Antimicrobial resistance: global agenda

Article from Fiocruz Brasilia/UNASUS Advisor, Claudio Maierovitch, published in the newspaper Correio Braziliense.

Claudio Maierovitch Pessanha Henriques – Master´s degree in Social and Preventive Medicine, Tropical Medicine Specialist, former Director of Incorporation of Technologies and Surveillance of Communicable Diseases, Ministry of Health

The 71st UN General Assembly included the commitment of Member countries with efforts to address the resistance of infectious agents to antimicrobial drugs. Conservative estimates indicate nearly 500,000 annual deaths in the world as a result of infections with multidrug-resistant organisms. Studies in the USA indicating annual cost of US$ 55 billion a year in the country, with US$ 20 billion spent directly with health services. Some projections indicate that, following the current trend, antimicrobial resistance (RAM) will compromise increasing resources, achieving from 2% to 3.5% of the global GDP in 2050. In contrast, the lack of investment is well illustrated by the information that most modern classes of antibiotics have 30 years. In general, there is little interest in the industry because most of these treatments lasts a few days and do not generate great income.

The priority of the issue, held as a flag by the Director General of WHO, Margareth Chan, was overshadowed by three international public health emergencies: in 2014, the growth of cases of polio and the disease caused by the ebola virus; in 2016, the epidemic caused by zika virus associated with microcefalias. Still, the overall plan on RAM was approved by the World Health Assembly in 2015, and now had its spectrum of commitments extended far beyond the area of health. Brazil was present in the preparation of this work from the very first moment. I have represented the country at the meeting of Ministers of Health and Agriculture that took place in the Hague, in 2014, in which an agenda was agreed that included the holding of preparatory steps in Brasilia, at the end of that year.

Here, several steps have been taken in recent years. The National Immunization Program covers the entire country and includes some vaccines able to prevent bacterial infections. In addition to robust programs of monitoring resistance to drugs used to treat malaria, Aids and tuberculosis, since 2010 the sale of antibiotics in retail is controlled by special medical prescription. There are, legally forced, infection control committees in health services and which developed also monitoring programs infections caused by multidrug-resistant bacteria. In addition, there are some regulations about the antimicrobial products that can be used in breeding.

The political opportunity to speed up our programs has been given. It is important that we are alongside those 25 countries that have already released their action plans. Such document involves complex tasks in the regulatory , scientific and communication fields. Several countries have developed projects to ban the use of antibiotics to accelerate the growth of cattle, pigs and poultry; Brazil, which is a big producer and exporter of these animals, it is virtually impossible to know how much and how they are used. Similarly, there is little publicly about the medicines used in plantations and in aquaculture.

Obvious investments in prevention need to be speeded up. The biggest highlight is sanitation, whose lack is still cause of many infections. The adoption of best practices in prevention in health services, in particular the frequent and careful cleaning of hands by health professionals, is obvious and of insignificant cost; it means, oddly enough, change in the culture of many assistance institutions. There are still insufficient mechanisms for the collection and dissemination of information on resistance of microorganisms that affect our population. Such data are precious to guide appropriate prevention and treatment of infections. Finally, even if the strength of science in the southern hemisphere is not much believed, we have here competent scientists and a universal health system, favorable situation for the development of clinical research and technologies for prevention, diagnosis and treatment, field in which Brazil can give important contribution.