Dear Joseph,
Thank you for alerting us to this WHO press release today.
The critical point, which is mentioned but not emphasised is that 'The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens.' Instead most of the focus is on other secondary aspects, such as how to develop new antibiotics.
The misuse and overuse of antibiotics includes:
- inappropriate prescription of antibiotics when they are not indicated (for example with viral infections)
- inappropriate prescription of broad-spectrum antibiotics and 'blockbuster' antibiotics when cheaper, more targeted antibiotics are indicated
- failure of the patient to take the full course of antibiotics
- prescribing the 'wrong' antibiotic
All of the above are major causes of antibiotic resistance.
Dr Tedros says: “Antimicrobial resistance is outpacing advances in modern medicine, threatening the health of families worldwide,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “As countries strengthen their AMR surveillance systems, we must use antibiotics responsibly, and make sure everyone has access to the right medicines, quality-assured diagnostics, and vaccines. Our future also depends on strengthening systems to prevent, diagnose and treat infections and on innovating with next-generation antibiotics and rapid point-of-care molecular tests.”
In fact, the problem is not just that "Antimicrobial resistance is outpacing advances in modern medicine". It is that poor clinical practice is driving resistance. Furthermore it can be said that "Pharmaceutical advertising is outpacing medical practice", driving the prescription of inappropriate blockbuster drugs that drive resistance in the population.
Meanwhile prescribers and users do not have access to the reliable information they need to use antibiotics responsibly, as noted by HIFA in our systematic review: How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review https://pubmed.ncbi.nlm.nih.gov/32337085/
A recent paper estimates that 30-36% of antibiotics consumed worldwide are used inappropriately, https://bmjpublichealth.bmj.com/content/3/1/e002411
And the latest district health study in India finds that 1 in 5 children with simple diarrhoea seen by a health worker are inappropriately given antibiotics. ('Simple' refers here to diarrhoea without blood. The presence of blood may indicate a bacterial infection that requires antibiotics) https://www.hifa.org/about-hifa/why-hifa-needed
Finally, I would like to consider two aspects of the relation between open access, responsible prescribing and better health for individual patients and populations.
First, in a previous message Joanna Donnelly (UK) said: 'Although pharma companies fund approximately half of all biomedical research, access to a substantial amount of this biomedical research is restricted by journal paywalls. Open access publishing ensures that the highest quality peer-reviewed evidence is available to anyone who needs it, anywhere in the world. This has the potential to improve transparency, advance medical science and, we believe, improve patient care.' Can we substantiate this or develop it further? If all pharma-funded research were open access, would this help drive improvements in patient care?
Second, health workers need not only information on individual medicines, but, even more importantly, guidance on which antibiotic to prescribe in any given clinical context. In the UK there is a guide called the British National Formulary, paper copies of which are commonly used by health workers worldwide (many of them supplied by the Commonwealth Pharmaceutical Association). The BNF used to be freely available on the internet, but this is no longer the case. Furthermore the publisher is stopping print copies. It is hard to estimate how many lives would be saved if the BNF - and national adaptations of it - were freely available to all prescribers (and to all users) of medicines. We have asked this question before, but it is worth asking again: What if the British National Formulary was made available under an open access licence?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org