“THE end of modern medicine as we know it”, with humanity hurtling towards a “post-antibiotic era in which common infections will once again kill”. This was the warning put out by the World Health Organisation in 2015, as it strove to alert the world to the clear and present dangers resulting from the misuse, or overuse, of antibiotics: the fast-proliferating growth of multidrug-resistant bacteria. Antibiotic resistance is rising to dangerously high levels everywhere, says WHO. Currently, some 700,000 deaths annually are attributable to infections by drug-resistant pathogens globally, and if the situation goes unchecked, this number could increase to 10m by 2050.

One response has been WHO calling for a World Antibiotic Awareness Week that just ended on Nov 19. As the matter is discussed worldwide, has Pakistan a reason to be concerned — not just in terms of being affected but also in the context of culpability? Distressingly, yes. It is well known that the irresponsible use of antibiotics is rife across the country. First, there is the issue of the drugs being easily and openly available everywhere, without a prescription being required. The state, despite the existence of several overseeing bodies including the Pakistan Medical Association and the Drug Regulatory Authority of Pakistan, has utterly failed to regulate or even seriously debate the high sales of antibiotics, or to study how far that is commensurate with the actual health needs of the population. Add to this the other, significant, challenges: self-prescription (which is the result of the over-the-counter sales of prescription drugs), and prescriptions issued by unqualified personnel. By the PMA’s own reckoning, there are over 600,000 non-registered medical practitioners in the country. After this, in the long line of Pakistan’s mea culpas, come irresponsible antibiotic prescriptions given out by even genuine medics, aggressive advertising — which, again, the state has been unable to control — by big pharma, the tendency of people to pass unused pills on and/or to discontinue a course halfway. All said, where the future of the successful use of antibiotics seems grim around the world, in Pakistan it would appear to be doubly so.

True, there have been a handful of initiatives, such as the Development of National Policy for Containment of Antimicrobial Resistance by the federal health department. Though some solutions have been offered, the success of such initiatives, if any, is difficult to discern. The number of deaths occurring as a result of antimicrobial resistance in the country have not been collated, but going by anecdotal evidence, they are high. In a country beset with issues of poor vaccination practices, hygiene challenges, illiteracy and unawareness, and an extremely patchy healthcare system, the costs may well be staggering. Far from the politics that take up the attention of our legislators and policymakers, these are issues that merit immediate action.

Published in Dawn, November 21st, 2017