Shirazum Munira :
While biting on the crispiest chicken legs or popping antibiotic pills for little sneezing, did it ever occur to you that your food or medicine might make your body unresponsive to antibiotics one day? If this isn’t making sense then let me tell you a story of the era of Antimicrobial Resistance (AMR) we are heading. Say, Rahim is a farmer who takes antibiotics even at the slightest sign of physical distress; he injects his poultry with high antimicrobials and sells them to a overcrowded city. Analysing the chain of actions, it is evident that unsupervised use of antimicrobials instigates pressure on the microbes for which organisms create adaptive solutions to antimicrobials. Residual of this resistant pathogen in food supply is transmitted to people. With globalization and urbanisation, antimicrobial resistant pathogens are mobilised globally proliferating more in hosts leaving antimicrobials: Antibiotics, Antivirals, Antifungal and drugs alike ineffective ultimately resulting in implementation of less effective resorts to fight infectious diseases burdening the healthcare system. This is where One Health Approach comes into play.
The US Centers for Disease Control and Prevention and the One Health Commission says: ‘One Health is defined as a collaborative, multisectoral, and transdisciplinary approach-working at the local, regional, national, and global levels – with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment’. The classes of antimicrobials like cephalosporins, tetracyclines used to treat bacterial infections in humans are also used in animals. Industrial-chemical-domestic-farm wastes are making microbes resistant of heavy metals, UV rays aiding to high adaptive modules. So the human-animal-environmental interface related to antimicrobial resistance makes multifaceted one health approach a perfect fit to curve this menace. WHO has launched new guidelines stopping routine use of medically important antimicrobials in food-producing animals by farmers and the food industry. It has developed Antimicrobial stewardship in hospital antibiotic policy and treatment policy. One health provides a multidisciplinary network following bottom to top approach of veterinarians, wildlife experts, environmental experts, community health workers, community-based animal health workers, NGOs, clinics, hospitals, farmers trained to act collaboratively on the surveillance by combining inter professional exchanges, upgraded communication, research, innovation, student engagement, public awareness, policy development on food safety, tackling corporate campaign on antimicrobials which helps limiting current antimicrobial use, reducing use of antimicrobials on animals and dissolve environmental threats because integrated multi sectoral efforts from stakeholders happen parallelly removing all causal factors simultaneously.
Now the question comes why it’s important for Bangladesh. Let me give you a quick example, in a study performed in Chittagong in 2003, typhoid patients were found to be unresponsive to second-line therapy (ciprofloxacin). First-line therapy was not even attempted because of existing resistance. There is a shortage of new antibiotics but controlled and lowered use of antibiotics can abate resistance (Barbosa and Levy, 2000).That being said, is there any national regulation for Antimicrobial resistance? Answer is yes.Are the regulations properly implemented? That will be a “No”.
Bangladesh is a member of Global Antibiotic Resistance Partnership (GARP) and it has a National Plan for containment of AMR developed in March 2018 which is predominantly based on regulating productions and dispensing of medicines in stages of manufacturing, procuring, supplying and end use. Yet according to Journal of Global Antimicrobial Resistance, only 35% of the recommended global action plan was implemented at February 2019 and evidence of 8 out of 20 actions of the Bangladesh National Plan were executed by the end of 2018.
By the 2017 report ‘Drug-Resistant Infections: A Threat to Our Economic Future’, each year 700,000 people die of AMR and if unintervened it will rise to 10 million annually with gross loss of 3.8% GDP. But we can save these precious lives as one health approach will be our biggest weapon to take down Antimicrobial Resistance now and in the days to come.
It is the demand of the hour that an integrated and holistic approach should be taken by the Ministry of Health and Family Welfare, the Ministry of Fisheries and Livestock, the Department of Livestock, Bangladesh Veterinary Council, the education ministry, the National Parliament and the Ministry of Finance to include one health steps like-integrated disease surveillance in animal, human and agriculture, improvement of awareness and communication among environmental, animal and human health professionals, adopting one health study in university and pre university education, safe use of animal and meat consumption and overall encouragement of more research, innovation and interprofessional collaboration along with international academic partnership to tackle poverty, lack of education, sanitation, consumer awareness, human animal proximity as well as other associated factors which aids in the upscale of antimicrobial resistance.
(Shirazum Munira is a 3rd Year MBBS Student, Shaheed Suhrawardy Medical College. Email: [email protected])
