CONSIDERING the growing inefficacies of antibiotics, a set of empirical studies has claimed that we are sliding back to the ‘pre-antibiotic era,’ highlighting the present and future crises borne out of antibiotic resistance. In today’s world, particularly in the global health discourse, antibiotic resistance has turned out to be a focal point of discussion due to its ominous public health concern. This is evident from seven million global deaths annually and a projection of 10 million deaths each year by 2050. Additionally, the World Bank estimated that antibiotic resistance could plunge 24 million people into extreme poverty and cause a $1-$3 trillion gross domestic product loss by 2030.
In this context, it is quite conceivable that people’s health outcomes could be severely degraded. To be more specific, the crisis is particularly severe when it comes to a resource-poor country like Bangladesh with a large population density, pluralistic healthcare systems, and a weak drug regulatory regime. A good deal of contemporary studies and reports have already underscored an alarming antibiotic resistance scenario across the country. Some key pieces of evidence from these studies include: a leading antibiotic called ciprofloxacin is ineffective against 90 per cent of the Bangladeshi population; 70 per cent of ICU deaths are attributed to antibiotic resistance; and on average, a child consumes more than 10 antibiotics each year, far exceeding the global standards.
Therefore, the rising public health threats demand that the existing policy interventions in addressing antibiotic resistance in Bangladesh be revisited. Since antibiotic resistance is primarily driven by the misuse of antibiotics, ensuring its rational use has been the major policy goal for Bangladesh, as in other countries across the globe. In particular, the WHO has called for adopting the National Action Plan, a multisectoral policy document to fight against antibiotic resistance. Bangladesh adopted the action plan in 2017. In addition, the National Antimicrobial Resistance Surveillance Strategy of Bangladesh aims to build a comprehensive antimicrobial resistance monitoring system to gather information for guiding policy choices and promoting the rational use of antibiotics. Guidelines for the judicial use of antibiotics and good pharmacy practices are well-codified in the National Drug Policy 2016. The 8thÌýFive-Year Plan has also incorporated the safe use of antibiotics intending to strengthen the health system in Bangladesh.
Despite existing policy interventions, the sale and use of antibiotics remain unregulated. Although the national action plan is considered a blueprint to combat antibiotic resistance, its implementation has remained inconsistent, as highlighted by recent studies. The Directorate General of the Drug Administration is the apex national drug regulatory authority mandated to implement drug regulations in Bangladesh. However, according to WHO’s report, it is not stringent in its operations. The governance of drug administration is not without contention, according to a report of Transparency International Bangladesh. This is also evident from a growing number of unlicensed pharmacies or drug stores involved in the over-the-counter sale of antibiotics. Meanwhile, aggressive marketing strategies of antibiotic drugs by pharmaceutical companies are a major factor that influences physicians’ and patients’ antibiotic prescribing and seeking behaviour, respectively. Moreover, in public mind, antibiotics are considered a ‘cure-all’’ medicine, resulting in antibiotics being sold like candy in Bangladesh. Another fact is that the pharmacy density is higher in Bangladesh than in many other countries.
Research in other areas has shown effective policy implementation can bring out significant health benefits. For instance, a recent article published in the International Journal of Applied Research in Social Sciences stressed that the implementation of environmental policies can yield public health benefits. The analysis underscored that effective policy implementation requires a strong governance and regulatory framework. Say, stringent regulation in water and air quality improvements leads to lowering pollution-related diseases, ultimately contributing to public health benefits. This study retains critical implications in terms of the effective enforcement of antibiotic policies in Bangladesh while taking into account the matter of governance and regulatory frameworks. Because proper implementation of such policies is linked to the better health outcomes of people. A similar outcome of policy intervention on the management of drug-resistant bacteria can also be expected.Ìý
The five-year strategic plan of the Directorate General of Drug Administration (2022–2026) intends to strengthen the regulatory systems as well as the capacity of the Directorate General of Drug Administration. Notwithstanding, its regulatory coverage must be widened to the grassroots levels in Bangladesh because approximately 68 per cent of people live in such areas. Studies conducted on rural people revealed that pharmacies or drug stores are the primary health-seeking point, and often they rely on informal healthcare providers. Thus, antibiotic misuse and self-medication are usual.
In conclusion, the prevailing health system loopholes and drug regulatory practices cannot be changed overnight. At the same time, the public health challenges associated with antibiotic resistance require collective and rigorous efforts. The implementation of policies relating to the rational and safe use, production, and distribution of antibiotics, therefore, knows no bounds. The proactive role of governance and inclusive regulatory frameworks is critical in facilitating the implementation of such policies, leading to safeguarding public health for today and future generations.
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Asif All Mahmud Akash is a freelance researcher.
