EDITORIAL : THE HINDU, INDIA

 

Tackling drug resistance

There was a time around the middle of the last century when it seemed that humans could decisively vanquish the microbes that caused so many dreadful, often deadly, diseases. But that sense of victory over an enemy has given way to alarm. Drug-resistant pathogens have sprung up and ‘superbugs' that can shrug off most drugs that are thrown at them have surfaced and spread across the world. With few new antimicrobials under development, there is a real sense among medical experts of humanity having its back to the wall and of the frightening possibility of a return to the bad old days when what started as a simple infection could get completely out of control. This year's World Health Day (April 7) focusses on antimicrobial resistance and its global spread. In a highly interconnected world, drug-resistant microbes can leap from one country to another. Last year, there was a furore over the spread of highly drug-resistant bacteria, which had the New Delhi metallo-beta-lactamase (NDM-1) gene, from South Asia to several countries. But ‘superbugs' have made their way to India from elsewhere in the world too. For instance, studies of methicillin-resistant Staphylococcus aureus (MRSA) bacteria isolated in India have indicated a movement of such organisms from the United States, Europe, and Australia to this country.

In India, as in other countries, such dangerous microbes are circulating not only in hospitals but also in the larger community; poor sanitation and faecal contamination of water supplies have allowed some highly antibiotic-resistant bacteria to spread. Drug-resistance is a major issue in tuberculosis. India accounts for one-fifth of the global burden of the disease and two people die of it every three minutes. The rise of resistance as a natural consequence of the process of evolution is perhaps inevitable. But the misuse of antibiotics greatly hastens this process. There is a great deal that can and must be done to conserve the drugs that are available and still effective. Over-the-counter sales of antibiotics must be stopped. Physicians need to be educated on when it is appropriate to use antibiotics. Even when an antibiotic is needed, it is essential that the right drug is given at an adequate dosage and for a suitable duration. A proper system of surveillance for antimicrobial resistance as well as regularly updated guidelines for treatment would help doctors make the right choices. Further, the use of antibiotics as growth-promoters in livestock needs to be curtailed. In all of this, the government, the medical fraternity, and the public must play their part. 

Changing an established order

The international monetary system has been in need of fundamental reform. It is dominated by dollar holdings, with the American currency remaining the world's principal reserve currency as well as the most widely used in private transactions. The dollar, which faced many challenges, has remained supreme mainly for want of an alternative. A recent G20 seminar held in Nanjing, China, ended without any consensus on international monetary reform. The stasis is unfortunate. The system may not have caused the recent global imbalances or current instability in the global economy, but it has certainly been ineffective in addressing them. First, it has created a global recessionary bias both during and after financial crises. Secondly, there is a certain amount of tension in using a national currency as a reserve. The U.S. has been running huge budgetary and current account deficits. Should it succeed in reining in the deficits, global liquidity would shrink. Thirdly, the system has encouraged large dollar accumulations by several countries by way of “self-insurance” against future crisis. The very large dollar holdings by China and some other countries have added to global imbalances.

Various attempts at identifying alternative reserve currencies have floundered. The euro seemed promising at one time but the current debt problems in some euro zone countries have raised doubts over its long term suitability. Given the strength of China, the yuan is bound to become an important reserve currency in course of time, freely convertible and with an exchange rate mirroring its growing clout. Some out-of-the-box solutions are required. Nobel laureate Joseph Stiglitz has, in a recent article in the Financial Times, suggested that the SDRs issued by the International Monetary Fund should play a greater role in the international monetary system. SDRs, which are strictly the IMF's unit of account, represent a potential claim on other countries' freely usable currency reserves, for which they can be exchanged voluntarily. The specific proposal is to issue a significant amount (up to $390 billion) of new SDRs every year for the next three years. Central banks can exchange the SDRs for hard currency and use it to finance imports. The inherent recessionary bias in the existing system is thus avoided. Being relatively small, the new issues will not accentuate global imbalances. The effectiveness of the SDRs ought to be enhanced through a variety of measures, which are inextricably linked to IMF reform. The medium-term goal is to make SDRs the main, or even the only, means of IMF financing. The dollar's pre-eminence in private trade and remittances will remain unaffected.