If you live in Asia and the Pacific, do you ever wonder how high your risk is of contracting antimicrobial-resistant bacteria or emerging infectious diseases such as a new strain of avian influenza? Unfortunately, I have to tell you that the risk here is higher that in any other region in the world.
1. South and Southeast Asia are epicenters for antimicrobial resistance.
South and Southeast Asia are home to the highest number of major bacterial pathogens for which there is antimicrobial resistance. Most developing countries in the region do not monitor or reinforce standards in antibiotic use and prescription, and the limited available data paints a picture of widespread non-compliance with antibiotic treatment regimen. Self-medication with antibiotics available over-the-counter is common throughout Asia, and an estimated 50% of patients fail to follow the recommended antibiotics course of treatment, mainly because it’s expensive. Traces of antimicrobials used in the animal husbandry sector find their way into the food chain; so most of the meat that was not grown organically was likely treated with antibiotics. Even fish is often bathed in antibiotic solution in many commercial fisheries. And of course the water you drink might also be contaminated due to lack of adequate water treatment plants. Constant exposure to antibiotics increases the risk of developing antimicrobial resistance.
2. Asia is a hotspot for emerging infectious diseases.
Asia as where new emerging infectious diseases are most likely to originate, particularly zoonosis (diseases transmitted from animals), vector-borne diseases and drug-resistant pathogens. This is evident in the increasing frequency of these events over the last decade and is correlated directly with socio-economic, environmental and ecological factors. Numerous outbreaks of emerging infectious diseases have had a huge impact in Asia. SARS rapidly decimated tourism to the region in 2003, costing the industry $18 billion or approximately $2 million per person infected. The H5N1 virus had a profound effect on the poultry industry: in 2003-2004 Viet Nam culled 45 million birds and lost $118 million, while a Thai ban on poultry reduced the country’s income from poultry exports by 93%, from $598 million in 2003 to $44 million in 2004.
3. Health risks are increasing in Asia.
Asia is one of the most globalized, mobile regions in the world, and trade facilitates the rapid spread of diseases that otherwise may have been contained by geographical boundaries. Climate change and the associated rise in temperature and flooding lead to more vector-borne diseases such as chikungunya, malaria and dengue. Pollution and natural disasters are also significant risk factors for respiratory tract infections and water-borne diseases.
4. Fragmented supply chains impact the efficiency of drugs and vaccines.
Too much medicine that needs cold storage but is exposed to heat and humid environments can lead to an overestimation of actual effective vaccination coverage and decreased efficacy of medicines – both contributing to increasing risk of disease outbreaks. You might have seen this affect in your own children, who have been vaccinated in Asia but still developed certain diseases they were supposed to be protected against because the vaccine probably wasn’t effective anymore.
5. Unregulated health service providers.
Chronic under-investment in public health systems has resulted in private sector provision of health services, which are often unregulated (threatening quality) and not required to report routinely to health management information systems. A consequence of this data gap is that critical information on incidence of infectious diseases or drug resistance identified in the private sector takes much longer to reach public health sector officials.
The above risks can only be addressed with strengthened health systems and increased accountability, both of which arise from collaboration between countries and development partners to invest in public health services. To combat health threats and to avoid significant economic losses, we must step up health financing and redouble their efforts in cross-sector, cross-border and regional coordination on health policies and practices.
Investing in health systems today will yield not only direct health and economic benefits tomorrow, but will also help protect populations from emerging health threats both within and beyond the region. Donors outside of the region must continue to support health system strengthening in Asia, as weak health systems in any country can pose threats to their own public health and economic security.
Health is having the same disease as your neighbor – so make sure your neighbor has no diseases.