Medicine Cabinet
Teodoro B. Padilla

(First of two parts)

THE GROUP of 20 (G20), composed of the top powerful nations, is meeting early this month to again discuss various issues of global importance. The outcome of the forum is considered to have a strong political force as leaders in attendance represent more than four-fifths of gross world product and two-thirds of the world’s population.

Ahead of this high-level meeting in Hamburg, Germany, health ministers from the G20 raised concerns over two global health risks, namely infectious disease outbreaks and antimicrobial resistance. Also called the Berlin Declaration of G20 Health Ministers, participants emphasized that these threats have a severe impact on the lives and well-being of millions of people as well as on the global economy. The Berlin Declaration called for a coordinated global response to prevent and cushion the adverse impact of health emergencies and antimicrobial resistance (AMR).

Antimicrobial resistance happens when different types of microorganisms such as bacteria, viruses, fungi, and parasites change in ways that make medications against them powerless. They turn into “superbugs” when they become resistant to most medicines used to fight against them.

The World Health Organization (WHO) said that antimicrobial resistance increases healthcare costs as it leads to longer stay and even intensive care in hospitals. Apart from the economic cost, it also puts achievements in modern medicine at risk.

In a post-antibiotic era, modern interventions such as organ transplantations, chemotherapy, and surgeries become riskier, since antibiotics are rendered ineffective to prevent and treat infections. Beyond the patient, AMR can also spread to other individuals, therefore infecting more people in the community.

While resistance occurs naturally, the WHO said that the misuse and overuse of antimicrobials accelerate the process. For example, some take antibiotics for colds and flu that are caused by viruses. There are also some who do not complete the entire antibiotic course, immediately stopping medicine intake as soon as they start to feel better.

Over the years, the WHO has documented AMR for diseases such as tuberculosis, malaria, influenza, and HIV, among many others in several countries.

It is estimated that there were close to 500,000 new cases of multidrug-resistant tuberculosis (MDR-TB), which is a form of tuberculosis that is resistant to the two most powerful anti-TB drugs. There is also the growing threat of the so-called extensively drug-resistant tuberculosis (XDR-TB), which is resistant to at least four of the core anti-TB drugs. The WHO monitored XDR-TB in about 105 countries while an estimated 9.7% of people with MDR-TB have XDR-TB.

Resistance to artemisinin-based combination therapies, the first-line treatment for P. falciparum malaria, has also been recorded in Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand, and Vietnam. If no action is taken, health experts warned that its spread to other countries could just be a matter of time.

Drug-resistant HIV is also an area where urgent attention is required. As early as 2010, the WHO said that between 7% and 40% of those starting or restarting Anti-Retroviral Therapy (ART) had developed resistance.

Meanwhile, it added that treatment failure to the third and last resort of medicine for gonorrhea (cephalosporin antibiotics) has also been recorded in at least 10 countries.

AMR is a complex public health concern that requires a whole-of-government and whole-of-society approach to slow down the process. Keeping a robust arsenal of antimicrobials is needed to challenge AMR. Doing so necessitates heavier investments in the research and development of innovative medicines, vaccines, and diagnostic tools that will outpace AMR.

(To be continued)

Medicine Cabinet is a column of the Pharmaceutical and Healthcare Association of the Philippines (PHAP), representing the research-based medicines and vaccines sector in the country. The author is the executive director of PHAP. Mr. Padilla is a cum laude graduate of Bachelor of Science in Business Administration from the University of the Philippines and further acquired a masteral degree from Kellogg School of Management.  E-mail the author at