11 Nov 2014
Written by Dr Abdul Ghafur
“In the end, we will remember not the words of our enemies, but the silence of our friends”
– Martin Luther King, Jr.
-The global citizenship of microbes and the global challenge of antibiotic resistance.
The Chennai Declaration is an Indian initiative to tackle the antibiotic resistance crisis in India while Longitude Prize is designed to stimulate brains across the world to find a solution to the same scenario at a global level.
The superbug phenomenon is a global one, with no country or continent spared from its venomous grasp. The Gram-positive superbug MRSA is a worldwide threat, with a particular impact in North America and Europe. South Asian and Mediterranean countries are seriously hit by Gram-negative superbugs, though there has been a significant overlap across different regions in recent times due to the global spread of superbugs. A large population with vast bacterial biomass makes South Asia the major epicentre of Gram-negative bacterial resistance.
The Indian subcontinent has reported one of the highest rates of Gram-negative bacteria resistance in the world. There are many social, political and cultural factors that contribute to the antibiotic resistance crisis in India. More than a billion people, a million doctors, twenty thousand hospitals and half a million pharmacies combined with indiscriminate antibiotic use in hospitals, easy availability to antibiotics over the pharmacy counter and an abundance of tropical infections makes managing the healthcare system difficult. Some of the social and cultural issues include wide socioeconomic disparity, cultural diversity, sanitation issues in the community, lack of functioning antibiotic policy and regulation. The scenario is not unique to India with most countries in South Asia sharing similar challenges.
In August 2012, representatives of all major medical societies with governmental delegates such as the Drugs Controller General of India, the Medical Council of India, and the Indian Council of Medical Research met with State Government representatives, media persons and policymakers in Chennai, India. Together, they discussed in detail the ways of formulating a roadmap to tackle the challenge of antimicrobial resistance in the country. A meeting of this significance on the issue of antimicrobial resistance had never before taken place in India. Bringing together medical societies and all stakeholders in a large country like India was a huge challenge, but the “Chennai declaration” provided a practical and implementable solution suitable to the current health-care system in the country. ‘Practical’ and not a ‘perfect policy’ was the motto of the Declaration.
Antibiotic resistance is not just a scientific topic to be dealt with by the medical or scientific community alone – joint efforts by the medical community, politicians and policy makers are essential to construct a practical solution. The Chennai Declaration initiative realised this important fact and so concentrated its efforts on Government, politicians and policy makers.
“Attitude is a little thing that makes a big difference.”
-Winston Churchill
Antibiotic resistance was not considered to be a popular topic of discussion in academic circles in India until a few years ago. The Chennai Declaration changed the direction of the wind. Persistence and perseverance could convince stakeholders of the significance of the resistance problem and the need to face the challenge with a positive attitude. The Indian medical community and authorities became more open to the resistance issue and this attitude change helped convince authorities to hold multiple high level meetings to discuss the topic. Many medical societies and colleges including the Royal College of Physicians of Edinburgh endorsed and supported the declaration and the International community became more sympathetic to the resistance problem in the developing world.
Silence is not the solution to any problem, especially on public health issues. Understanding the magnitude of the challenge, a willingness to face it with resolution and a positive attitude are the key factors for the success of any initiative. Chennai Declaration efforts — through inspiration of political leadership to discuss the issue in the Indian parliament, creation of public and professional awareness via media, journals and meetings at national and international level — have undeniably sped up the publication of the new over-the-counter rules to rationalise antibiotic sales in India.
Very high Gram-negative bacterial resistance rates in the Indian subcontinent forces doctors to prescribe third line, last resort antibiotics to patients admitted with sepsis before culture results are available. Longitude Prize will help stimulate scientists across the world to make a rapid, affordable test to detect drug resistant bacteria. This will help doctors to prescribe the right antibiotic at the right time, potentially avoiding over- and under- prescription of higher-end antibiotics which would be a blessing to the medical community and patients. The Chennai Declaration is proud to be a partner in this noble initiative.
