“Unless we solve the problem of antimicrobial resistance to drugs, we will be facing a post-antibiotic era where things as common as a strep throat infection or a child’s scratched knee could once again kill.” Margaret Chan, Director-General of World Health Organization (WHO), 2012
The discovery of antibiotics was one of the defining events in medicine in the 20th century, bringing about a massive reduction in the rate of human deaths from infectious bacterial diseases.
Jump ahead to the 21st century and Australians are one of the highest users of antibiotics in the world, with roughly 22 million prescriptions being dispensed every year. We sit well above the OECD average and our use is more than double that of Scandinavian countries.
But why should this matter?
Bacteria are able to resist antibiotics, with a number of important antimicrobial agents no longer being effective in fighting the bacteria which cause serious illness. This phenomenon is called antimicrobial resistance (AMR). Of greatest concern is the creation of disease-causing bacteria with resistance to multiple antimicrobial compounds – aka ‘superbugs’.
Given the gravity of the situation, the uninformed observer could reasonably assume that Australian governments, past and present, would have made this threat to public health a high priority.
This is far from reality and is the topic of a recent research paper by The Australia Institute.
Culture of Resistance: Australia’s response to the inappropriate use of antimicrobials reveals that while initially there was commitment to implementing the recommendations of a 1999 report by the
Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR), many initiatives failed to result in any comprehensive systematic response to the issue.
Committees, taskforces and groups were set up but disbanded, strategies were developed but not implemented, pilot programmes failed to be anything other than pilot programs, undertakings were not carried out.
Of particular concern is the failure to develop a comprehensive national surveillance system of both usage and resistance to antibiotics. This was recommended in the 1999 report and is called for by the World Health Organization. Such data is essential for effective management of AMR.
A surveillance strategy was developed by the government in 2003, and another in 2006 for an expert advisory group but neither was implemented in any meaningful way. In 2012 a new Advisory Committee on AMR was set up by the government and their first task was to oversee the production of a scoping study and development of a business case for national surveillance of AMR and antimicrobial use. This study looks only at human use, and does not include animals, agriculture or the environment.
It is unclear why such an important public health threat has been so badly neglected over the last decade but what is clear is that this neglect has serious consequences. It is essential to devise a much more accountable and transparent system of management of AMR in Australia if we are to avoid another largely wasted decade. Given the pressing nature of the problem and the catastrophic impact of antimicrobial resistance, effective action must be taken urgently.
The Australia Institute will this week give evidence to the Senate Finance and Public Administration Committee which is conducting an inquiry into the issue of AMR.