PHM-Exch> World Health Day 2011 Antibiotic Resistance Dr Chan's statement

[Claudio Schuftan]

WHO DIRECTOR GENERAL's STATEMENT



When the first antibiotics were introduced in the 1940s, they were hailed as
“wonder drugs”, the miracles of modern medicine. And rightly so. Widespread
infections that killed many millions of people every year could now be
cured. Major diseases, like syphilis, gonorrhoea, leprosy, and tuberculosis,
lost much of their sting. The risk of death from something so common as
strep throat or a child’s scratched knee virtually vanished.

The powerful impact of these medicines sparked a revolution in the discovery
of new drugs. The human condition took a dramatic turn for the better, with
signifi cant jumps in life expectancy.

The message on this World Health Day is loud and clear. The world is on the
brink of losing these miracle cures.

The emergence and spread of drug-resistant pathogens has accelerated. More
and more essential medicines are failing. The therapeutic arsenal is
shrinking. The speed with which these drugs are being lost far outpaces the
development of replacement drugs.

In fact, the R&D pipeline for new antimicrobials has practically run dry.

The implications are equally clear. In the absence of urgent corrective and
protective actions, the world is heading towards a post-antibiotic era, in
which many common infections will no longer have a cure and, once again,
kill unabated. The implications go beyond a resurgence of deadly infections
to threaten many other life-saving and life-prolonging interventions, like
cancer treatments, sophisticated surgical operations, and organ
transplantations. With hospitals now the hotbeds for highly-resistant
pathogens, such procedures become hazardous.

While hospital “superbugs” make the biggest headlines, these especially
deadly pathogens are just the extreme expression of a much broader, and more
disturbing picture.

The development of resistance is a natural biological process that will
occur, sooner or later, with every drug. The use of any antimicrobial for
any infection, in any dose, and over any time period, forces microbes to
either adapt or die in a phenomenon known as

“selective pressure”. The microbes which adapt and survive carry genes for
resistance,

which can be passed on from one person to another and rapidly spread around
the

world.

This natural process has been vastly accelerated and amplified by a number
of human

practices, behaviours, and policy failures. Collectively, the world has
failed to handle

these fragile cures with appropriate care. We have assumed that miracle
cures will last

forever, with older drugs eventually failing only to be replaced by newer,
better and more

powerful ones. This is not at all the trend we are seeing.

COMBAT DRUG RESISTANCE

No action today, no cure tomorrow

World Health Day 2011

RAL STATEMENT

Faulty practices and flawed assumptions have clearly made the inevitable
development of drug resistance happen much sooner, rather than later. For
some diseases, like malaria, our options are very limited as we have only a
single class of effective drugs – artemisinin based combination therapies --
with which to treat more than 200 million falciparum cases each year.
Although new drugs are under development, especially through the Medicines
for Malaria Venture, a public-private partnership, early signals of
artemisinin resistance have already been detected.

Similarly, gains in reducing child deaths due to diarrhoea and respiratory
infections are at risk.

And, while TB deaths are declining, in just the past year nearly half a
million people

developed multidrug-resistant TB, and a third of them died as a result.
These are just a

few of the stark warnings that must be heeded.

The responsibility for turning this situation around is entirely in our
hands. Irrational and

inappropriate use of antimicrobials is by far the biggest driver of drug
resistance. This

includes overuse, when drugs are dispensed too liberally, sometimes to “be
on the safe

side”, sometimes in response to patient demand, but often for doctors and
pharmacists

to make more money.

This includes underuse, especially when economic hardship encourages
patients to stop

treatment as soon as they feel better, rather than complete the treatment
course needed

to fully kill the pathogen. This includes misuse, when drugs are given for
the wrong

disease, usually in the absence of a diagnostic test.

In many countries, this includes a failure to keep substandard products off
the market, to

ensure that antimicrobials are dispensed only by a licensed prescriber, and
to stop over- the-counter sales of individual pills.

And this includes the massive routine use of antimicrobials, to promote
growth and for

prophylaxis, in the industrialized production of food. In several parts of
the world, more

than 50% in tonnage of all antimicrobial production is used in
food-producing animals. In

addition, veterinarians in some countries earn at least 40% of their income
from the sale

of drugs, creating a strong disincentive to limit their use. The problem
arises when drugs

used for food production are medically important for human health, as
evidence shows

that pathogens that have developed resistance to drugs in animals can be
transmitted to

humans.

On this World Health Day, WHO is issuing a policy package to get everyone,
especially

governments and their drug regulatory systems, on the right track, with the
right

measures, quickly. Governments can make progress, working with health
workers,

pharmacists, civil society, patients, and industry We all can plan and
coordinate our

response. We can expand surveillance efforts. We can improve drug regulatory
and

supply systems. We can foster improved use of medicines for human and animal
health.

We can actively prevent and control infections in health services and
beyond. And, we

must stimulate a robust pipeline for new antimicrobials, diagnostics and
vaccines.

Drug resistance costs vast amounts of money, and affects vast numbers of
lives. The trends are clear and ominous. No action today means no cure
tomorrow. At a time of multiple calamities in the world, we cannot allow the
loss of essential medicines – essential cures for many millions of people –
to become the next global crisis.

*For more information, go to:*

http://www.who.int/world-health-day/2011

*© World Health Organization 2011. All rights reserved. *

* *

* *

Press Release

*Public Information Office   Press Release*

Tel: *(63 2) 528 9991*

Email*: PIO_Unit at wpro.who.int*

*Antibiotics may lose their power to cure disease, WHO warns*

*MANILA**, 7 April 2011*—The World Health Organization (WHO) today warned of
a possible return to the days before antibiotics were developed unless
global action is taken urgently to combat the growing problem of drug
resistance.

WHO cautioned that the misuse and irrational use of drugs are weakening the
fight against

diseases, such as tuberculosis and malaria, that should have been contained
decades ago. At the same time, other age-old diseases are on the rise, with
the possibility of no cure.

The rallying cry of this year's World Health Day, observed on 7 April is
"Combat drug

resistance! No action today, no cure tomorrow." It seeks to raise awareness
about what drives

antimicrobial resistance and how to halt it.

"Antimicrobial drug resistance is a complex problem, and it requires a
comprehensive response among and between Member States across different
sectors," said Dr Shin Young-soo, WHO Regional Director for the Western
Pacific.

WHO will launch on World Health Day a six-point policy package for countries
in an effort to fight drug resistance. The six points are:

(1) committing to a comprehensive, financed national plan with lines of
accountability and

community engagement;

(2) strengthening surveillance and laboratory capacity;

(3) ensuring a regular supply of good-quality medicines;

(4) regulating and promoting rational use of medicines and proper patient
care;

(5) enhancing infection prevention and control in health settings; and

(6) fostering innovation, research and development.

WHO said antimicrobial resistance is a global concern not only because it
kills but because it

increases health costs and threatens patient care. The problems include:

(1) An estimated 440 000 new multidrug resistant-TB cases around the world
annually, with

extensively drug resistant-TB, identified in 58 countries to date.

(2) The fight against malaria is hampered by the emergence of resistance to
the frontline drug, artemisinin.

(3) Treatment for gonorrhoea is threatened by growing resistance to the
last-line treatment for

this sexually transmitted infection.

(4) The emergence of hospital-acquired "superbugs"*, *resistant to major
antibiotics, is

becoming increasingly frequent.

In response to the threat of antimicrobial resistance, WHO developed the
first Global Strategy for Containment of Antimicrobial Resistance in 2001,
but strategies for containment have not been widely implemented, WHO said.
While action is needed, commitment, implementation and accountability have
lagged behind. The newly launched six-point package will engage all WHO's
193 Member States and the global health community to foster action for
change.

The World Health Day' message will target health ministers, other
policy-makers and health

leaders; the public, patients and civil society; the pharmaceutical
industry, health institutions,

prescribers and dispensers; and the media.

____

For more information, please call Dr Dean Shuey, WHO Regional Adviser in
Health Systems

Development, tel: +(63 2) 528 9806/9805; email: shueyd at wpro.who.int.
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