‘There is no time to waste‘. The report WHO 29.4.19 on resistance to antibiotics presents a catastrophic scenario, for health and the global economy. Up to 10 million deaths a year over the next three decades, with social costs and culminations of inequality comparable to those of the 2008 financial crisis. (1)
Antibiotic resistance, the problem and its causes
Antibiotic resistance is a phenomenon that occurs when bacteria ‘learn to resist’ antibiotics once they are able to defeat them. And when microorganisms once considered almost harmless begin to resist different classes of antibiotics (multi-antibiotic resistance), the problem becomes serious. Increased mortality, prolonged hospital stays, unavailability of effective treatment.
The exorbitant cost of the mindless speculations of the drug giants, as always, is externalized onto the global community. Which for half a century has foraged the coffers of Big Pharma, Buying antibiotics like cough drops. Without anyone, until a few years ago, raising any doubts about the individual and social costs of their abuse. Except only to add a box of milk enzymes – to prescriptions or over-the-counter suggestions – to ‘restore intestinal flora,’ in a fairy-tale vision of theinteraction of chemical weapons with the microbiome.
Animal husbandry has in turn contributed and still contributes to causing and exacerbating antibiotic resistance, as veterinary drugs in ‘livestock’ farms have been used systematically rather than localized, as the ‘easiest way’ to prevent outbreaks of infection. If not also to compensate for hygiene deficiencies and ‘improve performance’ in production. Therefore, the European legislature intervened with a drastic reform (reg. EU 2019/6), for the express purpose of limiting the use of antimicrobials and antibiotics on farms to the absolute minimum.
‘No time to waste’. WHO Report 29.4.19
‘No Time to Wait. Securing
the Future from Drug-Resistant Infections.’
The report published on 4/29/19 by WHO stems from the activities of the UN Interagency Coordination Group dedicated to antimicrobial resistance (IACG, ‘
UN Interagency Coordination Group on Antimicrobial Resistance.
‘. (2) Managing a health and socioeconomic crisis of global impact indeed postulates a shared approach, according to the vision ‘‘One Health’. Where the so-called ”
Sustainable Development Goals
‘ (
SDGs
), on the UN 2030 agenda, represent both goals and tools for survival and problem solving. Particularly with regard to the rights of access to safe food and water, premises of health and hygiene.
At present., at least 700,000 deaths each year are attributed to drug-resistant diseases, 230,000 to forms of tuberculosis alone that do not respond to treatment. Common diseases become incurable and ‘life-saving’ protocols lose effectiveness. Food supply chains in turn increase fragility, due to the impact of multidrug-resistant pathogens on ‘
food safety
‘ (food safety) and so on ‘
food security
‘ (security of food supplies, i.e., availability of food for populations). The IACG predicts that antimicrobial resistance may drive 24 million people into extreme poverty between now and 2030.
‘
Antimicrobial resistance
is one of the most serious threats we face as a global community’ (Amina Mohammed, UN Deputy Secretary General and IACG co-chair)
The forecast scenario has a different scale; an unprecedented epidemic is predicted. Antibiotics, antivirals, antifungals are becoming ineffective. IACG reports 10 million deaths annually, planet-wide, by 2050. With prevalence in LMIC countries (‘Little Medium Income Countries‘) but without excluding more mature economies. In fact, the phenomenon is recorded at alarming levels in all countries regardless of national income level. We are still human and will continue to be human, all of us, regardless of insurance policies and checking accounts. Never losing, in any case, hope of achieving the universal health coverage so far proclaimed in vain by the United Nations itself and the politicians who participate in it. Empty words.
‘One health‘
, the indispensable synergy
‘
One health
‘
.
Human health, animal welfare, food safety, and environmental protection in its various aspects-including waste and wastewater management-are intimately related issues and must be managed in synergy. The IACG report stresses the need for a coordinated and systemic, multi-sectoral approach. Europe has already embarked on this path, starting with the White Paper on Food Safety (12.2.2000). And yet it is essential to develop it, including in the international arena, on several fronts.
‘
Abuse and overuse
of existing antimicrobials in humans, animals and plants are accelerating the development and spread of antimicrobial resistance‘ , highlights the IACG report. Stricter regulatory systems should be established, awareness of the proper use of antibiotics should be raised, research and development of new technologies to combat resistance to their active ingredients should be funded, and the use of critical antimicrobials and other veterinary drugs as growth promoters in animal husbandry should be abolished.
‘
The report’s recommendations
recognize that antimicrobials play a critical role in safeguarding food production, sanitation and trade, as well as human and animal health, and promote their responsible use in all sectors. Countries need to encourage sustainable food systems and agricultural practices that reduce the risk of AMR by working together to promote viable alternatives to antimicrobial use, as set out in the report’s recommendations‘ (José Graziano da Silva, FAO, Director-General)
Salmonella and
campylobacter
, increases resistance
Recent reports from EFSA.
(
European Food Safety Authority
) and the European Centre for Disease Prevention and Control (ECDC) show how antimicrobials used to treat diseases transmissible between animals and humans (e.g. campylobacteriosis and salmonellosis) are losing effectiveness and antibiotic resistance shows no signs of decreasing.
In some EU countries.
resistance to fluoroquinolones (such as ciprofloxacin) in bacteria of the genus
Campylobacter
is so high that such antimicrobials no longer work to treat severe cases of campylobacteriosis. Salmonella in humans is also increasingly resistant to fluoroquinolones, as is its resistance to several classes of antibiotics (MDR,
Multiple Drug Resistance
).
Antibiotics, consumption in Italy
The March 2019 AIFA (Italian Medicines Agency) report on antibiotic consumption in Italy shows our country among the top in Europe for antibiotic consumption – albeit with a slightly decreasing ‘trend’. As well as, dramatically, for higher rates of resistance and multi-resistance. (4)
Antibiotic consumption in Italy was 25.5 doses/day per thousand inhabitants, down from 2016 but well above the European average (21.7 doses/day per thousand inhabitants). Especially deserving of attention are the levels of drug use by children.
‘
During 2017, 41.4% of the pediatric population
(0-13 years) belonging to the six regions analyzed (Lombardy, Veneto, Tuscany, Lazio, Campania, and Puglia) received at least one prescription for systemic antibiotics, and an average of 2.6 packs of these drugs were prescribed.
A peak use prevalence of 50% is observed (administration at 1 in two, ed.) in the child’s first year of life, with no difference between boys and girls. This value remains almost constant until the age of six years. The prevalence then gradually decreases until age 13, where it stands at 30 percent’ (AIFA).
Sabrina Bergamini and Dario Dongo
Notes
(1) OMS (2019). ‘No Time To Wait‘ Report. https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1
(2) ‘UN Interagency Coordination Group on Antimicrobial Resistance‘ (IACG)
https://www.who.int/antimicrobial-resistance/interagency-coordination-group/en/
(3) Cf. Efsa, ‘The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2017‘
https://www.efsa.europa.eu/en/efsajournal/pub/5598
(5) AIFA, ‘Antibiotic use in Italy. National Report Year 2017‘ http://www.aifa.gov.it/sites/default/files/Rapporto-L’uso_degli_antibiotici_in_Italia_2017_0.pdf
Journalist. Consumption, rights, nutrition, social, environment. Head of Consumers Help. She collaborated with ResetDOC, Il Riformista, La Nuova Ecologia, IMGPress.
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
