EDITORIAL : THE HINDU, INDIA

 

The superbug effect

 

The discovery of the New Delhi mettallo-beta-lactamase-1 (NDM-1) in 51 of 151 sewage samples and two of 50 drinking water samples taken from India's capital indicates that the superbug is present in the environment and is no longer a hospital-born infection. The study published online in The Lancet Infectious Diseases journal (“Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environment point prevalence study,” by Timothy R. Walsh et al.) found that the NDM-1 gene has spread to families of gram-negative bacteria like E. coli that populate the human gut. The drug-resistant gene has been found even in pathogenic bacteria that cause cholera and dysentery. Transfer of the NDM-1 gene to bacteria belonging to a different species is possible as it is carried in the plasmids, which are capable of moving from one bacterium to another. Transfer of the plasmids carrying the NDM-1 gene was highest at 30°C, the average peak temperature, and within the daily temperature range of New Delhi from April to October. Most importantly, the transfer has been facilitated by poor sanitation, as reflected by the oral-faecal route of transmission.

It is clear that the two papers (August 2010 and April 2011) have at last shaken the government, which has initially been in denial, out of its slumber and inaction. The Indian Council of Medical Research has invited research proposals from scientists to generate scientific evidence on antimicrobial resistance. This move indicates that the apex medical research body has finally realised there is no place for jingoism in matters of science, and that the latest findings must be taken seriously and verified scientifically. The exercise will prove useful only if researchers are truly free to report the presence of the superbug and the extent of its spread. The second important development has been the drafting of the much-needed national policy for containment of antimicrobial resistance. The policy admits that the use of antibiotics is inappropriate in 20 per cent to 50 per cent of cases. It targets the indiscriminate use of antibiotics in food animals and intends to curb the practice since it ultimately causes drug resistance in humans. Most importantly, access to third generation antibiotics like carbapenems is to be restricted to tertiary hospitals. But even in these hospitals, efforts must be directed toward restricting its use to patients with severe infections. The government should waste no time in creating a national surveillance system for measuring antibiotic resistance if it is serious about getting on top of the problem. 

Syria starts reforming

 

Against a background of nationwide public protests in which scores of people were killed in the past few weeks, President Bashar al-Assad of Syria has, in two major speeches, outlined potentially far-reaching reforms. To start with, he would lift the 48-year-long state of emergency. He also signalled substantial changes of perspective. For example, he has stated that a “gap” had appeared between the public and the state as a result of corruption and unemployment, and that the government, state institutions, and the people must “move in parallel” on the basis of wider communication or a “broad dialogue” involving different sections of society, including trade unions. Explicitly recognising that transparency and public trust are essential to this process, Mr. Assad indicated that the draft law on multi-party political system would receive fresh attention, though he cautioned that reform must not turn into chaos and repeatedly referred to outside forces and conspiracies. The Syrian cabinet moved swiftly after the second speech, approving an end to the emergency and permitting peaceful protest.

Nevertheless, it could take some considerable time for institutions of state, and the security forces in particular, to fall in line with the government's new thinking. During the night following the President's second speech, the cities of Homs and Baniyas were virtually shut down after shootings by security forces, which reportedly claimed 25 lives. The Interior Ministry, for its part, has said “terrorist activities” would not be tolerated; it has blamed Salafist bodies for the continuing confrontation. In response to the killings, protesters now demand that Mr. Assad should step down. This has much wider ramifications in view of Syria's modern history. In 1916, Syrians paid with their lives because their country was the only one to resist the Anglo-French Sykes-Picot agreement, which arbitrarily divided West Asia. In recent decades, Damascus has resolutely favoured a Palestinian-Israeli peace agreement, while withstanding attacks and provocations. It has also granted citizenship to Kurdish communities within its borders. The Syrian political establishment's references to outside influences are likely to anger protesters — and the wider public — who see themselves as acting patriotically. It would be disingenuous to see faceless enemies pulling the strings behind the current protests. Mr. Assad's stated intentions of reform are unexceptionable, but it is to be hoped that he can put through genuine democratic change without recourse to conspiracy theories. Syria is too important regionally, and internationally, to allow itself to be in a state of denial.