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Fork in the road: Will we protect medicines that protect us or deal with incurable diseases?

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By SHOBHA SHUKLA – CNS

The spotlight is once again on preventing antimicrobial resistance that is not only devastating human health but also threatening the sustainability of our planet earth. Will we protect the medicines that protect us or lose them, resulting in diseases that become difficult or impossible to treat? “The answer my friend is blowing in the wind” as the legendary lyrics go.

What is antimicrobial resistance?

Antimicrobial resistance occurs when bacteria, viruses, fungi or parasites become resistant to, and hence no longer respond to the antimicrobials or drugs (antibiotics, antivirals, fungicides and parasiticides) used to treat the diseases caused by them. While antimicrobials are the backbone of modern medicine, their misuse and overuse in humans, animals and plants is driving the emergence and spread of antimicrobial resistance, making it difficult or even impossible to treat infections, increasing the risk of disease spread, severe illness and death.

Progress on all SDGs threatened by antimicrobial resistance

Antimicrobial resistance is not only causing a huge loss of human life (contributing to over 6 million deaths every year directly and indirectly) but also posing a crippling mountainous economic burden, said Dr Haileyesus Getahun, who is the Director, Global Coordination and Partnership on antimicrobial resistance, and also the Director, Quadripartite Joint Secretariat on antimicrobial resistance at the World Health Organization (WHO). Dr Getahun was the inaugural speaker at a recently concluded 2nd Annual Global Media Forum in lead up to 2022 World Antimicrobial Awareness Week.

According to a 2017 World Bank report, if no action is taken now, antimicrobial resistance is likely to cause an USD 1.2 trillion additional health expenditure per year by 2050, and push up to 24 million additional people (particularly in low-income countries) into extreme poverty by 2030. Dr Getahun warned that antimicrobial resistance can directly affect progress on at least 6 of the 17 UN Sustainable Development Goals and can be linked indirectly to the remaining 11 as well.

Inequity also ails antimicrobial resistance

As the burden of antimicrobial resistance is greatest in low-resource settings, particularly in sub-Saharan Africa, and South Asia, it is not only a global public health problem, but also an issue of health equity and socioeconomic development, says Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit at the World Health Organization (WHO). Along with ensuring a rational use of antibiotics “having access to clean water, sanitation, and hygiene, as well as good infection prevention and control measures, such as hand washing and vaccination, are vital in the fight against antimicrobial resistance,” he emphasises.

One Health approach is vital to address antimicrobial resistance

Humans, animals, plants and environment are continuously interacting and sharing with each other the microbials that have become resistant to drugs. So curbing antimicrobial resistance to protect human lives is not possible without protecting the health of our plants, animals and environment.

Jacqueline Álvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP), rightly points out that “Antimicrobial resistance is both, a cause and a consequence of the triple planetary crisis of climate change, biodiversity loss and pollution and chemicals.”

Dr Getahun calls for increased financing, political advocacy and coordinated global action to better respond to the converging threats of antimicrobial resistance and the climate crisis before it is too late.Scott Newman, Senior Animal Health and Production Officer for Asia and the Pacific at the Food and Agriculture Organization of the United Nations (FAO), stresses upon preserving antimicrobial efficacy while we sustain food and agriculture production.

“Loss of biodiversity and ecosystems, as well as of natural habitats for agriculture, has also led to an increase in antimicrobial use, and pathogen spread. We have to ensure that emergence and spread of antimicrobial resistance is slowed down across all food sectors (animal husbandry and agriculture). We need to switch to sustainable food production, by promoting climate-smart agriculture, agro-ecological approaches, nature-based solutions, and efficient and safe production methods biosecurity and disease prevention and control,” added Scott Newman.

Antimicrobials cannot compensate animal husbandry practices

“Antimicrobials are also used to prevent infections in animals apart from their use in treating animal diseases. But we must note that antimicrobials used in animals to prevent infections, must not be done to compensate poor animal husbandry practices. Rather antimicrobials should only be used for infection prevention in animals, who are at risk of acquiring a specific infection or in a specific situation where infectious disease is likely to occur, if the drug is not administered,” cautioned Delfy Gochez, Data Management Officer, antimicrobial resistance, and Veterinary Products Department, World Organisation for Animal Health (WOAH).

Jane Lwoyero, Technical Officer on antimicrobial resistance at the WOAH shared that in Africa, and globally, WOAH (World Organisation for Animal Health)’s strategy is followed by them to promote prudent use of antimicrobials. “We have also disseminated farm biosecurity guidelines in Kenya and Ethiopia to curb antimicrobial resistance. We also helped pilot the information and alert system for substandard and falsified veterinary products (during October – December 2021)” said Jane. “WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans.”

Improve the basics to strengthen antimicrobial stewardship

“To contain antimicrobial resistance, we need better evidence, and evidence-backed actions; we need to improve diagnostic stewardship; we need to have good infection control practices in the hospitals and the community; and without these pillars – we cannot truly practice antimicrobial stewardship,” said Dr Kamini Walia, Senior scientist, Indian Council of Medical Research.

“Diagnostic stewardship and infection control – both are significant challenges in our country because we have sub-optimal investment in the healthcare system, and we do not have good diagnostic laboratories in secondary and primary healthcare services (and good laboratories are essentially limited to tertiary care health services). Being a tropical country, we have a significant burden of infectious diseases. This further leads to sanitation and hygiene problems, and most of the antimicrobials which are prescribed are to compensate for poor sanitation and hygiene – both in communities and in hospitals. So, if we really want to make progress on antimicrobial stewardship we have to improve the basics, such as improving diagnostics, infection control, and other necessary actions,” rightly added Dr Walia.

“Studies done in India show that almost half of all prescriptions audited in the study, were of antibiotics, and over 55% of antibiotic use was prescribed for uncomplicated respiratory symptoms. More alarmingly, less than 1% of these patients had any microbiological diagnosis done. Many of these prescriptions show the levels of inappropriate use or higher use of antibiotics. Also, over two-third of these drugs are available over the counter. We need to prevent over-the-counter dispensing of antimicrobials,” said Dr Prapti Gilada-Toshniwal, senior microbiologist and founder head of UniLabs.

“We need stronger and practical antimicrobial stewardship programme for our context and ground realities so that we can effectively promote the appropriate use of antimicrobials (including antibiotics), improve treatment outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms,” added Dr Prapti Gilada-Toshniwal. “We need to boost diagnostic capacities at all levels. Access to accurate, rapid, and point-of-care diagnostic facilities for different diseases and conditions, should be scaled up.”

Clock is ticking

All this points towards the urgency of tackling antimicrobial resistance through an integrated and comprehensive response involving all the sectors, what is now referred to as the One Health approach. In the words of Dr Getahun, “One Health approach is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.”Collaborative efforts are needed that involve public health, agriculture, animal husbandry and environment sectors, as well as whole of society approach, to effectively address the challenge of AMR and make economies resilient to its impacts.



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Opinion

Is AKD following LKY?

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by Chula Goonasekera
Rev. Dato’ (Sir) Sumana Siri

We, the citizens of Sri Lanka, have already witnessed significant reforms in governance under AKD’s leadership. This personally led process must continue consistently, free of bias, and within the framework of the law to ensure sustainable governance by the State, not the individual. Such efforts will help minimise the waste of public funds and lay a strong foundation for the nation’s development in the long term. We often look to Lee Kuan Yew (LKY), Singapore’s founding father, as an example of transformative leadership. He united three diverse ethnic groups—Chinese, Malay, and Indian—under the principle of honesty. Today, Sri Lanka faces profound challenges from past political corruption, economic instability, and social divisions. LKY’s leadership serves as a reminder that integrity, accountability, and a commitment to the greater good can redefine a nation’s destiny, regardless of its size or resources, similar to Singapore.

When Singapore gained independence in 1965, it was a small, resource-scarce nation facing political unrest and ethnic divisions. Yet, within one generation, it became a global financial hub and a first-world country. LKY’s leadership was pivotal, centred on three core principles: meritocracy, integrity, and pragmatic governance. He prioritised national security, social cohesion, and economic growth. His efforts to foster ethnic harmony included implementing bilingual education policies and enforcing anti-discrimination laws. Similarly, AKD should consider enacting legislation to prevent racially motivated demands, i.e. anti-discrimination laws, to safeguard the government from evil, selfish minds trying to destabilise the government’s commitment to equality. Such legislation will stop this burden falling on the leadership case by case.

LKY’s policies, though sometimes harsh, were rooted in practicality and long-term thinking. The Internal Security Act ensured peace and stability during critical years. Likewise, his investments in education and infrastructure established a foundation for sustained growth. His focus on political stability, a robust legal system, and zero tolerance for corruption inspired investor confidence. Singapore’s Corrupt Practices Investigation Bureau (CPIB) was empowered to tackle corruption at all levels. Sri Lanka must adopt a similar mindset to revitalise the Bribery and Corruption Commission, moving away from populism and short-term fixes in favour of strategic, future-oriented policies.

AKD’s primary election theme was anti-corruption, reflecting a key aspect of LKY’s leadership. His unwavering stance against corruption defined LKY’s pragmatic governance. He held public officials to the highest accountability standards, ensuring that anyone guilty of corruption faced severe consequences, including dismissal, public exposure, and prosecution. By rooting out corruption, Singapore built domestic credibility and attracted global investment. We in Sri Lanka need such legislation at the earliest opportunity to deal with various kinds of corruption that are appearing again and involving many public officials.

In Sri Lanka, corruption has long undermined public trust in institutions and stifled economic growth. With overwhelming public support, AKD is well-positioned to deliver on his promise to combat corruption. However, this needs to be done early before the government gets entangled with controversy over its own ‘tiered’ standards. Through comprehensive legislative measures, Sri Lanka can rebuild its institutions, restore public confidence, and chart a course toward sustainable development.

LKY was considered “cruel” by some because he treated all races equally without favouring any. AKD shares a similar stance. One of the hallmarks of LKY’s leadership was his unwavering commitment to meritocracy. This created a culture of excellence where the best and brightest minds were responsible for leading the country. In Singapore, recruitment and promotions across all sectors were strictly based on merit—capabilities, skill sets, and abilities—not on connections, nepotism, racial considerations, or personal favouritism. Although challenging to implement, meritocracy can be implemented with the open advertisement of qualifications needed, a transparent appointment process, strict job plans with annual reviews linked to customer feedback, and personal development strategies that are considered a necessity to continue. This approach will foster a culture of excellence and innovation, like Singapore, ensuring that the most capable individuals propel the country forward.

Sri Lanka must break free from the grip of favouritism and focus on nurturing talent through equal opportunities for all citizens, regardless of ethnicity or social background. Early signs of this approach are visible under AKD’s leadership. LKY understood that for a nation to progress, its institutions must be led by those who are truly capable, irrespective of their background. By adopting meritocracy, Sri Lanka could break the cycle of favouritism, nepotism, and ethnic division that has often hindered its development. Establishing a system where opportunities are based on ability and performance could unlock the full potential of Sri Lanka’s people, fostering a culture of innovation, growth, and national unity.

After gaining independence in 1965, during Singapore’s formative years, LKY focused on eliminating corruption, gang activities, and communist threats to create a peaceful and secure nation. The Internal Security Act (ISA) granted his administration discretionary powers to arrest and detain individuals without trial, when necessary, to prevent actions deemed harmful to Singapore’s security, public order, or essential services.

The ISA allowed preventive detention, suppression of subversion, and countering of organised violence against persons and property. Sri Lanka urgently needs a similar act to ensure that politicians and public officials comply with legally binding measures. With its Parliament still in its formative stages, we hope Sri Lanka will soon establish a comparable Internal Security Act. By eliminating corruption at all levels, as LKY did, Sri Lanka can inspire public trust and attract international investors who view stability and a corruption-free environment as prerequisites for investment. This approach could transform Sri Lanka into a manufacturing, business, and financial hub for the Indian Ocean region.

Under LKY’s leadership—often described as strict—Singapore transformed from a third-world nation into a first-world country. Sri Lanka has the potential to achieve even more, given its abundant natural resources, strategic location, and educated population that can be developed into a skilled workforce. With its prime position in the Indian Ocean, Sri Lanka could become a regional economic powerhouse—provided it fosters a stable and investor-friendly environment. Like Singapore, Sri Lanka should adhere to a non-aligned foreign policy to emerge as a crucial node in global trade and finance, maintaining friendly ties with Eastern, Western, and Asian powers while leveraging its strategic location.

While some label LKY’s methods as “cruel,” his leadership was not about oppression but discipline and fairness. Whether these policies were “cruel” or benevolent is debatable, but their results speak for themselves. He treated all races equally, fostering harmony in a diverse society by ensuring everyone felt they had a stake in Singapore’s future. Moreover, LKY’s economic policies were marked by simplicity and foresight. Low personal income taxes, the absence of capital gains and inheritance taxes, and a business-friendly environment encouraged reinvestment and entrepreneurship. By positioning Singapore as a global trade and financial hub, LKY ensured its economic resilience. Sri Lanka, too, must prioritise national unity. Divisive politics and ethnic biases must be curtailed to build a shared vision of prosperity and peace, as AKD is striving to do.

LKY’s leadership was built on three core tenets relevant to Sri Lanka today: meritocracy, integrity, and pragmatism. Encouragingly, AKD appears to be moving in a similar direction. One of LKY’s greatest strengths was his pragmatic, long-term approach to governance. He maintained tight control over domestic finances, preventing the internationalisation of the Singapore dollar and limiting the operations of foreign banks. This created an environment that attracted international firms eager to establish themselves in Singapore. Sound financial policies, a corruption-free environment, and a focus on technological advancement helped Singapore become a hub for multinational companies like General Electric. State-owned enterprises like Temasek Holdings and Singapore Airlines were run with business efficiency, often outperforming private sector competitors. Sri Lanka could adopt a similar model to enhance the performance of its state-owned enterprises and boost economic growth.

Singapore adopted a two-pronged financial strategy: becoming an international financial hub while ensuring its financial sector supported key domestic industries like manufacturing and shipping. Additionally, integrating foreign and local talent fuelled decades of sustained economic growth. LKY’s focus on economic development, making Singapore an attractive investment destination, and drawing world-class manpower offer valuable lessons for Sri Lanka.

To replicate such success, Sri Lanka must invest in state-of-the-art infrastructure, establish excellent air and sea linkages, and maintain a low and transparent tax regime.

Clean and efficient bureaucracy, a strong regulatory and legal framework, and a neutral diplomatic policy—balancing relations with global powers like the US and China—are critical. Developing clean, green cities powered by sustainable energy will also be key to achieving remarkable economic success akin to Singapore’s.

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Opinion

‘A degree is not a title’ – a response

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Reference the above-captioned letter in The Island of 16 Decembe, its writer, Philosophiae Doctor (PD), he is incorrect in his analysis of a Ph. D degree as a title. As Dr. Upul Wijewardena has said, only a Ph. D holder who can use the title ‘Dr’. However, the tradition is for those who have a medical degree to be called Dr. PD has written about the history of universities and quoted chapter and verse about the origin of degrees. We are now in the twenty first century and most universities have their own system of awarding Ph. Ds. For instance, British universities award Ph. Ds based on 100 per cent research whereas in American universities Ph. D degrees are awarded on the basis of 50 per cent research and 50 per cent course work. The research degree is given more weight at interviews.

PD has also said that a Masters’ Degree (MA) is essential to teach in a university.  Many universities including universities in Sri Lanka offer Assistant Lecturer positions to those who have first degrees with classes. Some time ago, the Dean of the faculty of Arts at Otago university, New Zealand had only a B.A. He was appointed Professor because of his publications. In American universities lecturers with a Ph. D are addressed as Assistant Professor. Then a Professor after retirement has to get permission from his university to use the title as Professor (Emeritus). There is no such requirement for a person with a Ph. D to use the title Dr.  Modern universities do not follow procedures that were adopted in old Europe mentioned by PD.

Dr. P. A. Samaraweera

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Opinion

Electricity tariffs cannot be reduced due to CEB Mafia

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Ceylon Electricity Board (CEB) has apparently become a law unto itself; it is increasing the salaries and other perks for senior staff at their will. There are 26,131 employees of CEB and its monthly salary bill is around Rs. 3,000 million, out of which 600 million goes for the salaries of engineers. A special grade engineer’s monthly take-home salary is reportedly about Rs. 919, 432 while an E1 grade engineer draws around Rs. 694,240 a month. These include a vehicle allowance of Rs. 250,000 and other benefits. The CEB has thought it is fit to regularly increase the salaries at the insistence of the powerful engineers’ union every three years without getting the approval of the cabinet or the public accounts committee of the finance ministry.

Out of the total number of employees at least 50% are political appointees recrutied by successive ministers of the power and energy ministry. Even the salary of a meter reader is Rs. 54,420 and it comes to around Rs. 125,000 a month. This is far higher and about 100% more than a graduate teacher. With such an excessive workforce earning exorbitant salaries no wonder that the CEB cannot reduce the electricity bills of consumers. There are 6.29 employees for every megawatt (MW) of power generated by CEB while the Malaysian Electricity Board generates six times more power and has only 1.15 employees for one MW of power generated!

PAYE tax should be borne by the employee and it is against the Inland Revenue Act for an institution to pay the PAYE tax due from its employees.  It has been revealed before the COPE (the Committee on Public Enterprises) that Rs. 5 billion has been paid by the CEB as PAYE tax to its employees during the period 2010-2019 in contravention of a Cabinet decision on 13 December 2007. This, the CEB has been doing at the expense of consumers, who have to pay higher tariffs.

Verite Research has revealed that Sri Lankan households pay 2.5 to 3 times more for electricity than the average cost to their counterparts in South Asian countries. Our rates are much higher than in Bangladesh and Afghanistan. For instance, a consumer using 300 units of electricity has to pay an electricity bill of Rs. 21,860 while the average equivalent rate in South Asia is only Rs. 7,340. This shows how our professional engineers have managed the CEB power generation so inefficiently over the years.

 The reason for this inefficiency is due to the neglect of renewable energies in Sri Lanka. The CEB engineers have always advocated for more and more coal-powered plants. They have deliberately blocked renewable energy projects for obvious reasons.  The Supreme Court has found the CEB guilty of blocking a proposal by Vavuniya Solar Power Private limited for a solar energy plant and ordered it to pay Rs 01 million rupees as damages. This, too, would have been paid from CEB funds and those who took such corrupt decisions have got off scot-free. The technical officers of CEB allege that CEB management has purchased power from private power plants despite an increase in hydro power generation. In case hydropower is insufficient to meet the demand another idling turbine at Norochcholai could have been put into operation. There are serious allegations that CEB engineers are intimately connected to such private power plants and even own all or part of them. The new government should appoint an independent commission to investigate allegations against the CEB.

Concerned Consumer

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