While we kept our focus on the blunders, faux pas and blame games at the UN General Assembly meeting last week, a lot more happened there. I didn’t have the privilege of attending the sessions that were about accusations and aggression, instead I happened to be at conversations that focused on a truly global threat that seems to be unravelling many of our collective defences. The rise of anti-microbial resistance (AMR) continues to cause serious concern among public health workers, clinicians and even some politicians. The topic, directly or indirectly, was raised in dozens of sessions and meetings during the UNGA. Just because leaders from our region of the world do not talk, or care, much about it does not change the reality.
The rise of AMR means that our best arsenal of antibiotics is going to become ineffective against diseases that we can currently manage and treat. The number of new antibiotics coming to the market to tackle the resistant pathogens is next to nothing. The resistance also means procedures, including surgery, can lead to infections that may become deadly. There are several factors that contribute to AMR. The commonly considered ones are transmission of resistant strains through infection, widespread availability and lack of regulation in prescriptions, self-medication of antibiotics and overall unreliable quality of drugs. Rapid urbanisation, poor quality control, high population density all further contribute to the problem. Two regions of the world, namely South and Southeast Asia, are widely considered to be the hotbeds of resistant pathogens. Pakistan is in the crosshairs, whether we like it or not.
There is, however, one more factor that is often ignored but is just as serious. That is the rise of AMR among farm animals. A paper published in Science magazine last week discusses this important and often overlooked challenge. Globally, there is an increase in the demand for protein from meat. Antibiotics are routinely used to increase meat production (it allows for animals to grow faster) and the resistant strains can jump from animals to humans who consume their meat. All of these challenges further complicate our collective ability to tackle antibiotic resistance.
While the paper had a global focus, and did not specifically discuss Pakistan, the antimicrobial resistance from farm animals is a particular concern for the country and something that is rarely talked about, even in the public health sector. There are several factors that make the problem particularly acute and one that needs urgent attention in Pakistan.
First, our diet is heavily meat based. While a certain sector of the population may not be able to eat meat, which is not because of choice but economics, those who can (and sometimes those who cannot) afford to eat meat, often do, and packaged meat is increasingly accessible. Just because something is packaged cleanly does not mean that it poses no risk in terms of antibiotic resistance. As the population of the country continues to increase, so does meat consumption. Second, the lack of regulation in antibiotic prescription to animals. There are a few vague laws about antibiotic use in animals but they are poorly understood and seldom enforced. This means the farm animals are exposed to antibiotics unnecessarily without a clear guideline. Third, the quality of drugs available in the market is poorly regulated and medicines for animal use are rarely analysed for quality and content. Fourth, and perhaps increasingly concerning, is China’s interest in dairy farming in Pakistan through (and beyond) CPEC. China, in the recent past, have had significant issues affecting farm animal health and it is unclear what regulatory oversight will be administered in dealing with Chinese companies in dairy and meat farming.
There is a needed sense of urgency at the global level to tackle AMR. The road ahead is challenging and requires investment.
Published in The Express Tribune, October 3rd, 2017.