”- This statement was made by the US Centre for Disease Control and Prevention Report (2019) almost within a century of the invention of the first antibiotic by Sir Alexander Flemming. Now, globally, Antimicrobial Resistance (AMR) is the 3rd leading cause of death. In 2019, about 4.95 million premature deaths occurred due to AMR which was higher than HIV/AIDS or malaria and this could rise to more than 10 million by 2050.
Bangladesh also cannot escape the AMR threat. In 2019, about 26,200 deaths were attributed to AMR, and 98,000 deaths were directly related to AMR. Among 204 countries, Bangladesh was ranked 75 according to the age-standardized mortality rate affiliated with AMR per 1,00,000, which is alarming and needs proper action to control.
What is AMR?
Antimicrobial Resistance (AMR) is a condition where microbes, bacteria, and viruses evolve in such a way that the drugs that were previously used against them are no longer effective, thus leading to serious illness and in some cases death.
AMR is now a global concern that almost all countries including Bangladesh are suffering from. And, there is a heavy burden on the Sub-Saharan African countries. However, there is inadequate data regarding AMR-related fatalities in low-income countries.
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Misuse or overuse of the antimicrobials is a significant driver of resistance. If the treatment is too long or short or incorrect, this increases the chance of antimicrobials becoming resistant. If this occurs then it creates more opportunities for microbes to develop and multiply.
AMR scenario in Bangladesh
AMR is a serious public health concern as Bangladesh has a decentralized healthcare system. In Bangladesh, most healthcare facilities are concentrated in secondary and tertiary hospitals.
Besides these, the domestic pharmaceutical industries are now providing 97% of the countries’ medicine. Privately owned pharmacies and dispensaries resulted in easy access to the drugs. According to a CAPTURA report in collaboration with UK Aid, uncontrolled pharmacies in Bangladesh resulted in possible misuse of antibiotics. It is estimated that almost 50.9% of the total antibiotics were purchased without prescription, which is an alarming situation. The number of AMR deaths in Bangladesh is higher than deaths caused by diseases like chronic respiratory diseases, tuberculosis, respiratory infections, diabetes, kidney diseases, and digestive diseases.
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Due to the decentralised healthcare system, AMR surveillance in Bangladesh is difficult to monitor. To prevent this situation from worsening, the government should take steps for monitoring in collaboration with the research centres like icddr,b, IEDCR, and different NGOs working on the healthcare facilities. Furthermore, international organisations like WHO, US-CDC, FFCGB, and USAID need to play crucial roles in controlling the situation.
Analysis of the policy issue
According to a WHO report, Southeast Asian countries have the highest risk of AMR among all the WHO regions. Bangladesh is no exception to this. In Bangladesh, antimicrobials are widely available as over-the-counter drugs.
This situation became more complicated due to the presence of unqualified providers in the informal sector along with unethical marketing practices of the pharmaceutical companies. Besides human health hazards, the AMR has a drastic impact on the animals and the environment too (National Library of Medicine, n.d.).
Impacts on human health
A recent research in Dhaka showed that in the case of Urinary Tract Infection (UTI), the most used antibiotics like Amoxicillin (82%), Azithromycin (75%), and Cefixime (64.5%) were found resistant among 1308 samples used.
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Another newspaper report shows that almost 18% of bacteria isolated from children affected with pneumonia were resistant to all routinely used antibiotics like ampicillin, gentamicin, ciprofloxacin, and ceftriaxone. The report also showed that the frequent use of antibiotics to treat general colds, flu, and mild diarrheal illness is mostly responsible for fueling the AMR in the community.
It has been observed that almost all age groups are more or less resistant to antibiotics but the children and youth are mostly affected by its effect.
Economic impact
In 2019, the World Bank found that the impact of AMR is also negatively affecting the world economy. The report estimated that by 2050, unchecked AMR would reduce the world GDP by 3.8% and push 28 million people into poverty. As a developing country, Bangladesh will also be a sufferer of this problem as due to AMR, people are now spending more on healthcare compared to other spending.
A recent analysis showed that unaddressed AMR on livestock would cost global GDP up
to $950 billion and its spread from livestock to humans would cost up to $5.2 trillion of world GDP (World Health Organisation, 2024).
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Environmental impact
Multi-drug-resistant bacteria have already affected the ecology of Bangladesh. Common resistant phenotypes included common antibiotics like Ampicillin, Tetracycline, Aztreonam, Nalidixic acid, and Ciprofloxacin.
How does this issue affect different groups of people?
According to a report by Medical News Today, the most affected group by AMR is children under 5 years with pneumonia. Almost 18% of the total isolated bacteria are resistant to all routinely used antibiotics.
The unsafe drinking water and poor sanitation are responsible for some common diseases which creates the demand for the widespread availability of over-the-counter antibiotics from the local pharmacies. Besides this misconception about antibiotics, weak surveillance processes, and less awareness among the sellers and patients are continually contributing to the growing AMR according to a report by the Dhaka Tribune. The irrational use of antibiotics in animal feed like poultry farms, and defective water management in the city are also spreading AMR among city people.
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A report by the Business Standard shows that 8 of the 12 antibiotics used in poultry farms were ineffective by at least 40% against the most common bacteria like E.coli.
Comparative analysis
Different countries around the world are taking different approaches to tackle the situation like the One Health approach, Surveillance, Stewardship, awareness building, and agricultural steps.
USA
The USA has taken steps like strengthening national One Health surveillance efforts, assuring advanced and innovative diagnostic tests, running an Antimicrobial stewardship program and national awareness week, promoting improved international collaboration to slow down the AMR among the people, etc. Besides, the US Government enforced the FDA regulations to restrict antibiotics in animal feeds.
These initiatives resulted in a 15% reduction in overall antibiotic prescriptions in the last decade. However, resistance persists due to continuous overuse of antibiotics in outpatient care and agricultural misuse.
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UK
The UK has taken the National Action Plan focusing on the One Health approach, assuring strict regulation, and public campaigns named “Keep Antibiotics Working”. These measures helped to reduce 23% of human antibiotic consumption between 2014 and 2020. In recent years, the UK has undertaken a long-term plan“Confronting AMR 2024 to 2029.” However, in the case of rural areas, this problem is still prominent.
India
India initiated the National Action Plan in 2017 to address this issue. Besides this, they started surveillance through the Indian Council of Medical Research. These resulted positively in creating awareness against AMR. However, inadequate data was found regarding the use of antibiotics in the agricultural sectors.
Bangladesh
Bangladesh also initiated a national action plan to improve surveillance along with the One Health approach and stewardship. Besides this, different surveillance units are active in different hospitals to combat the situation. Public awareness has been created but is limited. Weak enforcement of regulations of antibiotics, the profit-maximizing attitude of pharmaceutical companies, and unregulated pharmacies lead to the persistence of the AMR situation.
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Key lessons for Bangladesh
The developed countries exhibited a long-term plan to slow down the AMR problems. Furthermore, they are successful in reducing the percentage of AMR to a great extent. They are now working on surveillance and creating public awareness in curbing the effects of the AMR. Moreover, the developed countries are taking action to reduce the effect on the agricultural sectors which Bangladesh lacks.
Proposed solutions and reforms
Bangladesh needs to take both short-term and long-term plans to curb the effect of AMR. Here are some proposed solutions:
- Introducing DHIS2 for every patient so that the diseases and prescriptions are documented and developed in such a way that if antibiotics are prescribed then signals will be sent to professionals. This will help to review the necessity of antibiotics.- Pharmaceutical companies should be properly regulated so that they cannot put pressure on doctors to prescribe unnecessary antimicrobials.- Public awareness should be created from the root level. The concept of AMR and its dreadful effect can be included in the national curricula.- The authorities may take initiatives to regulate the pharmacies and take the selling of antibiotics under surveillance. This will help the authorities to track the record of selling antibiotics.- Traditional methods of treatment like Unani, Ayurvedic medicines, and Homeopathy need to be revived by doing research.- The private sector in collaboration with NGOs may take initiatives to raise awareness among the rural people.- The international development partners need to collaborate with the government for funding and propose policies that are effective in different countries.- Doctors along with pharmacists should be properly trained about the AMR effects.- Mobile health courts may be established to regulate the local pharmacies. - The farmers need training and proper awareness should be created to control the use of antibiotics in the agricultural and livestock sectors.- The tannery industries should be taken under surveillance to reduce water pollution which is responsible for evolving germs in different ways.
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Conclusion
In the 21st century, Antimicrobial Resistance (AMR) is a global concern, and Bangladesh is at high risk. Proper actions and reforms in the healthcare sector may control the situation. In this case, proper steps should be taken by the government in collaboration with the private sectors, like NGOs, development partners, doctors, and pharmaceutical companies. And, most importantly, the mass population of the country should stand against the AMR effects. Otherwise, it would result in health hazards, economic problems, and environmental concerns to a greater extent.
1 week ago
GLG on AMR: Hasina seeks technology transfer to ensure equitable access to medical facilities, antibiotics
Prime Minister Sheikh Hasina has sought continued collaboration from global leaders to keep up the momentum for ensuring equitable access to affordable and effective antibiotics and other medical facilities through technology transfer and sharing of ownership.
“Let’s work at the same time for partnership for investment in Antimicrobial Resistance (AMR) containment,” she said on Tuesday.
The Prime Minister made the plea in her pre-recorded speech at the Second Meeting of Global Leaders Group (GLG) on Antimicrobial Resistance (AMR).
She said the AMR challenge requires sustained action across sectors. “I’m pleased to see the finalisation of the action plan in this regard. I’m also happy to support the GLG priority advocating for financing and implementation of multisectoral National Action Plans, with a One Health approach,” she said.
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Hasina said she was glad to approve the comprehensive communication strategy for the GLG. “We’ll do our part to raise the profile of the GLG work through different networks.”
She mentioned that financing across sectors is essential to reduce the burden of AMR. “I look forward to hearing your ideas on what the GLG can do to increase sustainable financing to directly address AMR.”
The Prime Minister gave importance to the need to make sure that adequate funding is available for the national action plan implementation, research and development, and for ensuring equitable access to new innovations.
“Needless to say, we need to prioritise political action to achieve our goal,” she said, adding that AMR should be embedded in implementation of SDGs.
Talking about her own country, Hasina said Bangladesh has developed a six-year (2017-2022) National Strategic Plan and National Action Plan on Antimicrobial Resistance Containment.
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“The Bangladesh AMR Response Alliance has also been formed.”
She mentioned that Laboratory-based AMR surveillance for both human and animal health are being conducted regularly to ensure WHO categorisation.
“We’ve also been providing AMR surveillance data to WHO GLASS Platform for the last two years.”
3 years ago
Antimicrobial resistance can even threaten food security: PM Hasina
Prime Minister Sheikh Hasina on Tuesday said Antimicrobial Resistance (AMR) will not only endanger human, animal and plant health, but also threaten food security and the progress achieved in SDGs.
"The Covid-19 pandemic is the defining public health crisis of our time that has already taken more than three million lives. However, the impending pandemic, in the form of antimicrobial resistance, will cause even more harm to the global health," she said.
The Prime Minister said this in her pre-recorded video message in the 'One Health Global Leaders Group on Antimicrobial Resistance (GLG-AMR)' as co-chair with Prime Minister of Barbados Mia Amor Mottley.
Sheikh Hasina said antimicrobial resistance can affect anyone, regardless of geographical location and socioeconomic condition.
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"For AMR containment, we’ve to ensure strict adherence to Infection Prevention and Control-IPC measures. That’s possible through implementation of Global Action Plan-2015 on AMR and 2016 UN political declaration on AMR," she said.
In this regard, she put forward seven suggestions for addressing the challenges of AMR which is crucial for preventing future pandemics.
These include: Setting up of global, regional, and national targets and inclusive monitoring as well as reporting system to achieve the goals of ARC, developing guidelines and policies at different tiers for the appropriate use of antimicrobials and Sharing of scientific knowledge and technical assistance for ensuring effective and inclusive AMR surveillance and capacity building.
The others are: Ensuring equitable access to affordable and effective antibiotics and other medical facilities through technology transfer and sharing of ownership, sufficient and sustainable financing for AMR-specific and AMR-sensitive actions with special attention to low- and middle-income countries, public-private partnerships for investment in AMR containment; and inclusive, affordable and sustainable universal health care coverage.
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Talking about Bangladesh, she said the government has adopted numerous initiatives to ensure effective antimicrobial usage at the domestic level.
"We’ve developed a six-year National Strategic Plan and National Action Plan on Antimicrobial Resistance Containment (ARC)," she said.
The Prime Minister said the plans aim to ensure rational use of antimicrobials in human health, livestock, fisheries, and agricultural sector.
She said Bangladesh is providing AMR data to WHO GLASS platform from 2019.
Besides, she said, the government is also involving the media to increase awareness among the mass people about the antimicrobial resistance.
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Hasina, as the co-chair of the Global Leaders Group on AMR, reiterated her call to the global leaders to establish AMR as a top priority issue in the political agenda to combat the threat of AMR and create a universal health care system.
The Prime Minister iterated her commitment to work together with the Prime Minister of Barbados as the co-chair of the Global Leaders Group on AMR.
She also appreciated the ongoing efforts of WHO, FAO, and OIE to formulate global strategies for tackling the upcoming challenges of AMR through a comprehensive and collaborative approach with diverse stakeholders.
3 years ago
PM Hasina suggests 5 actions to deal with drug-resistant diseases
Prime Minister Sheikh Hasina on Thursday stressed on the importance of five actions to fight against antimicrobial resistance (AMR) as it is crucial for preventing future pandemics.
The Prime Minister put forward the actions at the high-level Interactive Dialogue on AMR through her pre-recorded statement played at the opening segment of the dialogue at the United Nations Headquarters in New York.
The actions include an integrated multisectoral action plan on AMR, including a collective action plan by the international community at both regional and global levels with special focus on low- and middle-income countries; and good manufacturing, laboratory practices and surveillance framework.
The three other actions are equitable access to affordable and effective antibiotics, as required, through transfer of technology and sharing of ownership; sustainable financing for AMR containment activities and finally global public awareness in combating AMR through political commitment and partnership among the member states.
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“Addressing the challenges of AMR is crucial for preventing future pandemics. We need to implement the 2015 Global Action Plan on AMR, 2016 UN political declaration on AMR, and formulate AMR national action plans,” she said.
As co-chairs of the Global Leaders Group on AMR, the Prime Ministers of Bangladesh and Barbados stand ready to work with all relevant stakeholders in contributing to the fight against AMR, Hasina said.
She said the world is now witnessing the devastating pandemic of Covid-19. “However, antimicrobial resistance may cause even more lethal pandemics in the future.”
The Prime Minister mentioned that failure to tackle this hazard in time will result in huge loss of human lives, animals, and plants.
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According to an estimate by the WHO, she said, 10 million people will die every year by 2050 from AMR, and economic losses will be trillions of dollars disrupting food security and progress towards achievement of the SDGs and universal health coverage.
Turning to Bangladesh, the Prime Minister said the government has developed a six-year (from 2017 to 2022) National Strategic Plan and National Action Plan on Antimicrobial Resistance Containment (ARC).
Besides, she said, the National Technical Committee on ARC and the Bangladesh AMR Response Alliance have been formed.
Hasina said laboratory-based AMR surveillance for both human and animal health is being conducted regularly to ensure WHO categorisation. “Similarly, from 2019, we’ve been providing AMR surveillance data to WHO GLASS Platform.”
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President of the 75th session of the United Nations General Assembly Volkan Bozkir convened the high-level dialogue calling for accelerated action to tackle the growing threat of AMR.
AMR --referred to as a silent tsunami— has the potential to be the next global health crisis and has already affected the response to Covid-19.
AMR occurs when bacteria, viruses, fungi and parasites change over time. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat-increasing the risk of disease spread, severe illness and death.
According to the UN website data, the Covid-19 pandemic has shown the ease with which infections can spread, threaten global health security and destabilise economies, lives and livelihoods. AMR is a rising pandemic and challenges the effective delivery of the Sustainable Development Goals (SDGs).
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Currently, at least an estimated 700,000 people die each year due to drug-resistant diseases. If no action is taken, drug-resistant diseases could cause 10 million deaths each year by 2050 and damage to the economy as catastrophic as the 2008-2009 global financial crisis; and by 2030, AMR could force up to 24 million people into extreme poverty.
Prime Minister of Barbados and also Co-chair of the One Health Global Leaders Group on Antimicrobial Resistance Mia Amor Mottley, President of the 75th UNGA Volkan Bozkir, UN Deputy Secretary-General Amina J. Mohammed, Director General of World Health Organisation (WHO) Tedros Adhanom Ghebreyesus, Director General of Food and Agricultural Organisation (FAO) Qu Dongyu, Director General of World Organisation for Animal Health (OIE) Dr Monique Eloit and Deputy Executive Director of UN Environment Programme (UNEP) Joyce Msuya spoke at the opening segment of the dialogue.
3 years ago