Our generation has lived in a world where having
- a cut becoming infected ;
- a urinary tract infection; or even
- bacterial pneumonia …
...is not such a big deal. Each of these can be treated with drugs that are cheap, effective and widely available.
It is also a world where antibiotics have made surgery safe, and made surgery like joint and valve replacements possible.
But what happens if antibiotics no longer work? What if there are no effective drugs against sepsis or pneumonia? Suddenly minor infections become life threatening. Just like they were 100 years ago.
This is the real prospect the world faces – unless countries take practical steps to fight antibiotic resistance. This is why it is so important that Lao PDR has developed and agreed on this Strategic Plan. The ultimate goal of this Plan is to make sure our most valuable drugs – such as antibiotics – continue to work for us, our children and our children’s children.
Lao PDR is already doing important work to combat the spread of drug-resistant malaria and tuberculosis. Working with international partners, it has developed the capacity to:
- identify patients with drug resistant variants of these diseases; and
- give patients appropriate and effective treatment; and
- monitor, evaluate and improve the health interventions it uses
These successes show that – once it has the right staff, systems and equipment in place – the health system here is able to act against drug-resistant diseases. But implementing this AMR Strategic Plan will mean scaling up our efforts. I can illustrate this by looking at one of the Plan’s main goals - keeping antibiotics working in Lao PDR
This is a simple goal. And the main strategy to achieve it is simple too. Reduce the amount of antibiotics being used here. In particular, cut out unnecessary use of antibiotics. For example, make sure people don’t take antibiotics to treat the common cold or influenza. These are caused by viruses, so the antibiotics don’t help at all. The difficult bit is when you get to the details.
For a start, we do not currently know for sure how many – and what type – of antibiotics are used in Lao PDR each year. Then we have only limited knowledge of:
- Who is taking antibiotics in Lao PDR?
- Why they are taking them?
- Who supplied them?; and
- Whether the antibiotics worked.
The Plan aims to plug these, and other, gaps in our knowledge. It will strengthen surveillance of antibiotic use in Lao PDR. The national-level figures will, over time, let the Ministry of Health know if its measures to limit antibiotic use are working. But hospital level usage figures can also be incredibly useful.
We may see that some hospitals use antibiotics, or certain types of antibiotics, much more than others. This might be a signal they are not following best practice – or that new treatment guidelines are needed on some diseases.
The Plan also seeks to give the Ministry of Health information to guide other crucial interventions. For example, having information on who is selling and using antibiotics will help the Ministry’s Food and Drugs Department enforce the pharmaceutical law. It will be easier for them to spot pharmacies that are selling antibiotics to people who don’t have a prescription. It will also be easier for them to monitor the quality of antibiotics being sold, and take action against sub-standard products.
The Plan calls for advocacy and awareness raising about the health threat posed by antibiotic resistance. These actions will be aimed both at health workers and the public. The Plan also proposes studies to see if these actions are having an impact. If they are not working, then together we will need to rethink them.
I talked earlier about antibiotic resistance being a threat to future generations. That is true. But it is also killing people around the world now, in 2019. There would certainly be patients in hospitals here in Lao PDR who are dying of antibiotic resistant infections. We do not know the true numbers, because we are not gathering all the data we need. At least, not yet.
Once this Plan is in place and implemented we should have surveillance data showing the health impact of Antimicrobial Resistance in Lao PDR. This should help policy makers and development partners focus on the value of fighting this threat, and crucially be translated into ongoing and effective action.
Congratulations to everyone involved in producing the Lao PDR’s National Strategic Plan. It is a major achievement and an important milestone. But now the really important work begins.
Thank you and Kop Chai Lai Lai