– massive public awareness campaign to address people’s bad habits
– left unchecked, the problem could mean the difference between life and death
GUYANA, like countries the world over, has made significant progress in reducing the number of deaths caused by infectious agents by using anti-microbials (which include anti-biotics). But over the years, science has shown that  bacteria causing infectious diseases are developing resistance to the drugs.
And Health Minister, Dr. Leslie Ramsammy, on the occasion of World Health Day yesterday, made it clear that people’s “bad habits” contribute to this growing problem – a serious one that could mean the difference between life and death.
The minister was speaking to stakeholders at the ministry’s boardroom during the launch of World Health Day 2011, held under the theme ‘Combat drug resistance – no action today, no cure tomorrow’.

QUOTE: “The new anti-biotic pipeline is drying up and it is imperative that we preserve what we have…antibiotics are a treasure and a public good. It is our civic responsibility to preserve these or lose them,” Ramsammy said.

He explained that the bad habits include health professionals making incorrect prescriptions, for example prescribing an antibiotic for a flu or common cold virus and not a bacteria; persons not using their medications for the full course, rather stopping when they feel better; and self-prescription, for example one person shares his/her medications to others because they believe it will work.
“These actions only provide the bacteria with the space to spread and develop resistance,” Ramsammy said.
Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a micro-organism mutates or acquires a resistance gene.
Important to note, Ramsammy observed, is that resistance is an emerging concern for treatment of HIV infection, following the rapid expansion in access to antiretroviral medicines in recent years.
However, he said a national survey is underway to detect and monitor resistance.
In this context, he said the massive ‘Get Wise Campaign’ is being launched so that the average Guyanese can know his medicines.

KNOW YOUR MEDICINES
According to him, the ‘Get Wise Campaign’, in the first three months, will target the AMR problem, after which emphasis will be placed on other drugs used in the local health sector.
“Do we have the resources for this, no,” Ramsammy acknowledged.
However, he lauded the contribution of the Health Ministry’s partners, in particular the Pan American Health Organization (PAHO).
He noted that considering that no doctor will have enough time to sensitise each individual that comes to the health care delivery institutions to these issues, easy-to-read pamphlets and posters will be circulated across the country.
This is an addition to the sensitisation that will be done via television.
Ramsammy stated that in 2011, some $200M will be spent on buying antibiotic drugs, which translate to 20 million doses for the year or 55,000 doses every day, with the exception of drugs used in HIV, TB and malaria treatment.
He added that if the issue of resistance is not addressed, the health sector will be spending as much as 10 times the resources it  now spends for drugs that are not available worldwide as yet.
To bolster the efforts being made, the minister stated that the health sector system is being enhanced and its capacity boosted to facilitate better diagnosis and therefore better prescriptions; and better laboratory facilities to assess the levels of resistance.
“Guyana has a level of resistance, but it is difficult to assess this at present,” he said.
These initiatives are a must, according to the Health Minister, if there are to be drugs that will fight the infectious diseases in the future.
He observed that out of 50 pharmaceutical companies worldwide, only five are engaged in developing new antibiotic drugs; and 10 years ago, when there were 20 new antibiotics introduced annually, only two are made public now.
“The new anti-biotic pipeline is drying up and it is imperative that we preserve what we have…antibiotics are a treasure and a public good. It is our civic responsibility to preserve these or lose them,” Ramsammy said.

SIX-POINT APPROACH
The issue of AMR has engaged public health stakeholders at all levels; and according to Dr. Beverly Barnette of the Pan American Health Organization/ World Health Organization (PAHO/ WHO), policies at the top level are being developed to address this matter.
She noted that the WHO is engaged in guiding the response to AMR through a six-point approach, which addresses the:
* inadequate national commitment to a comprehensive and coordinated response, ill-defined accountability and insufficient engagement of communities,
* weak or absent surveillance and monitoring systems,
* inadequate systems to ensure quality and uninterrupted supply of medicines,
* inappropriate and irrational use of medicines, including in animal husbandry,
* poor infection prevention and control practices, and
* depleted arsenals of diagnostics, medicines and vaccines, as well as insufficient research and development on new products.
The PAHO/WHO country representative explained that inappropriate and irrational use of medicines provides favourable conditions for resistant micro-organisms to emerge and spread.
She pointed out, for example, that when patients do not take the full course of a prescribed antimicrobial, or when poor quality antimicrobials are used, resistant micro-organisms can emerge and spread.
Barnette stressed that the WHO is calling on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance.