By Samwel Doe Ouma
The scales have tilted in the war between humans and infectious pathogens as bacteria and other microbes are evolving to survive antibiotics, World Health Organization warns.
Since science brought penicillin into public use, opening a new era in infectious disease control but infectious diseases have been working on a comeback and today they are pounding at the door. WHO says they are breaking down the door.
Overuse of antimicrobials increases the speed at which multi drug resistance superbug infections develops, exuberating the human health and economic costs of Antimicrobial resistance (AMR).
According to Dr. Stella Kiambi of the Food and Agriculture Organization, United Nations, antimicrobials are quickly losing efficacy because of misuse, pointing the need for urgency in prohibiting use as growth promoters and rational use in human and animal health.
“It costs more than Sh1.8 billion and about 20 years of research to develop one class of antibiotic. For the manufacturing to break even in the market, they need to sell the antibiotic for minimum of 23 years,” she said.
However, antibiotic resistance develops as soon as the drug is introduced in the market, compounding bottom line for companies answering to shareholders while depriving the country of a wider good.
From 1928 the field antibiotic research and development (R&D) enjoyed a golden era until 1999 when resistance started to develop as soon as antibiotics are introduced, pausing a great health risk.
The main reason for this mismatch is that commercial return for a new antibiotic is uncertain until resistance has emerged against a previous generation of drugs. This she explains puts more pressure on the supply side as higher flow of new drugs through the development pipeline to replace existing ones as they become ineffective.
Kiambi explained that the market for antibiotics is different from that of other drugs in the field of infectious diseases. Antibiotic resistant and slow research and development incentives gives rise to a set of problems that economists call ‘negative externalities’.
When a patient uses an antibiotic, a collateral effect is that it contributes to additional bacterial resistance, which has a negative impact on all of society. Nevertheless there is also a positive externality of appropriate and proper antibiotic use, from its role in controlling the spread of infection.
Key drivers of the misuse and overuse of antimicrobials in Kenya are lack of awareness, gaps in legislation, and absence of or poorly implemented enforcement of legislation.
Antibiotic resistance is described by WHO as the single greatest challenge in infectious diseases today, threatening rich and poor countries alike, and yet has not had sufficient medical research.
Antimicrobial resistance is developed when microorganisms such as bacteria, viruses, fungi and some parasites are able to withstand the therapeutic effects of antimicrobials, rendering treatment of diseases in humans and animals ineffective.
A WHO report showing paucity of new antibiotics being developed, lists 12 other pathogens that are a danger to health as the world runs out of drugs to treat the infections they cause.
Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae that have become resistant to the carbapenem class of antibiotic are all on the critical priority list.
Known as gram-negative bacteria, they are capable of causing life-threatening infections such as pneumonia, sepsis and meningitis.
Studies show that there is rising resistance to ‘carbapenems’, a class of antibiotics that constitute doctors’ last line of defence against a range of potentially life-threatening infections such as pneumonia, and bloodstream infections.
Yet perhaps only three compounds under development at the moment have potential to be active against vast majority of bacteria resistant to carbapenems, despite them having reached worryingly high levels in some countries.
The Global Tuberculosis report 2018 revealed that 558,000 people across the world developed TB resistant to rifampicin (RR-TB), the most effective first-line drug in 2017.
Data from the National Tuberculosis, Leprosy and Lung Disease Programme shows that Kenya recorded 3,000 cases of drug-resistant tuberculosis.
Malaria, and in particular the risk that artemisinin-resistant strains of malaria could spread out of South East Asia into India and beyond, has been identified and is addressed through the work of groups including the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Dr. Evelyn Wesangula, head of the Antimicrobial Resistance Programme at the Ministry of Health says Kenya needs to explore alternative ways to tackle infections such as preventions, maintaining hygiene improving sanitation and health infrastructure and through vaccinations, phage therapy and exploring ways to use body’s own immune response.
“Health practitioners should encourage prudent and responsible use of antimicrobials, through appropriate prescriptions in animal, human and plant health,” she said.
As large proportion of consumption of antibiotics in the country is from the agricultural sector, farmers should stop routine use of powerful antibiotics on animals reared for food because the practice fuels dangerous drug-resistant superbug infections in people.
According to Dr. Michael Cheruiyot, Deputy Director Veterinary Services, demand for food and increased production has made misuse of antibiotics more common in agricultural sector.
“Farmers are advised to seek services of a qualified animal health specialist for diagnosis and treatment of their livestock,” he said, adding that “antimicrobials should not be used as growth promoters.”
Dr. Cheruiyot said that measures should be implemented to reduce the use of antimicrobials for growth promotion purposes while still maintaining comparable growth rates.
He said that the entrant of international high value food chains like KFC and others might not benefit local farmers because misuse of AMR affects market access.
At least 40-80 percent of antibiotics used in animal production in Kenya are inappropriate, Dr Cheruiyot noted, adding that facing out poor animal husbandry can lead to less dependency on antibiotics.
In 2011, a Kenya Medical Research Institute (KEMRI) study on food borne pathogens (Salmonellae Spp, Cambylobacter Spp, and E.Colli) and Antimicrobial resistant in poultry, pork and beef value chains in Kenya found high levels of Antimicrobial contamination in meat.
The study pointed out high level of resistance of food pathogens to Antimicrobial compounds that are used for human and veterinary treatments in Kenya.
In 2016, Kenya imported 5.2 million kilograms of antibiotics for use in veterinary practice.
Global Antibiotic Resistance Partnership, a project of the Centre for Disease Dynamics, Economics and Policy, reported that 70 percent of antibiotics imported for use in Kenya are given to chicken, pigs, cows and other animals that end up on dinner tables.
A Lancet report on antibiotic use pointed the increasing recognition that widespread antibiotic use in agriculture and aquaculture might contribute to the development of resistance to antibiotics.
Kenya has not developed a mechanism to survey how livestock farms use the drugs. This means information on which drugs are used, for what reasons, in what quantities and on what animals is unavailable.
This compounds efforts to document the relationship between routine antibiotic use in animals and antibiotic- resistant infections in humans.