Antibiotic pollution is a significant cause of Anti-microbial Resistance (AMR), according to experts from DSM Sinochem Pharmaceuticals (DSP), the Indian Institute of Technology (IIT), New Delhi, and other organizations that gathered together for a “Sustainability through Excellence in Manufacturing (STEM)” workshop at COEX InterContinental Hotel in Seoul, South Korea, that was sponsored by the Korea Drug Research Association and ALS Pharmaceutical. They spent the day imparting advanced training and education programs to their business advocates and industry stakeholders on the latest developments within pharmaceutical manufacturing. The workshop’s participants mainly included technical teams spanning manufacturing, research & development, regulatory affairs, quality control and assurance, and purchasing.
This STEM workshop was the 6th of its kind and the first held in Seoul. More than 20 companies sent more than 50 participants to the conference.
During his welcome address, Frans Vlaar, business unit director for Europe, America and the AMEA region from DSP, stated, “Without antibiotics, medicine would revert to the era when only hygiene practices could curtail infections. However, exposure to powerful antibiotics makes bugs more virulent over time through natural selection. Moreover, pharmaceutical waste is a key breeding ground for resistant bacteria. As a human health hazard, AMR is a time-sensitive issue and the potency of antibiotics must be preserved for future generations.”
He also went on to explain, “In 2016, DSP and 12 other pharmaceutical companies pledged to reduce the environmental impact of manufacturing discharges by 2020 by reviewing manufacturing and supply chains and providing an industry roadmap for risk mitigation.”
The first presentation of the day was on the subject of “Quality by Design Principles and Case Study” given by Prof. Anurag S. Rathore of the Indian Institute of Technology in Delhi. During his presentation, Professor Rathore stressed that “Multi-drug-resistant bacteria, or superbugs, are a visible global reality today. Judicious use of existing treatments and investments in innovative research for developing new drugs can counter current rates of antibiotic resistance. Two key challenges of affordability and quality need to be addressed.”
Valerio di Caprio, global strategy director and marketing director of the AMEA Region for DSP, spoke near the end of the event and brought up a good point. “As a critical stakeholder, the pharmaceutical industry is confronted with serious challenges of quality and regulatory requirements. DSP aims to consolidate these via collective action and promote compliance globally. Based on integrated multi-sectoral coordination and a “one health approach,” the Korean NAP calls for public-private partnership. DSP has always advocated this. Technological know-how must be shared and responsible manufacturing practices based on clean and economical production technologies should serve as benchmarks.”
DSP conducts these STEM workshops in collaboration with leading educational institutes so that the industry can manufacture antibiotics responsibly.
Korea’s Path Forward
The expected impact of antibiotic resistance by 2050, unless any urgent measures are taken, will be approximately US$100 trillion in lost output globally. This would also mean loss of close to 10 million lives every year by 2050 as a result of antibiotic resistance. Due to the seriousness of these challenges, the United Nations General Assembly (UNGA) has placed AMR on its agenda.
In 2000, the World Health Organization (WHO) declared antimicrobial resistance an international threat, calling for increased awareness among member countries and promoting sustained action for the appropriate use of antibiotics. The Korea Centers for Disease Control and Prevention (KCDC) participated in WHO’s technical meetings to share ideas on national AMR strategies. In response to the WHO global action plan on AMR (May 2015), Korea’s 5-year National Action Plan (NAP) was established on 11th August 2016 and is the cornerstone of its public health.
In July 2000, the government implemented separation of drug prescription and dispensation. From 2003-2013, Korea conducted the National Antimicrobial Resistance Safety Control Program, but superbugs increased despite rising annual investments. Infectious diseases caused by six types of multidrug-resistant bacteria were designated for sentinel surveillance in the 2010 Infectious Disease Control and Prevention Act. The major drivers of AMR in Korea were a lack of awareness and legislation about prudent antibiotics prescriptions as well as incomplete surveillance and infection control stewardship programme in the health system.
The Korean chapter of the Alliance for the Prudent Use of Antibiotics (APUA), established in 2000, is one of the most accomplished agents of change. Some of its achievements include collaboration with the Asian Medical Center that coordinates the National Antimicrobial Resistance Surveillance Network, and the establishment of the Center for Antimicrobial Resistance and Microbial Genetics at the University of Ulsan.
The Korean National AMR Action Plan aims to improve public safety by reducing antibiotic prescriptions and minimizing the spread of AMR amongst humans and animals in community and health care settings. As of 2014, Korea’s antimicrobial consumption is relatively higher (31.7 defined daily doses or DDD per 1000 inhabitants per day) compared to other OECD members (23.7 DDD per 1000 inhabitants per day). The Korean health minister has declared the goal to reduce the current usage rate to 25.4 patients per 1000 by 2020.