Antibiotic Resistance in the Developing World
We are living in a post-antibiotic world. The overprescription and use of antimicrobials, specifically antibiotics, is ironically creating “superbugs”. The pathogens that are meant to be destroyed by antibiotics evolve to become resistant, leading to infections that cannot be treated by any existing medications (Adeyi et al.). In this new reality, common and minor infections become deadly. For instance, Staphylococcus aureus, a bacteria that is commonly contracted in hospitals, has developed an antibiotic-resistant strain, MRSA (methicillin-resistant Staphylococcus aureus). If a patient is infected by MRSA, they become 64% more likely to die compared to if they’re infected by the non-resistant strain (“Antimicrobial Resistance”).
The resistance to antibiotics is a global issue. Superbugs are not constrained by geographical boundaries – the same strain of antibiotic-resistant pneumococci, like the serotype 23F clone, has been observed in Mexico, South Africa, South Korea, Croatia, Portugal, France, and the United States (Planta). However, it has become apparent to policymakers that the crisis is affecting the developing world in unique ways. The lack of regulation that is characteristic of developing countries has compounded the crisis, as the regulatory approach used in more developed nations cannot be effectively implemented in developing nations.
There is a correlation between poverty and susceptibility to superbugs. There was a 65% increase in worldwide consumption of antibiotics between 2000 and 2015, with poorer nations accounting for most of this increase (Sample). This increase has been explained by the economic growth experienced in developing countries, which has enabled them to afford more drugs (Sample). This has been a double-edged sword in light of the overuse of antibiotics around the world. In India and Pakistan, almost 95% of adults carry bacteria that are resistant to beta-lactam antibiotics, a class of antibiotics considered to be the ‘last resort’ (Reardon). In contrast, only 10% of New Yorkers carry such bacteria (Reardon). The relationship between poverty and antibiotic resistance is also observed in developed countries: self-medication with “leftover” antibiotics as well as sharing medication are common practices among the poor, as they are less able to afford new medication or can’t take time off from work to visit a doctor (Planta).
The developing world is also more susceptible to the crisis because of the lack of governmental regulation. For a start, it has been hard to trace the exact source of widespread antibiotic consumption. One explanation is that lax regulations are to blame for the widespread availability of antibiotic medications, the excessive use of antibiotics in rearing livestock, as well as the pollution of water with antibiotic-contaminated waste (Reardon). While many developed countries such as the United Kingdom require a prescription for antibiotics, in some less developed countries antibiotics can be bought over the counter (Planta). In the Philippines, 66% of antibiotic sales in pharmacies occurred without a prescription (Planta). This allows uninformed people to self-medicate with antibiotics for illnesses, such as malaria, that cannot actually be treated with antibiotics (Reardon). Even when antibiotics are regulated by medical staff, overprescription occurs. In Thailand, nurses of lower-income patients are faced with a difficult choice: overprescribe antibiotics as a quick fix to ensure an infection is fully treated, or put these patients’ lives at risk, particularly because they are unwilling to take time off from work to go to a follow-up medical appointment, or are unable to afford prolonged medical treatments (“Cultural Barriers to Tackling the Superbug Crisis”).
Weak infrastructure has been identified as a key reason for the need of these antibiotics in the first place. The lack of sanitation is a challenge in many developing countries, and this provides a hotbed for bacteria to flourish and for infections to be easily spread (Reardon). In Malawi, sepsis is the leading cause of death for infants, killing one in five newborns (Davies). The abuse of antibiotics in the past has led to the infections evolving to be resistant, rendering healthcare providers helpless in the face of a rising death toll (Davies). The problem of poor sanitation creates a vicious cycle feeding the superbug crisis. An unsanitary environment leads to more infections, meaning greater use of antibiotic drugs (Reardon). The plethora of bacteria exposed to these drugs mutate, and are easily spread in the same environment (Reardon). As Keith Klugman, an epidemiologist, points out, “If you get increased antimicrobial use but don’t have the infrastructure for infection control, you’re setting yourself up for a tsunami of antibiotic resistance (Reardon).”
The superbug crisis is not a “hypothetical threat”, it is real and takes half a million lives a year (Davies). It is undoubtedly a complex, multi-faceted issue that will be difficult to confront. The current “arms race” is an unsustainable one, as developing stronger medication will only unleash a deadlier strain of bacteria on us, limiting the already limited options of treatments that we have (Davies). In poorer countries, we have seen that this crisis is intricately linked to the circumstances of development. Economic growth can alleviate the spread of infections, but it can also contribute to rising antibiotic resistance. In these countries, where people die from both the lack of access to antibiotics, as well as from resistance to it, the superbug crisis is a uniquely perplexing problem.
Adeyi, Olusoji O., et al. Drug-Resistant Infections : A Threat to Our Economic Future. 114679, The World Bank, 1 Mar. 2017, pp. 1–172. documents.worldbank.org, http://documents.worldbank.org/curated/en/323311493396993758/final-report.
“Antimicrobial Resistance.” World Health Organization, http://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed 19 Oct. 2018.
“Cultural Barriers to Tackling the Superbug Crisis.” University of Oxford, http://www.ox.ac.uk/news/2018-03-08-cultural-barriers-tackling-superbug-crisis. Accessed 19 Oct. 2018.
Davies, Madlen. “Scourge of Superbugs Killing Malawi’s Babies.” The Bureau of Investigative Journalism, https://www.thebureauinvestigates.com/stories/2018-08-08/scourge-superbugs-killing-babies-malawi. Accessed 19 Oct. 2018.
Sample, Ian. “Calls to Rein in Antibiotic Use after Study Shows 65% Increase Worldwide.” The Guardian, 26 Mar. 2018, https://www.theguardian.com/science/2018/mar/26/calls-to-rein-in-antibiotic-use-after-study-shows-65-increase-worldwide.
Planta, Margaret B. “The Role of Poverty in Antimicrobial Resistance.” The Journal of the American Board of Family Medicine, vol. 20, no. 6, Nov. 2007, pp. 533–39. www.jabfm.org, doi:10.3122/jabfm.2007.06.070019.
Reardon, Sara. “Antibiotic Resistance Sweeping Developing World.” Nature News, vol. 509, no. 7499, May 2014, p. 141. www.nature.com, doi:10.1038/509141a.