Antibiotic resistance, the rise of the superbug, and an overloaded public health system killing the nation
Death and disease stalk South Africa in the form of a high resistance to antibiotics and the rise of the superbugs, perpetuated by an apparent failure to implement strategy to curb use and abuse.
Identified about 10 years ago as a growing health crisis that required intense national effort from the government and the pharmaceutical sector to curb, the resistance to antibiotics and completion of medication has been flagged as a public health crisis of international concern, which “threatens the practice of modern medicine, health, and food security” by the World Health Organization (WHO).
Health practitioners have raised the alarm yet again, saying the problem was bigger than it was being recognised, and they blamed the powers that be for failing to act, and on time.
“We have been asking, for years now, that the government and the pharmaceutical sector take discussions out of boardrooms and into communities, to speak to actual people on the ground, to raise awareness around these issues, and a safe and responsible way to take medication,” Pretoria family doctor Wilma le Roux said.
She said they, as health practitioners, had attended countless seminars where the issue had been raised, and where steps to be taken were agreed upon, “… but that is as far as it has gone”.
The need for clinics, ward officials, and other mechanisms operated by the state, to go out there and spread the word, was bigger now … more than ever, she said.
And agreeing with her was Pretoria North doctor Sibulele Mokoena, who said the willy-nilly dispensation of antibiotics was killing people.
“What we see is, patients coming in and admitting to having asked for – and been given – antibiotics at clinics and pharmacies, even when the need was not there. A quick history recap shows us that the patient could either have done well with a lower dose medicine or sometimes none at all.
“But now, even for a cold, a muscle ache, and even a wound that could have been cleaned and dressed frequently, they tell you they took antibiotics.
“So big is the belief in antibiotics among our people, that if they cannot get it at the clinic they convince pharmacies to give it to them, what with so much medical aid available at low prices and a system which is not as well regulated,” Le Roux said.
And, this extended to the sharing of medication – and antibiotics. Some patients took antibiotics and other medication from friends and relatives, said Mokoena, something which should not exist, if the original patient appreciated that they had to have finished the course in the first place.
This gave rise to the “superbug”, he added, as antibodies developed resistance if the course was not finished.
“I mean, we can give someone tablets to strictly take for five days, but if they feel better on the third they stop. The medication has not completely destroyed the ailment, and this is a disaster waiting to explode. When it hits there will be no turning back.”
The double-edged sword of taking unnecessary antibiotics and stopping the course of therapy would explode in the faces of South Africans, the SA Medical Council said, throwing the country into panic it would never recover from.
The Centres for Disease Control and Prevention, speaking about the failure by patients to complete prescribed course of medication, said it caused antimicrobial resistance, which happened when germs such as bacteria and fungi developed the ability to defeat the drugs designed to kill them.
“That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible, to treat,” they said.
They described this as an urgent global public health threat, responsible for at least 1.27 million deaths across the world and associated with nearly five million deaths in 2019.
They said: “Antimicrobial resistance has the potential to affect people at any stage of life, as well as the health care, veterinary, and agriculture industries. This makes it one of the world’s most urgent public health problems.”
Bacteria and fungi did not have to be resistant to every antibiotic or antifungal to be dangerous; resistance to even one antibiotic can mean serious problems, they added.
Speaking on condition of anonymity, as she holds a high-ranking position within the Department of Health and in a tertiary hospital, one doctor explained that it was a lack of decisive action by senior government officials, who, even though they knew, did not want to become uncomfortable going into the communities to implement strategy that was the major problem.
She said that before 2017, health experts – national and international – got together to highlight the immediate need for awareness raising.
“What we all agreed that there was a need for health workers to all the time pass this important and life-saving information to those who walked into institutions, that medication had to be taken as instructed, and that it was not to be shared.
“Nurses, health and community care workers, NGOs and NPOs who are rooted in society and on the ground, had to be armed with the information,” she said.
This was coupled with an overburdened public health system and burnt-out staff, who worked to get people out of the way and reduce queues. Those who dispensed medication were also called on to be cautious, as a leak had been identified in that sector.
“Minister of Health, Dr (Aaron) Motsoaledi, was passionate about this, and he stressed on the need to save our people who would no doubt perish from lack of knowledge,” the official said.
But once they left the boardrooms there was no evidence of information filtering down. Instead a report was sent to the WHO that it would.
The rise of fake doctors also threw a spanner in the works, she added, as these made their millions by obeying the masses. “They have the ability to source medication from legitimate sources and dispense it to anyone who has money to pay for it.
Mokoena said: “Gone are the days when it was the older generation who shared antibiotics among each other, advising sister and neighbour that they had the solution to what ailed them, even children are given antibiotics and other meds, because the one had symptoms and another had the medication.”
Acknowledging the issue, the government said: ”If antibiotics and antifungals lose their effectiveness, then we lose the ability to treat infections and control these public health threats.“
In a framework marked for implementation between 2017 and 2024, the government said there was a need to provide a structure for managing antimicrobial resistance, to limit further increases in resistant microbial infections.
“It is also meant to improve the health of the population, and the goals of the strategy are to define the principles and short- to medium-term interventions needed to preserve the effectiveness of antimicrobials for future generations to improve the appropriate use of antibiotics … and to improve the effective management of antibiotic-resistant organisms and prevent their transmission.”
While admitting to the widespread threat to the country’s health – and socio-economic – well-being, the government said resistance to antibiotics and the rise of the superbug was indeed threatening to get out of control. They said all was being done to ensure all sectors of both health and society understood the need to arrest it as soon as possible.