Recently, I have spent a good deal of time working on the issue of anti-microbial resistance. I was set on this path by the discovery, nearly a decade ago now, that the drugs we were using to treat STIs among sex workers in Indonesia didn’t work. Sending the bugs off for resistance testing, we found that 100% were resistant to one of the medicines recommended by national guidelines, and over 60% were resistant to a second medicine. Despite that, we went on treating people with these largely useless drugs for the FOUR YEARS that it took to change Indonesia’s national guidelines for STI treatment. Welcome to the fiercely political world of drug procurement and prescription (and the ethically appalling behaviour it promotes).
Recently, I’ve been focusing on one of the most political and (therefore) most neglected drivers of drug-resistant infections: poor quality medicines. Essentially, the pressure to increase access to drugs for everyone who needs them (a good thing) has created all kinds of loopholes that allow lazy, unscrupulous and criminal manufacturers of very bad drugs to prosper without proper oversight. Every time someone tries to raise the issue of bad quality generics, the companies that make them, the governments of countries where they are made, and a number of very shouty NGOs simply accuse the critics of being in bed with Big Pharma. There the conversation ends. But it is simply not true that access to bad drugs is better than no drugs at all, because bad drugs breed resistant bugs, and then even the “good” drugs are, well, no good.
There’s a very detailed report on the interaction between drug quality and antimicrobial resistance over at my day-job site. But for a shorter and better read on the subject, check out Why we are losing the war on bugs over at Prospect Magazine. (January 21, 2016). An archived .pdf of the article is available here