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By Cosmas Omegoh
A recent report by GAVI, a Vaccine Alliance Group that babies are now being born in Nigeria with anti-biotic resistance, is raising dust.
In this interview with Sunday Sun, Dr Joel Adagadzu, chairman, Board of Fellows of Pharmaceutical Society of Nigeria (PSN), gives reasons for this new development, warning against the looming danger that is to follow.
Among other things, he highlighted what all stakeholders must do to reverse the ugly trend.
How worrisome is it that certain infections are becoming resistant to antibiotics these days?
It is very, very worrisome, more so when that is becoming a global issue for which the WHO has expressed grave concern. That tells you that it is an issue that must be taken seriously. Many lives are being lost as a result of what is now known as Anti-microbial Resistance, a situation characterised by poor response to treatments of infectious diseases with anti-biotics. Anti-biotics which were once life savers are becoming increasingly ineffective in treating infections thereby posing danger to lives. We have had such cases in the past mainly among adults. Now, children are being born with that challenge. That means that when they fall ill with a disease like sepsis or serious bacteria or other diseases-causing organisms at birth, treatment with anti-biotics will most probably fail. That is a big problem. Recently, a stakeholder and I were sharing concerns that even an anti-biotic like Colistin which offers the greatest hope of treatment of resistant infections is proving to be ineffective. The reason that is happening is because there has been widespread abuse and misuse of anti-biotics over the years in both human and animal populations. In most cattle or even fowls markets, sellers now use anti-biotics randomly to treat animals without the input of Veterinary experts. I have seen where sellers open anti-biotic capsules and pour the contents into the water for the animals to drink. I have seen where cattle were being injected with anti-biotics. One would not show concerns if veterinarians are the ones doing that. But now, everyone who handles animals seems to be doing so. They load them with chemical substances, drugs, and anti-biotics. The meat from these animals will often contain residues of the anti-biotics that were used indiscriminately in treating those animals. When the meat from those animals is consumed by humans, the residues are passed unto them. Therefore, it is not surprising for pregnant women to give birth to babies who also inherit those residues that organisms have developed resistance to. Such babies when exposed to infections that are resistant to treatment with anti-biotics there will be consequences. Again, that is no longer something strange because there is now wild spread abuses of anti-biotics by individuals who will just pick up a few capsules and swallow or those who at the point they see that they are getting better, will jettison the rest of their drugs. They forget that anti-biotics like most drugs are supposed to be taken for a certain period of time. When anti-biotics are taken half way, they only succeed in knocking off the bacteria or virus or whatever it is for a while. It becomes unconscious and you think that you have been cured only for the infection to bounce back and when it does, it will do so with more anger and vengeance. What does happen is that because of the natural processes in the bacteria, or fungi and parasites, they get used to the drugs to the extent they develop resistance against the drugs. So, when the same anti-biotics are used to treat similar conditions in the future, they fail. That is what is happening.
A good example that is even more common is that of malaria. Most people who suffer from malaria hardly take the full dose of malaria treatment. They take for a day or two and when they feel better, they abandon the rest of the treatment. Naturally, the parasites will over time develop resistance such that the next time you want to treat the malaria, it proves more difficult to do so. I read somewhere, a warning that by 2030 to 2050, anti-microbial resistance will cause more casualties than HIV/AIDS and cardiac problems, put together.
Are younger persons worse abusers?
No, no! Younger persons are not the worse abusers of anti-biotics. If you talk of hard drugs perhaps the younger ones will be the worst abusers.
Misuse of anti-biotics cuts across all age groups. The process of development of resistance to anti-biotics does not happen overnight. It takes some time. So, as people keep misusing or abusing drugs, the parasites keep developing resistance to the drugs. With time, resistance develops with many antibiotics, making it difficult to use them in successfully treating many of the bacteria, parasites, fungi and other disease-causing organisms. Many drugs will not be able to have any effects on them. And that will be a huge disaster and people will be dying. It is happening and will get worse unless there is a global concerted effort to halt the situation.
How can we then reverse this trend?
One, we must ensure that we don’t take anti-biotics unless it is prescribed by a qualified healthcare practitioner. People should not self-medicate with antibiotics. Two, when a prescription is made, people should ensure they complete the dosage. If it is prescribed that they take one capsule for five days, they should please do so. Third, people must keep returning to medical practitioners for regular assessment to ensure the prescribed anti-biotics are effective and if not the expert will decide on the next steps to take immediately. Fourth, the government must take necessary steps to curb the treatment of animals by those who are not trained to do so while all animals slaughtered for consumption should be subjected to tests to ensure that there are no residues of anti-biotics in the meat being consumed. Fifth, the government must invest in sensitisation of the populace. Everyone one of us is a part of the government. We all must join hands to confront this danger.
Other measures include increasing the fight against counterfeit medicines with the regulatory agencies, ensuring that all medicines used in Nigeria are of good quality. The health workers must also ensure that patients are well advised about the medicines they consume and the need for proper medication.
Is people’s failure to afford drugs contributory to that?
Oh yes! The high cost of drugs forces the people to seek for cheaper alternatives which may be counterfeit or fake. Besides, some citizens buy the quantities their money can afford. Even anti-biotics are purchased that way. So, in a way, the high cost of medicines may be a contributory factor. We as pharmacists have been a part of the many groups that appealed to the government to act fast and bring down the costs of medicines. Thank God, the president listened and signed the well heralded Executive Order in response to the pleas by the people to bring down the cost of drugs. That is a step in the right direction. But I want to call on President Tinubu to prevail on those saddled with the responsibility of implementing his Executive Order not to allow bureaucracy to delay the implementation process. The president should direct that having signed the order, anyone who delays it, will be sanctioned. I’m pleading with the president to so direct. They should not derail the good intentions of Mr. President. They should ensure that the Customs duty is removed, the numerous taxes suspended, foreign exchange provided urgently for imports of pharmaceutical raw materials and other inputs. If these are done, within the shortest possible time prices of drugs will begin to ease.
What are other likely effects of anti-microbial resistance challenge?
I have mentioned earlier that many people will lose their lives. Cost of treatment will rise, adding more strain to the already struggling populace who are faced with a high level of out-of-pocket healthcare expenses. Pressure on the health workers will be unbearable due to the severity and poor response of patients to their medication. Something like sepsis that we usually see in infants, if you cannot treat it, an infected child cannot even last a few days. So, we will be losing our children. Everyone is at risk. Sadly, the rate at which new anti-biotics are developed is not as encouraging. It takes a long time and a lot capital to develop new anti-biotics required in fighting anti-microbial resistance. It will require the use of modern technology and the deployment of huge resources just like what happened in the development of the COVID-19 vaccines.
In what other ways can government help in a matter like this?
Government should increase the tempo of awareness creation by sensitising the populace on the grave danger posed by anti-microbial resistance.
Government should further empower NAFDAC to carry on with its statutory roles of safeguarding the health of Nigerians. Government should promote the existing collaboration among relevant ministries such as Federal Ministries of Health, Agriculture and Environment in order to curb the trending anti-microbial resistance. The Ministry of Finance should be ready to provide the resources required for the collaborative processes and sensitization programmes. These are big issues we must face.
Government should also collaborate at the global level with the international communities so that the future of mankind will be assured.
What lessons would you say have been learnt from this emerging challenge?
The lessons from the recent COVID-19 pandemic are still fresh. We must not go to sleep thinking that all is well with our health. Every citizen must avoid practices that will promote anti-microbial resistance.
That there is hunger in the land does not mean we should be careless about existing threats and dangers lurking around. All hands should be on deck to form the necessary alliance with the press in order to increase sensitisation and awareness to stall the looming dangers. Those of us in the health sector must look out for anti-microbial resistance in our practice settings and immediately report it for prompt follow up.
