The access vs excess debate

An often-overlooked facet of the AMR issue is that many life-saving antibiotics are either unavailable or insufficiently supplied, particularly in low- and middle-income nations. This circumstance compromises controlled distribution and contributes to a vicious circle of poverty and antibiotic resistance. The “access vs. excess” debate on antimicrobials is a critical issue in global health, highlighting the balance between ensuring access to lifesaving drugs and preventing their overuse, which contributes to antimicrobial resistance (AMR). This debate is particularly significant as it affects not only individual patient care but also public health and the global fight against AMR.

Access to Antimicrobials: A Lifesaving Necessity

Access to antimicrobials is essential for treating infectious diseases, saving lives, and preventing the spread of infections. In many low- and middle-income countries (LMICs), there is still a significant gap in access to appropriate antimicrobial treatments. Lack of access can lead to prolonged illness, increased mortality rates, and the spread of infections. Inadequate access often results from several factors, such as weak healthcare systems, poor supply chains, economic barriers, and limited availability of essential drugs. In these settings, individuals may resort to purchasing substandard or counterfeit medicines, which can further drive AMR. Ensuring equitable access to quality antimicrobials is a fundamental component of universal health coverage and a global health priority.

Excessive Use of Antimicrobials

On the other hand, the overuse and misuse of antimicrobials are key drivers of AMR. In high-income countries, antimicrobials are often prescribed unnecessarily for viral infections or non-bacterial illnesses, such as the common cold or flu, where they have no effect. In both high-income and low-income settings, antimicrobials are sometimes used without proper diagnosis or guidance from healthcare professionals, contributing to their overuse. Additionally, the misuse of antimicrobials in agriculture, animal husbandry, and aquaculture, where they are often used to promote growth or prevent disease rather than treat infections, further exacerbates the problem. This excessive use creates selective pressure on bacteria, leading to the emergence and spread of resistant strains, which can then spread to humans through food, water, and the environment.

The Global Impact of AMR

The access versus excess debate is particularly challenging in a global health context. While high-income countries grapple with the consequences of excessive antimicrobial use, LMICs face the dual burden of inadequate access and growing AMR. These countries often lack robust antimicrobial stewardship programs, surveillance systems, and regulatory frameworks to monitor and control the use of antimicrobials, leading to both underuse and overuse in different settings. The consequences of this imbalance are devastating; resistant infections increase healthcare costs, extend hospital stays, require more intensive care, and lead to higher mortality rates. In the absence of effective antimicrobials, common infections become deadly, routine surgeries carry higher risks, and the effectiveness of treatments for conditions such as cancer and diabetes is compromised.

Addressing this Challenge

To address the challenge of AMR, a One Health approach is crucial. This approach recognizes the interconnectedness of human, animal, and environmental health and promotes coordinated action across sectors. Strengthening health systems to ensure equitable access to quality antimicrobials, coupled with effective stewardship programs to prevent overuse and misuse, is essential. Policies should focus on enhancing diagnostic capacity, educating healthcare providers and the public on appropriate use, and implementing regulations to curb the misuse of antimicrobials in agriculture and animal husbandry. Global cooperation, investment in research and development for new antibiotics and alternatives, and sustained political commitment are needed to tackle the access vs. excess dilemma effectively.

In short, the debate on access versus excess of antimicrobials underscores the complexity of addressing AMR from a global health perspective. Balancing the need for access to lifesaving medicines with the imperative to prevent their overuse is a formidable challenge that requires coordinated, multi-sectoral, and global efforts. Without such efforts, the world risks a future where minor infections become untreatable, medical advancements are rolled back, and AMR emerges as one of the most significant global health threats of the 21st century.