High level of corruption increases the chances of poor control of antibiotics distribution and poor management of agriculture and water sanitation, which support the growth of antibiotic resistant bacteria, according to a study published in PLOS One (18 March).
The rising number of antibiotic-resistant bacteria, the so-called “superbugs”, has become a major health problem especially in developing countries where antibiotic resistance is so much higher than in most countries in Europe.
According to Peter Collignon, a professor of infectious disease at the Australian National University and lead author of the study, antibiotic resistance is a broad issue that covers not only the medicine aspect but also important social factors such as poor governance.
Collignon’s team collected data on antibiotic resistance from 28 countries in Europe and found that this is not related to income level but was higher in countries with more private healthcare where there are fewer controls and supervision.
“Surprisingly, we found that corruption level is the most significant factor compared with other factors that we tested,” Collignon tells SciDev.Net.
He explains that high corruption level means many rules are broken. Thus, there is a higher chance of undocumented antibiotic usage and distribution, bribery by pharmaceutical companies and poor government controls on agriculture, water sanitation and food hygiene. These he says affect the quality of antibiotic usage and control, and the spread of resistant bacteria at national levels.
Collignon suspects the same result will be found in developing countries where corruption is widespread.
“I would recommend every country to make regulations to control antibiotic usage and distribution. In addition, law enforcement should be [stricter] in various sectors, including the health industry, agriculture, environmental hygiene, food production,” adds Collignon.
Laura Bowater, senior lecturer at Norwich Medical School in the United Kingdom, tells SciDev.Net she is not surprised with the findings of the study because antibiotics are a precious resource that have a high market value.
“This means that antibiotics can be bought and traded especially in societies where black market forces are prevalent,” she says.
In Indonesia, where corruption is considered widespread, 50-80 per cent antibiotic use has been recorded with no strong diagnostic reason. Bribery by pharmaceutical firms of doctors and hospitals is considered standard practice.
Siswanto, who heads clinical epidemiology research at the ministry of health, agrees that a key solution to antibiotic resistance is reforming the country’s health system.
“We are now adopting the Social Insurance Organizing Body (BPJS) to control the irrational use of antibiotics in the hospitals,“ he tells SciDev.Net.
Under the BPJS system, hospitals will incur losses if they prescribe many expensive antibiotics since they will not be covered by health insurance.
>Link to full paper in PLOS One
This article has been produced by SciDev.Net's South-East Asia & Pacific desk.