Vemu Lakshmi is one of several Indian physicians who had long been calling for more to be done about drug resistance. Then, last year, a whirlwind of controversy blew up in her country about the highly resistant "superbugs", bacteria containing the so-called "NDM-1" enzyme.
"Some Indian microbiologists had been flagging the urgent need for micro biological laboratory support for doctors and strict guidelines on antibiotic prescriptions and policies for quite some time;' says Lakshmi, who is professor and head of the Department of Microbiology at Nizam's Institute of Medical Sciences, in Hyderabad.
Lakshmi and her colleagues knew that antimicrobial resistance would be the inevitable result of inappropriate use of antibiotics in hospitals and in the community (including sub-therapeutic doses due to ignorance about resistance mechanisms), widespread over-the-counter sales of antibiotics and patients failing to complete their courses of antibiotics. She discussed these problems in detail in an article in the Indian Journal of Medical Microbiology in 2008.
The spread of the resistant bacteria in India, Pakistan and the United Kingdom of Great Britain and Northern Ireland was described in a paper published in the Lancet Infectious Diseases in August 2010. "NDM-1", or New Delhi metallo-beta-lactamase, was first identified in a Swedish patient who had returned from New Delhi in 2008.
Experts were particularly concerned about the fact that the enzyme was found in one of the most commonly encountered bacteria in the human population, Escherichia coli, and that at least one in 10 of the strains containing this enzyme appeared to be resistant to all known antibiotics.
Antimicrobial resistance is a global problem that affects all countries. This year's World Health Day on 7 April aims to make governments more aware of the problem and to encourage them to take measures to combat this global threat.
"[Antimicrobial resistance] is a real public health problem and it is emerging globally and in Europe. We have to do much more about it--both in the World Health Organization (WHO) and also in Member States" says Zsuzsanna Jakab, WHO Regional Director for Europe. Jakab is well aware that the struggle against antimicrobial resistance in Europe requires continuous vigilance if problems such as drug-resistant tuberculosis are not to get worse. "This is the start of a process; we can and have to raise awareness among policy-makers and the public, and follow up with strategies after World Health Day" Jakab says.
It is not the first time WHO has tackled the issue. In 2001, WHO released the Global Strategy for Containment of Antimicrobial Resistance, containing recommendations that countries could customize for their own use. But the launch in Washington DC coincided with the attacks of 11 September 2001 in the United States of America (USA) and any momentum was lost in the subsequent turmoil.
For Dr Gerald Dziekan, from WHO's Patient Safety Programme, the 2001 initiative nevertheless provided a start for some countries in tackling the problem.
"It certainly triggered the development of national plans in some countries, but all in all the response was quite weak in the sense of global awareness and coordinated action,' Dziekan says. One of the challenges governments face in Dziekan's view is enforcing laws banning over-the-counter sales of antibiotics. "This is particularly difficult in [low- to middle-income] countries where there are often no doctors to prescribe medicines but people need to get the drugs somehow."
But it is also in these countries where the problem is increasingly being felt. "Antibiotic resistance is not confined to the emergency rooms of rich countries in Europe and North America" according to Anthony So, professor at the Sanford School of Public Policy at Duke University in the USA. …