Behavioural change in the public, prescribers, pharmacists and policy makers is the first step, writes Olivier Oullier
We can all do our bit to stop antibiotic overuse
“This is something that has to bind the world together”. Professor Jeremy Farrar, the Wellcome Trust director, was not referring to climate change in Davos earlier this year but what most leading lights in global health view as perhaps the greatest global public health threat: resistance to antibiotics.
The World Economic Forum raised this issue in its 2013 flagship global risk report and rightly stressed it again in this year’s edition. What is known as antimicrobial resistance (AMR) is already killing more than 700,000 people globally each year and the annual death toll could reach 10 million by 2050 if nothing changes.
According to the World Bank, in addition to human losses, AMR will increase poverty and have a global economic and financial impact of the magnitude of the 2008 financial crisis but with “no prospects for a cyclical recovery in the medium term”.
So why has something as common as taking antibiotics to treat infections become such a threat to the very lives it is meant to save? The overuse – and sometimes misuse – of antibiotics in treating humans and animals has led to the rise of resistant bacteria. Also called superbugs, they can reduce or even eliminate the effectiveness of antibiotics.
When a patient is infected with antibiotic-resistant bacteria, illnesses last longer and are harder to treat. They require stronger and more expensive drugs as well as more doctors’ visits. More importantly, resistance to antibiotics can lead to deadly bacterial infections. Superbugs are also highly infectious.
Global healthcare stakeholders as well as governments are well aware of the issue and many initiatives have been launched globally to change antibiotic-related behaviour. At the end of last year, the World Health Organisation (WHO) set up an informal consultation in Geneva, Switzerland, to hear from some of the foremost health experts in behaviour change.
Four key target audiences for behaviour change were identified, referred to as the “four Ps”: public, prescribers, pharmacists and policymakers.
Often, pressure from the patient plays a key role in a physician’s prescription of antibiotics. Patients need to be informed that when it comes to viruses, for instance, prescribing antibiotics will not help.
Behaviour change experts from the UK’s Behavioural Insights Team have conducted a successful field experiment to persuade GPs to prescribe fewer antibiotics.
Letters were issued by Dr Sally Fields, the country’s chief medical officer, to GPs who were “prescribing antibiotics at a higher rate than 80 per cent of practices” in their local area.
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The results of this randomised control trial, published in the Lancet, indicate that peer pressure induced by the letter – “other practitioners prescribe less than you do” – succeeded in reducing antibiotic prescription over six months.
Besides GPs, the food and agriculture industry also needs to make significant efforts. In its report focusing on AMR in animal production, the UN’s Food and Agriculture Organisation indicates that white meat – the main sources of animal protein – are “important food-based vehicles of AMR transmission to humans”.
It is a conclusion that some key stakeholders in the agriculture industry, not surprisingly, dispute.
The Davos talk I mentioned earlier was organised for the launch of the antimicrobial resistance benchmark by the Access to Medicine Foundation.
This initiative compared AMR efforts across the pharmaceutical industry. The evaluation was based on the companies’ effort in research and development for new antimicrobials, policies for ensuring antibiotics are manufactured responsibly and approaches to ensure antimicrobials are accessible and used wisely.
The benchmark indicates that in the global pharmaceutical companies group, GlaxoSmithKline and Johnson and Johnson were leading, followed by Pfizer and Novartis. The leaders in the generic medicine manufacturers and biotech groups were Mylan and Entasis respectively.
The UK and Dutch governments, who sponsored the benchmark, as well as the German, US and Chinese governments, are among the most proactive countries in fighting AMR.
A month ago in Dubai, during the UAE’s International Conference on Antimicrobial Resistance, Dr Najiba Abdulrazzaq, the national AMR committee co-chair, declared that a Cabinet decree will be released to regulate the UAE AMR action plan, in line with WHO’s global action plan on antimicrobial resistance.
It is estimated that more than 90 per cent of the global population lives in countries that have an AMR plan in action or under development. It is therefore our individual responsibility to change our behaviour to contribute to the fight against AMR.
Simple actions like putting less pressure on GPs to prescribe antibiotics and consuming food that is antibiotic free are necessary steps to fight the resistance – and in doing so, save millions of lives.
Professor Olivier Oullier is the president of Emotiv, a neuroscientist and a DJ. He served as global head of strategy in health and healthcare and member of the executive committee of the World Economic Forum