Day 6

Low-income countries face COVID-19 vaccine shortages. But they also need antibiotics, experts say

The rise of the COVID-19 omicron variant has experts around the world sounding the alarm about access to vaccines for developing countries, but experts say that the inaccessibility of antibiotics is also a looming threat, as antibiotic-resistant superbugs become more common.

Pharmaceutical companies missing opportunities to improve access, says head of medication access foundation

A pharmacist holds a bottle of the antibiotic doxycycline hyclate. A recent report says that pharmaceutical companies aren't doing enough to provide access to much-need antibiotics in low- and middle-income countries which is, in part, fuelling growth in antibiotic-resistant bacteria. (Rich Pedroncelli/The Associated Press)

The rise of the COVID-19 omicron variant has experts around the world sounding the alarm about access to vaccines for developing countries, but experts say that the inaccessibility of antibiotics is also a looming threat.

Lack of access to certain antibiotic medications has, in part, led to growth in antibiotic-resistant superbugs, an issue the World Health Organization (WHO) calls one of the "biggest threats" to global health and development.

"If the news was not completely covered by issues like the COVID-19 pandemic today, you will see news reports from every corner of the world — high-income countries, low-income countries around the whole world — about instances of drug-resistant infections," said Jayasree Iyer, CEO of the Access to Medicine Foundation.

A November report by the Amsterdam-based organization, which surveyed 17 pharmaceutical companies around the world on their responses to antimicrobial resistance, suggests several factors contribute to the growth in resistant bacteria. 

While antibiotic resistance is a concern worldwide, Iyer says that it's particularly acute in low-income countries due to the overuse and misuse of antibiotics, the release of medicines into the environment either through waste or agriculture, and poor water and sanitation facilities.

The use of antibiotics in agriculture is helping fuel antibiotic-resistant superbugs, experts say. (Don Ryan/The Associated Press)

Slow progress by pharmaceutical companies to make some antibiotic drugs available in developing nations has also created roadblocks, she said.

"All companies miss opportunities to improve access in low- and middle-income countries, and the priority that they make to ensure [drugs go] where the need is greatest ... doesn't necessarily match the scale of their efforts so far," said Iyer.

While the report found that pharmaceutical companies are improving their efforts, more needs to be done. Only one third of 166 established antibiotic or antifungal drugs are covered by an access plan, such as efforts by drug manufacturers to reduce their cost or provide licensing agreements to local manufacturers.

Concerns around over-use of antibiotics

Without that access to antibiotics and antifungal drugs available in other parts of the world, doctors are forced to find workarounds with those medications that are available.

According to the Access to Medicine Foundation, that gives bacteria the opportunity to evolve and develop defences against them.

"In some countries [doctors] will find no antibiotics, basically, work against [an] infection, so the physicians try different ways," said Amin Islam, an assistant professor of global health at Washington State University, who researches anti-microbial resistance in Bangladesh.

"They come up with some sort of combination therapies, trying to use two or three antibiotics at the same time, but that also makes the situation complicated."

Islam adds that in Bangladesh and other countries, antibiotic-resistant infections are no longer limited to hospital settings, but rather spread through communities as a result of poor sanitation.

According to Islam, the COVID-19 pandemic offers a key example of how antibiotics have been misused, particularly in low- and middle-income countries where vaccines are scarce and medication is the only option.

Antibiotics do not fight viral infections, but he said doctors have prescribed them to treat coronavirus infections. He noted that they may be useful in the treatment of some secondary infections that related to COVID infections.

"You are basically risking yourself being colonized with antibiotic-resistant organisms if you overuse the antibiotics," said Islam.

WATCH | WHO special adviser calls for greater sharing of COVID-19 vaccines amid omicron variant spread: 

Vaccine sharing more effective than travel bans, WHO says

2 months ago
Duration 6:54
As fears grow about the omicron variant, there needs to be 'more of a sense of urgency' on sharing vaccines, says Dr. Peter Singer, special adviser to the director general of the World Health Organization. 'This is a five-alarm blaze and we're not sending out enough fire trucks.' (Credit: AP Photo/Alastair Grant) 6:54

'Netflix' model for accessing drugs

Iyer says the government funding models could improve access to drugs around the world.

One approach, which Iyer calls the "Netflix" model, would see governments pay pharmaceutical manufacturers a set fee for use of the drug in a particular region, regardless of how many doses are used.

The model would guarantee that when new drugs are brought to a country, they are used, while ensuring health-care providers have access to much needed medicines.

"The major mistake that we're making right now is that very few people actually end up benefiting from the scientific discoveries that we have," said Iyer.

"And at the end, we have a gross inequity of access for drugs and vaccines and many different health commodities."


Written by Jason Vermes. Interview with Jayasree Iyer produced by Devin Nguyen.

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