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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

In Loving memory of our Seeya – Late Mr W P Upasena

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Its been a year since you left us, and while the pain of your absence remains, so too does the warmth of your memory. There is not a day that goes by where we don’t think of you.

We are deeply grateful for the love, wisdom, and kindness you shared with us all. Your unwavering support, gentle guidance, selflessness, and extensive knowledge left an incredible mark on everyone who knew you. You were not only the cornerstone of our family but also a source of inspiration for all who crossed your path.

As we gather to honor your life, we extend our heartfelt thanks to friends, family, and well-wishers who have supported us over the past year. Your love, and kind words have been a source of strength and comfort during this journey.

Though you are no longer with us in person, Seeya you continue to live on in our hearts and through the values you instilled in us. We will continue to honor your life by cherishing each other and carrying forward your legacy of love, compassion, and integrity.

May you attain the supreme bliss of Nirvana, Seeya.

Fondly remembered by:
Achchi, Loving Children & Grandchildren

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Major eyesore on Beira banks

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In the last decade or so the government, the private sector and even private citizens have made a concerted effort to beautify Colombo. And it has worked!

Yet, eyesores like the Jinarathana Vocational Center at 142 Sir James Peiris Mawatha exist. The building belongs to one of the most influential and revered temples in Colombo. Gangaramaya is also a major tourist attraction.

Not only is the building in disrepair, it is also a health hazard with garbage, rats and other infestations. Nefarious activities go on in the night, as it would in any “abandoned” building. It seems the building is used as a car park for the temple vehicles! Not only does this go against every Buddhist principle, but is this building on the banks of the Beira even legal?

Why does government after government keep donating public land to this temple, when it refuses to use or maintain the buildings it already has?!!

Podi Hamuduruwo – Venerable Galboda Gnanissara – as Chief Incumbent, transformed the temple into “a dynamic center of spiritual growth, education and community empowerment”. But he is no more. And if the temple is no longer able to use or maintain this structure according to the vision of the revered Podi Hamuduruwo, it is surely up to the Ministry of Urban Development and Housing and/or Colombo Municipal Council to take immediate action.

M. S. De Silva
Colombo 02.

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A tribute to a quintessential friend and colleague

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Kuru as a cadet sergeant and Queen’s Scout meeting the Queen at India’s 1961 Republic Day.

A talented son of Sri Lanka, Dr. Mahinda Kurukulasuriya (1942-2025) passed away peacefully in Vientiane, Laos on 29 January 2025 – with his daughter Liza by his side. According to his wishes, a three-day memorial service was held in a Buddhist temple in Vientiane, Laos.

Among close friends, he was fondly referred to as ‘Kuru” and as “Dr. Kuru” among his professional colleagues.

He was born in 1942 to a wealthy family in Nakulugamuwa. His father owned the Ruhunu Transit Bus Company that was nationalized in 1957.

Kuru had his Education at Mahinda College, Galle, where he excelled in studies, sports, and athletics. In 1961, as a Cadet and a Queen’s Scout, he had the rare opportunity to greet Queen Elizabeth II at the Republic Day Celebrations in New Delhi.

After a 13-year hiatus of losing cricket matches to Richmond College, in 1962, Mahinda College under Kuru’s captaincy won a memorable victory against Richmond.

In 1962, he won a Scholarship to pursue engineering studies at the Moscow State University. That same year, I met Kuru in Moscow, and we forged a friendship that lasted 65 years.

Kuru married his University batch-mate Elena – an amiable person who also completed her Ph.D. and the rare Doctor of Science (D.Sc.) degrees along with Kuru. She predeceased him in 2015 leaving two equally brilliant daughters who live in Europe.

Kuru’s education abroad opened up the world for him to explore. Upon his graduation in 1968, he returned to Sri Lanka and worked for the River Valleys Development Board (RVDB). From 1971-1976, he and his wife Elena were appointed as water engineers in Zambia. They returned to Moscow and completed their Ph.D.’s. Kuru returned to Sri Lanka in 1979 and worked for the Mahaweli River Development.

Later, he worked on United Nations assignments as a senior engineer and Program Manager in Zaire, Congo, Maldives, Myanmar, Cambodia, Thailand, and Laos. He was fluent in English, Russian, French, Burmese, Khmer and Thai, and he excelled in his UN assignments.

In 2006, he garnered another Ph.D. from the Postgraduate Institute of Agriculture of the Peradeniya University. Over the years, he wrote several books, including his memoirs “One Drop of my Sweet Sweat”.

Upon his mandatory UN retirement, the Government of Laos – aware of Kuru’s technical expertise, commitment and integrity – persuaded Kuru to lead several key development projects in Laos. It allowed Kuru to continue working with the perks of a UN official, and the Government took good care of him as he was away from his native Sri Lanka, and his beloved family. He had many Laotian friends.

Above all, he was kind and friendly to everyone he knew. Despite many achievements, Kuru was the most virtuous and unassuming person I came across in my life.

Kuru is survived by his sisters Indra and Lalita, daughters Angelika and Liza, and his wife Seuth and his son Souminta.

His family and friends will miss him dearly. Yet, we shall cherish his memory forever.

May he attain the supreme bliss of Nirvana.

Somar Wijayadasa

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