Two weeks ago a mission from the Ohio State University visited Belize to sensitize the Ministers and Chief Executive Officers in both the Ministry of Health and Agriculture on antibiotic resistance as part of a two year project to do the same in the Caribbean. This is as a result of international reports that bacteria in both China and Britain have developed resistance to a last resort antibiotic, Colistin. What makes this resistance to antibiotics concerning is that the resistance has been transferred easily between bacteria as a result of a new mutation.
The development of antibiotic resistance is not new. While antibiotics have revolutionized medicine, resistant strains in bacteria have always been developing against the wonder drugs. For example, Penicillin was discovered by Alexander Fleming in 1928, and in 1940 several years before the introduction of penicillin as a therapeutic, a bacterial penicillinase was identified. This showed that once an antibiotic was used widely, resistant strains capable of inactivating the drug became more pronounced. In another case of the antibiotic resistance, streptomycin, introduced in 1944 for the treatment of tuberculosis, mutant strains of Mycobaterium tuberculosis arose during patient treatment. Today, tuberculosis has evolved within the human race and currently infects one third of the World’s population, despite the development of streptomycin and isoniazid antibiotics; as bacteriological resistance to antibiotics has developed rapidly.
In Belize part of the difficulty has been to pinpoint all the antibiotics that the private sector imports. Also, the fact remains that several of the antibiotics that are being used for humans can also be used for animals, which introduces new variables in the discourse of antibiotic resistance.
“People still go and buy antibiotics…like they are taking a flu medicine, use antibiotics without a prescription, the fact that they smuggle antibiotics into the Country…that is what is creating antibiotic resistance,” says Dr. Marvin Manzanero, Belize Director of Health Services.
While Ministry of Health Officials say that they can attest for the antibiotic use in the public health sector it is much more difficult to do so in the agricultural sector. For the meantime, Chief Executive Officer within the Ministry of Health Dr. Ramon Figueroa continues to encourage the Health Sector to ensure that our physicians are “…a little more responsible on how we prescribe antibiotics from the pharmacy perspective…”
“Probably a lot of the problems arise from antibiotic use in the agricultural sector and so that’s another thing that we will have to look at and work closely with the agricultural sector…” he also said.
Within the Department of Agriculture, the main body that attempts to monitor antibiotic use is the Belize Agricultural Health Authority BAHA. Dr. Joe Myers, who is a veterinary drug registrar within BAHA and whose role is to register antibiotics for animal use, assures that antibiotic use in animals in Belize are all registered.
“Where we fall short is to monitor the use of it (antibiotics) and that’s because of the limited resources,” he says.
Dr. Myers also says that farmers are using antibiotics in animal feed to increase weight.
“What we look at is to make sure that they observe what we call ‘withdrawal period’, that after a certain time that no trace of antibiotics or limited traces is found in the tissue. However; admits the Cuban trained veterinary technician and veterinary medical doctor, “…now whether that is complied with or not is difficult to say and that’s where…it could bring antibiotic resistance.”
Both the experts from the Belize Ministry of Health and Agriculture concede that there is a limited local budget that they can work with to combat antibiotic resistance, in addition to the many other contending issues that they have to deal with. But Dr. Joe Myers says that since antibiotic resistance is a global issue, there is opportunity to seek international funding. While he and two other persons from the Ministry of Health are now part of a ‘Health Leadership Series’ tasked to face the antimicrobial resistance, “We need to provide evidence and show the need for funding to be justified and followed up too…I see the need for us to work closely as an entity, instead of separate Ministries or Departments or Groups.”
For the meantime, Dr. Marvin Manzanero believes that we can enforce the pharmacy act in terms of the prescription and the misuse of antibiotics, Belize can also start culturing its own antibiotics and doing what is called in clinical medicine a rotation of antibiotics, so that in a given cycle a certain type of antibiotic is used and a different one used for the other year “…so that the bacteria don’t continue to be exposed to the same antibiotic.”