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By Bernard Muthaka
When he discovered the antibiotic penicillin close to one hundred years ago, Alexander Fleming could already foresee that mankind would soon be poor stewards of the miracle drug.
“There is the danger that the ignorant man may easily under-dose himself, and by exposing his microbes to non-lethal quantities of the drug make them resistant,” he said.
Scientists are unanimous that antibiotics and vaccines are the greatest inventions of medical science, but today the former are becoming an expensive and even dangerous tool.
Despite constant warnings by the World Health Organisation (WHO) that a health crisis is looming due to the increase in multi-drug resistant bacteria, major pharmaceuticals are refusing to invest in new antibiotics, saying it does not make business sense.
Widespread problem
The problem has been widespread and sometimes inappropriate use of antibiotics. Doctors often prescribe them without justification and the antibiotics are now used liberally to enhance growth in veterinary animals and poultry.
Such factors have led to evolution of super bugs that render many antibiotics ineffective in a short while, meaning drug companies cannot sell them long enough to recoup their investments in research and development. For instance, Australian Pharmaceutical Association says it takes 12 to 15 years of research and development to get one new medicine approved for use in that country. WHO recently said antimicrobial resistance is one of the three greatest threats to health, but in the last 40 years, only two new antibiotic classes have been approved, mainly because commercial considerations out-compete public health need in the eyes of the pharmaceutical industry.
Data indicates that in 2010, there were close to 3,000 medicines under development, including more than 800 cancer drugs and 250 cardiovascular medicines, but only about 80 antibiotics.
More resilient
As the bugs become more resilient, doctors are increasingly opting for alternatives that are more toxic and more expensive.
A major reason why drug manufacturers are giving antibiotics a wide berth is that most people who need antibiotics are from poor countries. These countries have low budgets for health and depend largely on donations. For those in R&D, conditions that require long-term medication are more appealing.
A study by the London School of Economics and Political Science said that there are costs and commercial risks involved in developing new medicines, therefore, companies make long-term decisions about which potential cures they will commercialise years in advance. Drug resistance in developed countries forced health authorities to issue restrictions and kept new antibiotics as a treatment of last resort, but the move also served to limit the size of the market for companies developing new medicines. According to Dr Samuel Kariuki, Chairman of Kenya’s Working Group in the Global Antibiotic Resistance Partnership, Kenya is already experiencing high levels of antibiotic resistance, and in most cases, it is worsening.
He blames inadequate dosing, poor adherence and counterfeit antibiotics to play a big role in resistance in Kenya and says that drugs to treat diarrhoea, typhoid and salmonella infection are the worst affected by resistance.
“Exactly how high the rates are currently or how quickly they are increasing is not known because antibiotic resistance surveillance is not systematically done,” says Dr Kariuki.
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