As germs become more resistant to antimicrobial drugs, infections will become less treatable, and treatments that compromise immunity – like chemotherapy – will become more risky, according to a new report by the Prime Minister’s Chief Science Advisor.
The report points out that New Zealand is the fourth highest prescriber of antibiotics in the OECD. It also warns against losing focus on other infectious diseases in the face of the COVID-19 pandemic, and makes a series of recommendations to combat the rising tide of antimicrobial resistance in New Zealand.
The SMC asked members of the report’s panel to comment on what they see as the report’s most important aspects.
Associate Professor Mark Thomas, Clinical Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, comments:
“My expertise is in the area of antibiotic use in humans in New Zealand, and in strategies to improve the quality of antibiotic prescribing: by encouraging doctors and patients not to use antibiotics where they wont work, and by using the best antibiotic for the shortest possible period of time, to slow the rate of spread of antibiotic resistant bacteria in New Zealand.
“New Zealand has a very high rate of antibiotic use in the community, we are among the 10 highest antibiotic using nations in the world. This high rate of antibiotic use inevitably will result in faster spread of antibiotic resistant bacteria in NZ than in other countries that have lower rates of antibiotic use.
“Increasing antibiotic resistance will make many infections harder to treat, and an increasing number of infections will be untreatable.
“We need to take steps to drastically reduce unnecessary antibiotic use by humans in New Zealand. For many years we have lacked national leadership to reduce unnecessary antibiotic use in New Zealand.
“We need to:
- have a minister take responsibility for the issue
- draw on the expertise and enthusiasm that there is to tackle this challenge among doctors, pharmacists, nurses, and the general population
- establish groups that can do the work of encouraging wise antibiotic use throughout New Zealand, by engaging with health care workers (especially GPs), and pharmacists, and the wider community
- provide adequate funding to support this work.”
Conflict of interest statement: Associate Professor Thomas is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.
Dr Sharon Gardiner, Antimicrobial stewardship (AMS) pharmacist, Canterbury DHB, comments:
“I am most excited about the raft of recommendations that are for immediate action to improve our antimicrobial use in human health. Aotearoa New Zealand has embarrassingly high antimicrobial use, and much is unnecessary or inappropriate. This is one of the biggest drivers of antimicrobial resistance, for individuals and for our community.
“We need to bring down our total volume of antimicrobial use, which means using this really precious family of medicines only when the benefits outweigh the harms, and using them well when we do.
“The report provides clear recommendations on what we need to do to achieve this. Everyone in our Team of 5 million has a role to play – policy makers, health workers, researchers, teachers, farmers, even our children. Now, we need to crack on with getting this all done.”
Conflict of interest statement: Dr Gardiner is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.
Professor Jack Heinemann, School of Biological Sciences, University of Canterbury, comments:
“To solve the problem of antimicrobial resistance will require that we change our ways, not just our drugs. Putting all our efforts into the invention of new antimicrobials without addressing how we misused older antimicrobials will rob future generations of new and old alike.
“This report emphasises the need for drug stewardship – use only what you need when you need it – to preserve the effectiveness of antimicrobials. What makes the report different is a bigger concept of stewardship – to preserve ecosystems of bacteria that thrive without resistance.
“To do this requires that we think about more than the antimicrobials we use as drugs, and instead think about all the chemicals with strong and weak antimicrobial activity that we expose bacteria to in our homes, lawns, fields, lakes, streams, oceans and atmosphere. To restore antimicrobial susceptibility is a goal that each of us can help achieve.”
Conflict of interest statement: Professor Heinemann is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.
Professor Nigel French, Co-Director, One Health Aotearoa; and Chief Scientist, NZ Food Safety Science and Research Centre, comments:
“Antimicrobials are important for the health and welfare of animals, and many of the antimicrobials used in animals are the same or similar to those used in people. Although we are relatively low users of antimicrobials in animals compared to other countries, there is definite room for improvement – this is important to ensure that antimicrobials remain effective for the treatment of infectious diseases in animals, and that use in animals doesn’t contribute to resistant infections in people.”
Conflict of interest statement: Professor French is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.
Professor David Murdoch, Dean and Head of Campus, University of Otago, Christchurch, comments:
“From my perspective, the key elements of the report are the strong recommendations about NZ’s future preparedness to tackle infectious diseases risks and antimicrobial resistance. Its about national coordination that extends beyond human health to animal, plant and environmental health. Kotahitanga – unity, togetherness. It’s about having better surveillance systems and information sharing. It has clear messages about the importance of capacity building and the development of a workforce that is comfortable working across disciplines, while focused on equity.
“Although this report has largely been badged as being about antimicrobial resistance, it is also very much about infectious diseases in general.”
Conflict of interest statement: Professor Murdoch is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.
Associate Professor Siouxsie Wiles, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, comments:
“Antimicrobial resistance is already having an impact on us here in Aotearoa New Zealand and we’ve been talking about what needs to be done for years. Our recommendations are evidence-based and what we need to do to improve the health of our people, animals, plants, and environment. They are all equally important. It’s time to stop talking and act.”
Conflict of interest statement: Associate Professor Wiles is a panel member for the Prime Minister’s Chief Science Advisor’s work on antimicrobial resistance.