Bugged by superbugs
Think about all Indians, not just tourists
NDM-1, short for New Delhi metallo-beta-lactamase-1, popularly dubbed as “superbug”, has been causing much angst in the medical fraternity, media and government. A British journal, Lancet, published an article titled “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study” that documents the emergence of a new gene that can make a range of bacteria highly resistant to most, if not all, antibiotics. The paper — authored by 31 researchers, 16 of whom appear to be of Indian and South Asian origin working in the UK, India and Pakistan — finds that the “superbug” is found in multiple locations across north, west, east and south India, across Pakistan and even in Bangladesh. The paper also finds that in its sample most people affected in the UK had some connection with South Asia. Different types of genes that make bacteria and are highly resistant to antibiotics have been found in other countries as well since at least the mid-1990s, so this is not the first such case. International medical research has identified such “superbugs” in all continents, and countries such as China have also been much pointed to. The emergence and potential spread of such genes are, therefore, of great concern and close monitoring is required both within the country and internationally. Unfortunately, the paper does not stop there and points to medical tourism from the UK to India as a major cause of the spread of the NDM-1 in the UK, raising doubts about Lancet’s professional ethics and the hidden agenda of its editors and benefactors. This has taken the focus away from the problem at hand to questions about medical tourism and professional ethics. For if this superbug has to spread it will spread anyway, with or without medical tourism, as all pathogens eventually do.
The larger issue is the misuse of antibiotics in India and elsewhere. In India, the misuse spans trained allopathic practitioners and untrained informal health care providers, public and private facilities, and rural and urban locations. Antibiotics of all types are widely available via chemists who do not insist on proper prescriptions; moreover, individuals self-prescribe antibiotics, and start and stop medication at will. The emergence of genes that are highly resistant to antibiotics is a natural outcome of such mismanagement of ailments. What is, therefore, surprising is that such “superbugs” are only now being found. One reason behind that is the lack of a good quality monitoring mechanism in the country. Hospitals in India rarely have an ongoing monitoring mechanism that is capable of identifying and isolating such genes. Poorly trained health professionals and low availability of good quality diagnostics further reduce the likelihood of timely medical intervention.
The solutions are well known — a strong public health system is missing in India. This includes: (a) efficient implementation of rules and processes governing prescription, sales and use of medicines; (b) a multi-tiered disease monitoring system that is rooted in local health facilities and supported by good quality research facilities at the state and national level; and, the most important, (c) an appreciation that such problems are here to stay, they cannot be prevented, and rather than bickering over where they originated, India needs to put its energies in figuring out how it is going to deal with them. This is important not because we may lose medical tourists, but we may lose Indians to ailments that need not have spread in the first place.