World Health Day 2011 speech by Dr. Harrison “Combat drug resistance: No action today, no cure tomorrow”
Dr Graham Harrison
World Health Organization Representative to Viet Nam
Minister Trieu, Vice Ministers, Directors
Distinguished Guests, Colleagues, Ladies and Gentlemen:
Today is World Health Day, and marks the 63rd year of the World Health Organization's founding. This year we focus on Antimicrobial Resistance with the key message: No Action Today, No Cure Tomorrow, in order to bring to everyone's attention the growing concern about antimicrobial resistance.
Antimicrobial resistance is the ability of a microorganism to stop an antimicrobial medicine from working against it. Microorganisms that can develop resistance include viruses, bacteria and some parasites. When antimicrobial resistance develops, standard treatments become ineffective and infections persist and may spread to others.
Antimicrobial resistance is a consequence of many factors – but primarily it is caused by the inappropriate and irrational use of antimicrobials. This occurs in a health care environment where doctors and health workers overuse, misuse or underuse antimicrobials that are prescribed or provided to patients. It can also occur when patients self-medicate, and when antimicrobials are sold and dispensed by pharmacists without prescription. Globally WHO has identified that weak supportive systems such as:
• inadequate national commitment to a comprehensive and coordinated response
• ill-defined accountability and insufficient engagement of communities
• weak or absent surveillance and monitoring systems
• inadequate systems to ensure quality and uninterrupted supply of medicines and
• poor infection prevention and control practices
All contribute to the emergence and increased spread of antimicrobial resistant organisms and drug-resistant infections. Furthermore, the use of sub-therapeutic doses of antibiotics in animal rearing for promoting growth or preventing diseases can result in resistant microorganisms, which can spread to humans. All of these weaknesses allow, and even encourage microorganisms to mutate or acquire a gene that will give resistance.
Antimicrobial resistance is a major concern because it has tremendous consequences for patients and society. Antimicrobial resistance can kill as infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death. Antimicrobial resistance challenges control of infectious diseases. As effectiveness of treatment is reduced, patients remain infectious for a longer time and thus increase the risk of spreading an antimicrobial-resistant infection to others. The failure to treat common infections also threatens the achievement of the Millennium Development Goals and other national health objectives. Antimicrobial resistance also threatens government and patient resources, as more expensive medicines will become necessary to treat common infectious illnesses. The prolonged duration of illness also increases the financial burden on health care institutions, families and societies.
The problem of antimicrobial resistance is not new, but in recent years the emergence of highly resistant strains has heightened global concern. New patterns of antimicrobial resistance have emerged in recent years. For example about 440,000 new cases of multidrug-resistant tuberculosis (MDR-TB) have been emerging annually, causing at least 150,000 deaths. In Viet Nam, WHO estimates that there are 5,900 cases of MDR-TB, causing 1,800 deaths per year. However, even worse than multidrug-resistant tuberculosis is extremely drug resistant tuberculosis (XDR-TB). As XDR is virtually untreatable, mortality from XDR-TB is extremely high (> 50 %). In 2010, 58 countries reported to WHO the existence of XDR-TB and within a year, the number of countries had increased to 69. XDR-TB has also been reported in Viet Nam.
Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine has also become widespread and Falciparum malaria, which is resistant to the newer drug artemisinin is emerging in South-East Asia. In Viet Nam, almost 3% of cases of Plasmodium falciparum in Quang Tri, Gia Lai and Dak Nong are resistant to artemisinin combination therapies.
Surveillance and prevention of HIV drug resistance is also critical for Viet Nam. Surveillance of transmitted HIV drug resistance in HCMC in 2008 reported an estimated 5%-15% of people are already resistant to antiretroviral medicines even before starting the life-saving therapy.
In addition a high percentage of hospital-acquired infections globally have been caused by highly drug resistant bacteria, and some common infections such as diarrhea and gonorrhea have become resistant to older antibiotics which used to be considered as the first-line of treatment.
The danger posed by antimicrobial resistance demands urgent action. As we celebrate the World Health Day today, WHO proposes a collaborative action from all sectors. To begin with, WHO advocates that countries adopt a policy package which includes the following:
• commit to a comprehensive, financed national plan for antimicrobial resistance with accountability and civil society engagement
• strengthen surveillance and laboratory capacity
• ensure uninterrupted access to essential medicines of assured quality
• regulate and promote rational use of medicines including animal husbandry and ensure proper patient care
• enhance infection control; and
• foster innovations and research.
WHO therefore calls on all key stakeholders, including policy-makers and planners, the public and patients, health practitioners, pharmacists, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance.
In closing, I would like to thank Minister Trieu and the Ministry of Health for hosting this important event. WHO acknowledges the substantial work of MOH, including that of other partners, in combating antimicrobial resistance in Viet Nam. WHO will continue to support the Government and strengthen collaboration with other partners in this field. WHO appreciates the key actions outlined by the Minister in his opening address and we would also like to encourage Viet Nam to move towards the development and implementation of a national action plan to combat Antimicrobial Resistance.
Thank you for your participation this morning.