By Kerrie Tucker
March 31, 2013
EDITOR’S NOTE: We’ve known for many years that antibiotic resistance is a clear and present danger to public health. There have been countless headline stories on the matter, and growing evidence that antibiotics in our food is adding to the problem. Yet a terrible failure of public policy in Australia means we are still virtually at ground zero in addressing the issue, with a Senate inquiry now starting all over again.
What went wrong?
Kerrie Tucker is a friend of mine, and one of the people who helped save my life after my breakdown in late 2005. She was the first Greens MP elected to the ACT Parliament, and is distinguished by her deep interest in evidence based policy and practice, as distinct from the politics of politics. Since her retirement from politics, she’s been having her first go at investigative journalism on the issue of where Australia is at in combatting antibiotics resistance for the Australia Institute.
I read a draft of her report when I visited her new home in the hills behind Melbourne in November, and was shocked by its tale of the collapse of a top priority policy response laid to waste by bureaucracy, failure of co-ordination, big business and a failure of leadership. Yet it is a story that is hard to sell to mainstream media because of the structural nature of the scandal. Interesting, but too complicated, Kerrie feels. So the headline grabbers on the problem continue, without context.
The Greens Senator for Victoria Richard de Natale is a medical doctor, and has convinced colleagues to establish a Senate Inquiry into AMR to look at the issue yet again. ‘If we don’t learn from the past, this inquiry will have no different result,” Kerrie said. ‘We still have no national approach to drug regulation, and we still have no surveillance of antibiotic use.’
Perhaps we need an activist academic like Dr Simon Chapman, who popularised and drove debate on the danger of smoking, to drive this debate in public.
Anyway, here is a piece by Kerrie on the sad history of public non-policy on the matter. I’d like @NoFibs to keep tabs on the issue and welcome participation by readers. And here’s a challenge for citizen journos. There are several great news stories in the report – how about writing one for @NoFibs?
Margaret Chan, Director-General of World Health Organisation (WHO) warned in 2012 that “Unless we solve the problem of antimicrobial resistance to drugs, we will be facing a post-antibiotic era where things as common as a strep throat infection or a child’s scratched knee could once again kill.”
The Australia Institute’s recent policy brief Culture of Resistance-Australia’s response to the inappropriate use of antimicrobials looks at how successive Australian governments have responded to antimicrobial resistance (AMR) and the emergence of superbugs.
Of particular importance in Australia’s response to AMR was the 1999 establishment of The Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR), set up to provide independent scientific advice on the threat posed by antibiotic resistance by looking at antibiotic use in human medicine and in animals. The Government accepted the recommendations of JETACAR; stating there was international concern about AMR and that Australia needed to respond with strategies that were ‘consistent with and complementary to global initiatives’.
The Institute’s paper provides a snapshot of progress since the release of the 1999 report using information gained through interviews with experts, Freedom of Information requests and publicly available information. It reveals that while initially there was commitment to implementing the recommendations of the 1999 JETACAR Report, many initiatives failed to result in any comprehensive systematic response to the issue.
Committees, task forces and groups were set up but disbanded, strategies were developed but not implemented, pilot programmes failed to be anything other than pilot programs, undertakings were not carried out. In other words, the ball was dropped pretty quickly.
Of particular concern is the failure to develop a comprehensive national surveillance system of both usage and resistance to antibiotics. This was recommended in the 1999 report and is called for by the World Health Organisation. Such data is essential for effective management of AMR. A surveillance strategy was developed by the government in 2003, and another in 2006 for an expert advisory group, but neither was implemented in any meaningful way.
In 2012 a new Advisory Committee on AMR was set up by the Government and their first task was to oversee the production of a scoping study and development of a business case for national surveillance of AMR and antimicrobial use. This latest study looks only at human use and does not include animals, agriculture or the environment.
Absence of evidence is not evidence of absence. The failure to monitor use and resistance creates uncertainties which weaken the capacity of regulators to develop evidence based policy and allows the various competing interests to interpret existing data – or lack of it, differently.
And there are many interests involved. Not only is there the challenge of bringing the various federal government departments and regulators together, but because states and territories have a role in regulation there are complex cross jurisdictional issues.
Other diverse interests, some very powerful, include multinational pharmaceutical companies, professional medical and veterinary organisations and practitioners, food producers and retailers, private and public research laboratories and research organisations, the nano-science industry, consumer health groups and other public interest advocacy groups as well as the broader Australian community.
The lack of a cross-sectoral and coordinated approach was made very evident in a recent ABC radio program Superbug threat on the rise through animals, when the Chief Medical Officer was asked about the need for testing of foods for superbugs. He was apparently unaware that such testing was not regularly undertaken and when asked why he responded that it was “not within my purview”. Also in Senate Estimates hearings when Senator Richard Di Natale asked a series of questions about overall coordination of management of AMR the Secretary of the Department of Health and Ageing said: ‘The point you make about relationships across agriculture et cetera are absolutely well made. Following on from this, I am happy to undertake to write to my colleagues in agriculture.’
She also mentioned the Food Regulation Standing Committee and committed to write to it to make the point that work was going on in the Department of Health, adding that, ‘we will make sure that there is high-level liaison, and at the next Estimates we will be able to tell you what has been going on’.
It is concerning that such high-level liaison was only prompted by the questions of a Senator and was not part of an ongoing organised and strategic response to AMR informed by the 1999 report and calls from the WHO. Presumably in acknowledgment of the inadequacy of this response and the administrative failures it reveals, the Government last month announced the establishment of a high level liaison committee.
It is unclear why such an important public health threat has been so badly neglected over the last decade. What is clear is that this neglect has serious consequences.
Despite the 1999 report and calls of the WHO, most of the underlying factors listed by the World Health Organisation as drivers of AMR are evident in Australia: Inadequate national commitment to a comprehensive and coordinated response; ill-defined accountability and insufficient engagement of communities; weak or absent surveillance and monitoring systems; potentially inappropriate and irrational use of medicines, including in animal husbandry; a need for improvement in infection prevention and control practices and insufficient research and development on new products.
The Australia Institute’s paper concludes that it is necessary to devise a much more accountable and transparent system of management of AMR in Australia to avoid another largely wasted decade. Successful development and implementation of a comprehensive strategy and action plan to reduce AMR requires there to be:
- strong political awareness, leadership and will
- transparent and accountable public sector practice
- one Government Department/Minister with overall responsibility for reducing AMR
- a long term view and commitment with appropriate and ongoing resourcing
- a coordinated cross sectoral approach including political, public, community and private interests
- a single independent management body with its own legislative base who reports regularly and directly to the parliament. The body should be empowered to self-initiate reports where necessary and should itself be reviewed, at a minimum, every three years by an independent expert individual or body.
Given the pressing nature of the problem and the catastrophic impact of antimicrobial resistance, effective action must be taken urgently.
Full report here Culture of resistance
The Australia Institute