AS evinced in recent days, come monsoon season and Pakistan is awash with multiple crises. Yet one emerging issue, endemic in the country and exacerbated at this time of year, has failed to receive the sustained attention it merits. Earlier this year, the revelation that a typhoid outbreak, which began in Hyderabad in 2016 and has since spread to Karachi and other districts, features a strain of the disease that is extensively drug-resistant (ie worse than multidrug resistance and one step closer to total drug resistance), sent shockwaves across the global medical community. On Wednesday, the US triggered an XDR typhoid-related health warning for travellers to Pakistan. Given our poor immunisation record and inability to implement comprehensive disease prevention and control protocols, one need not be reminded of the possibility of escalating travel restrictions, such as those imposed due to polio in 2014. For those of us living in Pakistan, however, there is no comforting answer to the question of whether authorities have taken the requisite steps to protect citizens from this deadly outbreak. In Sindh, the epicentre of the crisis, though a programme to immunise 250,000 children against typhoid has been under way, the worsening conditions of the province’s water and waste management systems, poor access to potable water and questionable hygiene practices and food preparation methods have left many people vulnerable to infection.

The consequences could be catastrophic. Patients with XDR typhoid are currently being treated with fourth-line drugs, but doctors warn it is not a matter of if but when this last line of defence is no longer effective. The emergence of XDR typhoid dovetails into the broader issue of the exponential rise in antimicrobial resistance in Pakistan to many infectious diseases (including TB, Staphylococcus and E. coli) brought on by hazardous trends of over-prescription, self-medication and misuse of antibiotics, and its overuse in the livestock industry. Add to this inadequate or absent diagnostic practices and a dearth of reliable laboratory facilities; since many febrile illnesses tend to mimic each other but require different drug regimens, health experts have warned against rampant treatment of undiagnosed fever. The effect of drug resistance on an overburdened healthcare system cannot be overemphasised; treatments for MDR and XDR diseases require administration in hospital settings, and are lengthier, costlier and riskier than conventional therapies. This is a national health emergency that needs urgent tackling.

Published in Dawn, July 6th, 2018