A team of researchers based in the UK are unsettled by the fact that even the most potent antibiotics, are rendered ineffective by a newly discovered enzyme NDM1. In its most virulent forms, NDM1 or New Delhi Metallo Beta Lactamase- 1, produces multi-resistant strains of bacteria, dubbed as superbugs. Infections caused by such superbugs increase disease morbidity and the cost of treatment putting health care systems the world over under the gloom of an impending pandemic due to the unchecked spread of these superbugs.
This serious public health concern surrounding NDM1 has been published in the recent issue of The Lancet, a reputed medical journal with international readership. The article also implicates the Indian sub-continent as the focal point of spread of the NDM1 carrying superbugs, underscoring the controversial name given to this enzyme. There is understandably a knee-jerk reaction from the Indian media, politicians and the scientific community to demand greater evidence for such a claim.
Rightful indignation notwithstanding, a lot of questions need to be answered for a deeper understanding of this issue. Scientific facts and data need to be presented in a balanced way to bring about greater public awareness about dealing with this crisis if it were to happen and also the means to prevent such an eventuality, taking a cue from the international response to the SARS and the H1N1 virus.
Can bacteria harboring the NDM1 enzyme exist in an individual’s body in a state of ‘suspended animation’ so that the individual may not show the symptoms, yet remain a carrier of the infection? What needs to be done to avoid exposure to such multi-drug resistant bacteria? Is the history of a brief visit to India evidence enough to prove that exposure to the superbug also happened in India? Is it possible that some of the infected individuals who tested positive for carrying NDM1 had acquired the infection elsewhere but it was only detected in India?
What are the public health implications of such difficult-to treat infections for a country like India? Should every individual suffering from a bacterial infection not responding to conventional treatment be tested for NDM1?
Can foreign nationals visiting India for elective surgeries carry a medical report declaring their NDM1 status? Would this be akin to asking for declaration of the HIV status, which is appropriately an infringement on an individual’s right to confidentiality and not mandatory in our country, despite enough evidences pointing to the origin of the virus in the West? Should alarm bells ring at airports the world over suspecting every traveler from India to be a potential carrier of NDM1?
Should there not be concerted efforts to contain the spread of the superbug before it poses a global challenge?
Lack of widespread awareness about treatment protocols amongst the masses, an indiscriminate use of antibiotics as over-the-counter medications by health care providers and a dearth of targeted public health interventions to improve the health seeking behavior of an uneducated, disempowered and indifferent population contribute to the increasing challenge of drug-resistance in India.
The powers that be should garner political will to strengthen preventive health strategies and fund research in India to contain the superbug with different treatment modalities. Immunotherapy, evidence-based herbal remedies are perhaps some research avenues worth exploring. Simple messages about personal hygiene and rational use of antibiotics need to be scaled up into national campaigns to raise public awareness about reducing the susceptibility to infections.
India cannot afford publicity for the wrong reasons, what with the world sitting up and taking notice of the country’s growing economy. Medical tourism is bringing revenue to the nation’s coffers like never before. Yet, the possibility of contracting the NDM1 while on a medical tourism trip to India printed in an internationally acclaimed scientific journal would be sufficient for the developed countries to rethink their strategies to collaborate with Indian multispecialty hospitals.
Superbugs will don newer, more sinister avatars and continue to do what they are best at: bugging the harried health care providers and threatening to wreak havoc amongst vulnerable communities. Conscientious scientists need to stay focused and work speedily towards inventing the next super drug to crack such superbugs. Else, the politics of power, the billion-dollar pharmaceutical industry interests and mass media hysteria have the collective power to rechristen the ubiquitous NDM1 into a sensational new weapon of mass destruction the ‘Non Destructible Missile 1.’
Manisha Shashank Bhise
September 8, 2010