I am privileged to be able to conduct the research I am doing, i.e. using bacterial genomes to look more closely at antimicrobial resistance (AMR), since the extent of this type of work is limited to high-income countries such as Canada. My research involves bacterial whole-genome sequence data extracted using high-throughput sequencing technologies or next-generation sequencing (NGS). With access to the complete genome information, I can answer many questions about my organisms of interest and aim to make the next impactful discovery related to AMR. But like many things, this type of research is a luxury that only high-income countries (HICs) can afford. Today, I write this blog in order to highlight the research and health disparities between high and low-middle-income countries (LMICs). I will use AMR as an example because this is my field of study – a topic that is both my baby or my nemesis, depending on the day.
Did you know that the burden of AMR is bigger in LMICs, yet Western societies use more antibiotics per person? Antibiotic consumption is one of the drivers of AMR, but it is not as significant as we thought. A study by Collignon and colleagues (2018) showed that poorer infrastructure (which leads to poor sanitation) alongside poor governance, are more considerably associated with higher levels of AMR. I would say that these results are to be expected since poor sanitation usually leads to poorer health outcomes. However, it is important to note that HICs rely on LMICs to produce antibiotics. For example, about 20 per cent of the world’s generic drugs are made in India. But the poor infrastructure and regulations at the production sites and the dumping of drug production waste without proper treatments are fuelling the AMR evolution in such regions. As I mentioned in my previous post, AMR can then quickly disseminate via the resistance contributing genes that are horizontally transferred. Many HICs reap the benefit of outsourcing their pharmaceutical supply chains, yet the grave consequences of manufacturing in under-resourced settings are not discussed or managed. Ultimately, the communities around the production sites are the ones that suffer the most from these chain reactions without even consuming the drugs themselves.
I am not here to point fingers. Instead, I seek to highlight the problems associated with increased AMR rates more holistically. If we want to truly control the issue of AMR, we need to consider every part of the cycle. AMR is a global problem, yet the burden is not distributed equally across the globe. Even if Europe and North American-centric AMR research communities were to present the most ground-breaking findings, the root of the problems in production is still somewhere else in the world, where the perpetuation of AMR depends on the HICs’ product demand. I do not know the solution, nor is there one solution that will resolve the problem. However, international consortiums and researchers are working hard to improve this negative cycle. I hope to spread more awareness about our global responsibility to tackle and slow the momentum gained by AMR as well as help to mobilize change.
Photo by Yogendra Singh from Pexels
