Can Africa Survive if Antibiotics Don’t Work?

Scientists are sounding a global warning about a ‘post-antibiotic’ era that is set to commence following the growing rate at which bacteria, in both humans and animals, are mutating and becoming resistant to antibiotics. These bacteria, dubbed ‘superbugs’ are threatening to plunge medicine back into the “dark ages” when it was difficult to fight basic infections.

The latest discoveries on superbugs were made in China, where studies showed that a new mutation, called the MCR-1 gene, is now preventing antibiotics of last from killing bacteria. It was concluded that this gene will likely go on to align itself with other antibiotic resistance genes, throwing the planet into an ‘antibiotic apocalypse’ Although the pharmaceutical industry is currently developing new drugs such as teixobactin that can work in the face of ever increasing microbial resistance, none have been approved for medical use yet.

Africa still suffers the burden of many communicable diseases caused by bacterial infections and because of poor health systems and lack of access to clean water. The continent is projected to have the highest number of deaths from superbugs, at 4,150,000, after China’s 4,730,000 if antibiotic resistance goes global.

Ventures Africa reached out to Dr. Chikwe Ihekweazu, an infections diseases and public health specialist who is also the Editor-in-Chief of Nigeria Health Watch and a  Managing Partner at EpiAfrica, to discuss why Africa could have such a high mortality rate in the face MCR-1 resistance and if there are ways for the continent to prevent the predicted outcome.

Ventures Africa (VA): What would massive antibiotic resistance mean for the continent?

Dr. Chikwe Ihekweazu (CI):It is a big problem. We have one of the largest burdens for infectious diseases in the world, on the continent. So, if we lose the opportunity of antibiotics, then we are faced with a massive increase in mortality rates from infections such as E.coli or Salmonella, or Typhoid that no one is presently worried about because there’s antibiotics to cure them.

Once the population scale starts to get affected by these deaths, then we are in trouble, because this is not a situation that can be fixed in a few weeks. Therefore, the old model which I described before, which involves pharmaceutical companies only being interested for profit, would no longer be sufficient in the future for drug discovery. Because there’s not a lot of money to be made from the continent.

We need to think of interesting new mechanisms for investment in the discovery and production of new antibiotics, maybe through the government or ‘big donors’. For that to happen, however, we have to secure our distribution mechanisms. If we continue to distribute in the disorganised way that we are now, nobody is going to invest in it, because it would be a waste of time.

VA: Do you think there was a pause in medical research for antibiotics that has led to the threat of a global ‘antibiotic apocalypse’ brought on by superbugs?

CI: First of all, I think we should steer clear from emotionally-laden words like “apocalypse” or “invasion”, because they are not helpful for the discourse on the matter. This bacteria resistance is a slow-burning issue. It has been going on for years, and would continue to do so.

The evolution process between bacteria and antibiotics that are used to treat them is a continuous one. Naturally, the bugs are always getting better at surviving antibiotics, because the instinct of every living thing is to survive. The role of science, which is to continuously search for ways to fight it under the umbrella of the pharmaceutical industry, is driven by profit. If they don’t think that producing antibiotics is profitable, then they don’t invest in further research.

Secondly, these bacteria are becoming more resistant to available antibiotics because we’re misusing antibiotics to a large extent. In many countries antibiotics are administered when they are not necessary without properly diagnosing the infection causing the problem, such as in cases of a common cold, for example.

Normally, physical examinations are not enough, and specimen should be taken to labs for testing to know what sort of bacteria the patient is infected with. But when there is no capacity for such, then there’s a misuse of antibiotics, and resistance increases.

VA: The last class of new antibiotics (Colistin) was discovered in the late 1940’s, and there have been talks about limiting its current use, and reintroducing it in the future in an attempt to find a solution to the superbug problem. Do you think it would work?

CI: I won’t go on the record on specific antibiotics and state reasons for them to be produced or stopped, as the process is often very complex. You can’t force anyone to produce a drug, even if it’s needed.

The production of antibiotics is not an altruistic science. There’s no mechanism in the world where people just sit down and decide to do it. It’s driven by an industry; by need. If there’s an opportunity for a new antibiotic that will make money for the pharmaceutical industry, they will invest in it. Generally, the antibiotic discovery process is no longer interesting. Many of the diseases we’re talking about have declined in the West, and that is where the purchasing power for antibiotics lie — because they’re very expensive

Unless we create a more efficient market in the developing world, which means taking a lot of these drugs out of the common markets, and creating a regulatory environment for the sale of antibiotics, whatever anyone suggests, it’s not going to happen unless there’s an efficient market for the antibiotics to be sold.

VA: Nigeria happens to be one of the countries said to be positioned towards feeling the most impact from a superbug comeback, with one in four deaths by 2050, according to analysts. Do you think our healthcare system is prepared to avoid such an event in any way?

CI: We’re not prepared to tackle it now, and like I mentioned earlier, if we continue with the status quo, we won’t still be prepared by 2050. It requires a fundamental change in our attitude towards antibiotics, and to all medicines. We are growing up in an era where you can buy antibiotics like groundnuts in the streets, and it has become impossible to continue that way. Even if we continue to discover new medicines, it would be like pouring water into a leaking bucket if we also keep misusing them.

We’re continuously digging ourselves into a hole, but because it’s a slow process, we don’t notice how far we’ve gone. We need to restrict antibiotics prescription to when they are absolutely needed, and that must be after the necessary diagnostics. We also need to reduce their availability on the streets, and their use on animals to prevent sickness and enable their growth, otherwise we would keep spiralling into a situation that we would all regret.

VA: Besides the pharmaceutical industry, what other parts of the healthcare sector can help to ensure that we don’t slide into an unfortunate situation with superbugs?

CI: We all need to work together in areas such as training new doctors in antibiotics ‘governance’ — that is how to use antibiotic– and this includes medical associations, organisations and hospitals in Nigeria. Ten years ago, NAFDAC tried to regulate the sales of antibiotics in open markets, under the late Dr. Dora Akunyili, but they gave up. And we really have to address that situation. I’m not saying we should put these stores out of business, because they have their roles, but there are other over-the-counter antibiotic items that they can sell.

As doctors, we need to educate the masses that not every cold is caused by a bacteria, and so there’s no need to buy antibiotics for every single one. And where antibiotics are definitely needed, then they have to be taken them properly, and in complete dosages.

So, to reiterate, the facets involved in helping the fight against superbugs are educating the population, regulating the professionals, regulating the distribution environments in markets, and finding new mechanisms to enable new discoveries.

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