Microbes are becoming increasingly resistant to drugs, largely caused by the overuse or abuse of medication like antibiotics, making it more difficult to treat certain diseases.
To fight this, Singapore set up an inter-ministerial committee called the One Health workgroup in January, to provide a whole-of-government effort to combat antimicrobial resistance (AMR).
Yesterday, Senior Minister of State for Health and Transport Lam Pin Min launched the group's National Strategic Action Plan on AMR. "It is only a matter of time after the discovery of an antimicrobial and its introduction to market that a micro-organism develops resistance to it, often fuelled by the overuse or abuse of these antimicrobials," he said.
He was speaking at the Public Health Thought Leadership Dialogue on Antimicrobial Resistance at the National University of Singapore.
Should resistance mount and antibiotics become no longer effective, then even simple infections could kill.
Dr Lam said the plan includes educating the public on the problem and what they can do to prevent it. For example, one key message is that antibiotics do not work against viral infections such as the flu. Such education involves even children, with school activities to teach them about the risk of AMR.
"These can include simple steps such as maintaining good hand and personal hygiene, to more in-depth understanding of antibiotics and how they work," he added.
Aside from public education, the One Health agencies will also work with professionals and the industry.
-
Plugging the gaps to beat the bugs
-
The National Strategic Action Plan launched yesterday to combat antimicrobial resistance (AMR) as a whole-of-government effort will look at gaps in current efforts and suggest ways to deal with them to prevent the AMR problem from getting worse.
People
• Greater awareness of the importance of using antibiotics correctly. For example, antibiotics are of no use against viral infections such as the flu.
• Getting more people to be vaccinated against infections. Fewer infections mean less need for antibiotics. The recently launched adult vaccination programme is a step in this direction.
• Strengthen AMR education among doctors. Many doctors believe antibiotics are over-prescribed in primary care.
Animals
• Greater education among veterinarians and farmers on the proper use of antimicrobials. This is because animals are fed antibiotics, and some of them would remain in the food we eat.
• Expand surveillance of bacteria and resistance to include all animal production sectors such as poultry and fish farms.
• Identify resistance against certain bacteria in poultry, dairy and food-fish farms.
• Promote use of vaccines to prevent diseases rather than use drugs to treat them.
• Improve animal management process to reduce infectious diseases in animals, and thus reduce the use of antimicrobials.
• Reduce inappropriate use of antimicrobials in food-producing animals.
Industry
• Educate industry on the proper disposal of antimicrobial waste as it could spread resistance. This involves not just farmers, but also manufacturers, distributors and pet owners.
• Standardise data reporting of resistant drugs and other related information for easier surveillance.
• Enhance laboratory testing capacity, including identifying a core panel of microbials for surveillance.
• Surveillance of drug-resistant organisms in retail food and meat. Identify risks and trends of drug-resistant organisms along the food chain.
• Surveillance of the environment, including water bodies and used water in treatment processes, which may harbour traces of antibiotics or drug-resistant organisms.
• Educate food handlers to maintain high levels of hygiene.
Salma Khalik
Professor Keiji Fukuda of the University of Hong Kong, who gave the main lecture, said there is a growing shortage of effective antibiotics. The last new class hit the market in 1987, with nothing new since then. He added that one problem is the high cost - about US$2 billion (S$2.7 billion) - of producing a new antibiotic.
Professor Patricia Conway, a visiting professor at Nanyang Technological University, said another problem is the short life of antibiotics, with resistance setting in as early as six months from launch.
Prof Fukuda also pointed to agriculture as a major cause of AMR. In the United States, more than 70 per cent of antibiotics are used on animals, he said.
Resistance can develop along the food chain as people eat these animals, or through waste water containing traces of antibiotics.
In Singapore's fight, Dr Lam said three key elements are:
• Integration of the various agencies, such as the coordination of surveillance activities and data sharing across sectors. "This is important to improve our understanding of how AMR develops and circulates between humans, animals, food and the environment," he said.
• In-depth research to understand the complex factors influencing AMR. Dr Lam highlighted a recent four-year study by clinicians and researchers of the National University Health System, Singapore General Hospital and Communicable Diseases Centre. The study focused on the use of novel diagnostics, infection control strategies and behavioural sciences to strengthen institutional and national capability in targeting drug-resistant bacteria.
• International collaboration. "Our domestic efforts must be complemented by cooperation and partnerships with our neighbours and international counterparts, where we learn from each other through the sharing of best practices in our collective effort to fight AMR," he said.
