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  • Biomed Analysis: End complacency on drug resistance

Controversy has pressed India into action to tackle antibiotic resistance. Now other countries must do the same, says Priya Shetty.

The naming of a superbug gene after the city of New Delhi strained international relations and caused irate Indian health officials to say it unfairly tarnished the reputation of the country's healthcare system.

The New Delhi metallo-beta-lactamase 1 (NDM-1) gene, believed to have originated in India, causes several types of bacteria to become resistant to a group of antibiotics called carbapenems, which are used by doctors when other antibiotics don't work.

But the discovery of the gene, which can jump between different strains of bacteria, has had one undeniably positive outcome. Under the fierce spotlight of global attention stirred up by the NDM-1 furore, India is finally taking long-overdue action to curb antibiotic resistance.

What's more, there are signs of a domino effect in China, where resistance to antibiotics is an enormous problem.

Growing resistance

The NDM-1 gene was first identified in 2009 by a team of researchers led by Timothy Walsh at Cardiff University, UK. But it only came to international attention in August last year after Walsh and colleagues published additional research in The Lancet Infectious Diseases describing the gene's spread through India and Pakistan to UK nationals who had recently travelled to either country.

The Indian government's anger at the naming of the gene, probably triggered by its potential ramifications for the country's booming medical tourism industry, eventually elicited an apology from Richard Horton, editor of The Lancet, who described it as an "error of judgement".

The latest findings are clearly a cause for serious concern, even as the Indian government may be questioning the ethics and motive behind the way that the data were obtained. Walsh's team found that the NDM-1 gene has now spread to bacteria that cause cholera and dysentery.

The naming of NDM-1 made headlines by sparking political ire, but scientists have long warned of the deadly threat posed by resistant bacteria such as MRSA (methicillin-resistant Staphylococcus aureus).

At next month's European Congress of Clinical Microbiology and Infectious Diseases, researchers will present evidence gathered from around the world showing how antibiotic resistance has skyrocketed in the past decade.

Time for action

Against this backdrop and amid continued apathy in many countries, the WHO made drug resistance the theme of this year's World Health Day.

It introduced a six-point plan to help countries commit to a comprehensive national policy with civil society engagement; to strengthen surveillance and laboratory capacity; to ensure access to high-quality medicines; to promote the prudent use of medicines and reduce the use of antimicrobials in food animals; to enhance the prevention and control of infections; and to foster research and development for new tools to fight resistance.

The Indian government seems to be listening. Despite an initial strong denial of the presence of NDM-1 bacteria in water supplies, it has recently made an abrupt U-turn and decided to take action.

Last week it announced a National Policy for Containment of Antimicrobial Resistance — an important first step showing how it intends to tackle the problem.

Surveillance for drug resistance is a key part of the policy. The document indicates that the government is planning to set up a Drug and Therapeutics Committee, which would approve new drugs and develop a list of over-the-counter drugs — India currently has no specific regulations specifying which drugs require a prescription.

It is also set to introduce regulations for the prescription of antibiotics, as well as an antimicrobial policy for hospitals. And for the first time, it will set a limit for the volume of antibiotics used in food animals, such as poultry and fish, as these fuel resistance in people. The policy also recommends setting up a National Technical Advisory Group to encourage research into new antimicrobials.

An example to follow

Hot on the heels of India's move, China is finally acknowledging its own drug resistance problem. On World Health Day, China's health ministry said it would curb the overuse of antibiotics, especially in hospitals.

The proportion of drug-resistant infections is growing by an estimated 22% each year in China. One factor that explains this rapid growth is that China's health system offers strong financial incentives for prescribing drugs. It is estimated, for example, that 75% of patients infected with the seasonal influenza virus are given antibiotics. Such 'blanket' prescribing is known to raise the risk of drug resistance.

China received a clear warning sign in October, when the first human cases of infection with bacteria carrying the NDM-1 gene were reported. So far, it seems that the country has not seen any more cases of the superbug gene. But the discovery shows that neither China nor India can afford to be complacent.

With any luck, their actions will set an example for other Asian countries, such as Indonesia and Thailand, where antibiotic resistance is rife.

 

Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.