Corruption in governance breeds antibiotic resistance

March 26, 2015 02:12 am | Updated November 16, 2021 06:59 pm IST

A sample bottle containing E. coli bacteria is seen at the Health Protection Agency in north London March 9, 2011.

A sample bottle containing E. coli bacteria is seen at the Health Protection Agency in north London March 9, 2011.

This is the startling conclusion that an Australian research group has arrived at. Infection by pathogenic bacteria occurs the world over. And scientists and pharma companies are busy discovering and inventing yet another molecule to kill the pathogens, when penicillin was first made and used by Alexander Fleming, it proved so effective that it was heralded as the wonder drug that saved the lives of millions across the world-and won him the Nobel Prize in 1945. But, widespread use of it made the bacteria resistant to penicillin and new antibiotic molecules such as streptomycin had to be invented. By now we have what is referred to as the fourth generation antibiotics.

What causes resistance to antibiotics? Bacteria have a life cycle and generation time of hours and days. And when a colony of such bacteria is treated with a drug like penicillin, the colony is wiped out. But in the colony, an occasional mutation may occur by random chance, and generate a cousin which is resistant to the action of the drug being used. And given the time frame of reproduction, this drug-resistant mutant can multiply and take over the colony. We now have an antibiotic-resistant strain of the pathogen. The more you try to kill them with the same antibiotic the less successful you are. And you now have to look for a new generation antibiotic drug to wipe out the resistant variety of pathogens.

How then does one win this battle? It costs money, stopping the use of such drugs which are found to be of no use any longer, and discover/invent new ones. It also helps if the community keeps its water and environment — the breeding grounds of pathogenic germs — clean or “swach”. This needs money, understanding and action by the community at large, and use of new generation antibiotics rather than the earlier ones which no longer kill the infecting germ. The war against antibiotic resistance is thus dependent on not just new generations of drugs but also action by the community, the health authorities and the governments.

The Australian group, led by Dr. Peter Collignon of the Canberra Hospital, Australian National University, decided to study the contributions made by each of the above parameters to antibiotic resistance across the 28 nations of Europe. The parameters were: (1) The quantity of antibiotic usage in people (defined daily dose per 1000 people per day or DDD), (2) The availability of data on antibiotic resistance of a few well known pathogens affecting our health (ABR) ( Streptococcus , pseudomonas , Klebsiella , E. coli , E. faecium and E. faecalis ), (3) The level of people educated at the tertiary level (TER), (4) The major economic activity- agriculture, trade, technology and others in the country (AGR), (5) The normalized per capita gross domestic product, which defines the economic status of the country (PGDP), and (6) The quality of governance (GOV), the level of corruption and how it is handled and effects the governance; the one with the worst governance and high level of corruption scored as of 0 and the best governed (or the least corruption) scored 6, in a scale of 0 to 6.

The group choose to work on countries in Europe because reliable data on each of the above 6 parameters are available here, thanks to the World Bank’s “Worldwide governance indicators” the European commission’s “EU-Anticorruption Report 2014”, and data from the European Centre for Disease Prevention and Control.

The results they obtained upon such and analysis were quite revealing. At first cut, it suggested that only 33 per cent of the total variation in antibiotic resistance across Europe was attributable to antibiotic usage by the people. PGDP was only poorly correlated to the amount of resistance. Poverty is thus not necessarily the factor, though we would have thought so. The higher the education level (TER, as in Finland), the less antibiotic resistance (ABR) and lower the DDD, perhaps the awareness level in the population was high. Tellingly, countries where private health expenditure is higher (and less public/government support) fared poorer. But the one parameter that stood out was the quality of governance. Where it is low and anti-corruption laws were ineffective, they found greater amount of antibiotic resistant strains of pathogens (ABR high) and the percentage of resistant strains shot up from 33 per cent to 63 per cent. The Scandinavian countries stand out for their high quality of governance, levels of tertiary education, universal health care and also the lowest levels of antibiotic resistance strains. Greece, Cyprus, Bulgaria and Latvia score poor on all these and have the highest prevalence of antibiotic resistant strains.

Corruption is dangerous for health! This is attributed to less supervision and enforcement of laws that cover not just drugs bust also food and water safety. I urge the interested reader to access the paper at (PLOS ONE 10(3): e0116746.doi:10.1371/journal:pone.0116746), and look at graphs 1 and 2 which capture the analysis succinctly.

The paper also tells us how important the information collected by the World Bank and the European Commission are, and what they teach us. We have similar collections in India, and a similar analysis would be of great value. Organisations such as the Public health Foundation of India, The Centre for Policy Research, Indian Statistical Institute and others are capable of doing such joint work, and can be supported by the Department of Health research of the Health Ministry.

(dbala@lvpei.org)

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