Overprescribing antibiotics poses ‘serious’ risk of antimicrobial resistance in Pakistan— health experts 

Pharmacy employees wearing facemasks as a preventive measure against the COVID-19 coronavirus attend to customers in Islamabad on March 23, 2020. (AFP/File)
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Updated 27 January 2024
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Overprescribing antibiotics poses ‘serious’ risk of antimicrobial resistance in Pakistan— health experts 

  • AMR could cause as many deaths as 10 million per year around the world by 2050, warns UN group 
  • OTC sales of antibiotics, incentive-linked prescribing causes surge in drug-resistant microbes, say experts 

KARACHI: Pakistan faces a “serious” risk of Antimicrobial resistance (AMR), which refers to the ability of bacteria, viruses and parasites to develop the capability to fight drugs designed to kill them, health experts warned this week, citing indiscriminate prescription of antibiotics by health practitioners as the main reason. 

According to the World Health Organization (WHO), bacterial AMR was directly responsible for an estimated 1.27 million deaths worldwide in 2019 and contributed to 4.95 million deaths indirectly. The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens. the international organization says. 

Pakistani health care stakeholders say a serious risk of drug-resistant microbes exists due to Incentive-Linked Prescribing (ILP), the practice of doctors and physicians receiving personal benefits or incentives from pharmaceutical companies for prescribing specific medications. 

They also cite over-the-counter (OTC) sales of antibiotics and self-medication as reasons for the emergence of drug-resistant microbes. 

“90 percent of private doctors meet pharmaceutical sales representatives on a weekly basis, and that accepting or seeking out incentives is normalized in Pakistan,” a recently compiled report by The Aga Khan University and London School of Hygiene and Tropical Medicines, said. 

The report said 40 percent of these doctors agreed to accept incentives and prescribe medicines to patients. The doctors agree to prescribe medicines due to financial pressures and inadequate consequences for breaking rules in the country, it added. 

The UN’s Interagency Coordinating Group on AMR has estimated that by 2050, the AMR could result in the deaths of 10 million people worldwide.

Dr. Abdul Ghafoor Shoro, Pakistan Medical Association’s (PMA) general secretary who is also a member of the Sindh Healthcare Commission, acknowledged that certain doctors, due to conflict of interest, were engaged in prescribing antibiotics and other medicines to increase sales of pharmaceutical companies. 

This, he said, they do in exchange for gifts, offers to go on tours and other financial benefits. 

“Many people are involved, so when you take monetary benefit, you try to pay back,” Dr. Shoro told Arab News. “But in this case, only patients pay back and suffer.” 

Shoro said the resistance level in tuberculosis cases in Pakistan has increased from MDR (multi-drug resistance) to XDR (extensively drug-resistant) while in cases of typhoid, the resistance level has also increased to XDR. 

The world witnessed its first case of XDR typhoid in late 2016 in Pakistan’s Sindh province. 

“You have limited availability of antibiotics and going forward, all [diseases] will be resistant which would be a big problem,” Dr. Shoro warned. 

The PMA official also blamed the presence of around 600,000-800,000 “quacks“— a term frequently used to refer to someone who practices medicine without necessary qualifications, skills, or training— in Pakistan for the indiscriminate use of antibiotics. 

“The big issue is that they don’t have the knowledge themselves about its usage,” Dr. Shoro said. “What they do is that they prescribe antibiotics one day and change [it] another day.” 

The head of the National Institute of Health (NIH) in Pakistan also recognized AMR as a significant public health problem, warning of a “serious burden of multi and multi-drug resistance organism, particularly in hospitals or health care settings.” 

“There are reports of complicated surgeries due to resistant organisms,” Muhammad Salman, acting executive director of the NIH, told Arab News this week. 

“And then other health care-associated infections such as ventilator-associated pneumonia, blood stream infections, catheter-associated infections, and urinary tract infection.”

Dr. Salman said that in communities, it has been observed that diseases similar to XDR typhoid are endemic in Pakistan. “So that actually reflects that the problem is actually very serious in Pakistan.”

NIH, which is responsible for researching and monitoring Pakistan’s health status, is working on a National Action Plan (NAP) developed in 2017 in line with global objectives to contain AMR. 

“AMR containment is a rather difficult task,” Dr. Salman admitted, adding that more efforts had been put in extracting evidence of AMR’s presence in the past five to six years. 

He said collecting evidence was critical as it would generate sufficient evidence to reflect and would help in advocating for more investment to contain AMR. 

When asked to comment on the conflict-of-interest allegations related to health practitioners in Pakistan, Dr. Salman said the institute lacks sufficient evidence. 

“But there are practices, especially unnecessary prescription practices of antibiotics, by the doctors and physicians, both in private and in public sectors,” he conceded. 


Sixteen soldiers, eight militants killed in northwest Pakistan gunfight — military

Updated 21 December 2024
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Sixteen soldiers, eight militants killed in northwest Pakistan gunfight — military

  • The killings occurred in the South Waziristan district after a group of militants ambushed a security outpost
  • Pakistan blames the surge in militancy on militants operating out of Afghanistan, Kabul denies the allegation

ISLAMABAD: Sixteen Pakistani soldiers and eight militants were killed in a gunfight in Pakistan’s northwestern Khyber Pakhtunkhwa (KP) province, the Pakistani military said on Saturday, amid a surge in militant attacks in the region.
Pakistan’s Khyber Pakhtunkhwa, which borders Afghanistan, has witnessed a number of attacks by the Tehreek-e-Taliban Pakistan (TTP) and other militant groups that targeted security forces convoys and check posts, besides targeted killings and kidnappings of law enforcers and government officials in recent months.
The latest killings occurred in the South Waziristan district during an exchange of fire after a group of militants ambushed a check post of Pakistani security forces in the Makeen area, according to the Inter-Services Public Relations (ISPR), the Pakistani military’s media wing.
“Sanitization operation is being conducted in the area and the perpetrators of the heinous act will be brought to justice,” the ISPR said in a statement. “Security forces of Pakistan are determined to eliminate the menace of terrorism and such sacrifices of our brave men further strengthen our resolve.”
The Pakistani Taliban claimed the brazen raid on the outpost near the border with Afghanistan, saying it was staged “in retaliation for the martyrdom of our senior commanders.”
The development came days after the Pakistani military said it had killed 11 militants in separate operations in KP’s Tank, North Waziristan and Mohmand districts.
Pakistan has struggled to contain surging militancy in KP since November 2022, when a fragile truce between the TTP, or the Pakistani Taliban, and the state broke down.
Islamabad has frequently accused neighboring Afghanistan of sheltering and supporting militant groups that launch cross-border attacks. Afghan officials deny involvement, insisting Pakistan’s security issues are an internal matter of Islamabad.
On Saturday, the Pakistani military urged the Taliban administration in Kabul to ensure robust border management after a group of militants tried to infiltrate from Afghanistan, leading to a skirmish that left four militants and a soldier dead a day earlier.


Authorities evacuate over 50 people from remote Pakistan district hit by sectarian clashes

Updated 21 December 2024
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Authorities evacuate over 50 people from remote Pakistan district hit by sectarian clashes

  • Clashes between Sunni, Shia tribes have killed over 100 people in Kurram since last month
  • On Friday, authorities set a deadline of Feb. 1 for the warring tribes to surrender weapons

PESHAWAR: More than 50 injured and ailing persons were evacuated on Saturday from the northwestern Pakistani district of Kurram, which has been hit by sectarian clashes in recent weeks, to Peshawar, provincial capital of the Khyber Pakhtunkhwa province, disaster management authorities said.
Kurram, a tribal district of around 600,000 near Pakistan’s border with Afghanistan where federal and provincial authorities have traditionally exerted limited control, has been a flashpoint for sectarian tensions between Shia and Sunni tribes for decades.
Fresh clashes last month killed more than a hundred people, triggering a humanitarian crisis with reports of starvation, lack of medicine and oxygen shortages following the blocking of the main highway connecting Kurram’s main city of Parachinar to the provincial capital of Peshawar.
The injured and ailing persons were airlifted through helicopters from Kurram and safely transported to Peshawar on the instructions of KP Chief Minister Ali Amin Gandapur, according to the Provincial Disaster Management Authority (PDMA).
“Fifty-three affected people, including 14 patients, were brought to Peshawar by helicopter from Kurram district,” the PDMA said in a statement.
“The Khyber Pakhtunkhwa Relief, Rehabilitation & Settlement Department has declared an emergency for relief activities in Kurram district in view of the prevailing situation. An emergency cell has been set up to safely transfer the affected people to hospitals in Peshawar.”
The PDMA said it was in touch with the Kurram district administration and utilizing all resources in this regard, adding that people could contact its emergency operations center at helpline 1700 for any information or guidance.
The development came a day after KP authorities set a deadline of Feb. 1 for warring Sunni and Shia tribes in the district to surrender all weapons and dismantle their bunkers to stem sectarian clashes in the region.
The decision was made at a meeting of the KP apex committee, which comprises civilian and military officials, to discuss a sustainable solution to the issue. It allowed the launch of a special air service for temporary evacuation from some parts of Kurram to protect people’s lives, according to the apex committee declaration.
“The agreement outlines that both sides will submit a detailed action plan within 15 days for voluntary submission of weapons,” read a declaration issued after the apex committee meeting.
“All weapons are to be deposited with the local administration by February 1. Additionally, it was decided that all bunkers in the area will be dismantled by the same deadline.”
In the meantime, land routes to the area would be opened intermittently on humanitarian grounds and a mechanism was put in place for secure transportation, according to the statement.
“Personnel of police and Frontier Corps will jointly provide security to the convoys,” it read.
Last month’s clashes erupted after rival tribes attacked convoys of passengers on the Parachinar-Peshawar road, which were followed by attacks on each other’s villages.
The apex committee asked both sides to avoid any violent action in the future to keep the land route safe and open at all times, hoping that the parties would fully cooperate with the government for a lasting solution to the issue.


Pakistan PM directs measures to increase sugar industry revenues, end hoarding

Updated 21 December 2024
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Pakistan PM directs measures to increase sugar industry revenues, end hoarding

  • Sugar remains one of the largest consumed food commodities in the South Asian country
  • PM Sharif says government making efforts to ensure supply of sugar at affordable prices

ISLAMABAD: Prime Minister Shehbaz Sharif has asked officials to take steps to increase revenue collection from the sugar industry and to end hoarding of the commodity, Sharif’s office said on Saturday.
The prime minister issued the directives at a meeting he presided over in Lahore to review the implementation of a strategy to improve revenue collection.
Sugar remains one of the largest consumed food commodities in the South Asian country and is used in large amounts in food processing, beverages, and bakery items.
Owing to its huge demand, the government sets its procurement prices while the sugar industry is protected by a 40 percent import tariff to ensure prices remain stable. 
“Revenue collection will improve after the installation of video analytics in the sugar industry,” Sharif was quoted as saying by his office. “These reforms will end sugar hoarding and help balance prices.”
The prime minister said the government was making all efforts to ensure the supply of sugar at affordable prices.
“Regular monitoring of sugar stocks should be carried out so that the sugar supply chain is not affected,” he instructed officials, calling for strict and indiscriminate action against sugar mills that were evading taxes.
Over the decades, Pakistan has failed to generate tax revenues in higher amounts due to a narrow tax base, low compliance rate, an inefficient tax administration and massive tax evasion.
The South Asian country has set an ambitious target of collecting $46 billion through taxes this financial year (July 2024 till June 2025), amid efforts to revive its fragile $350 billion economy.


Pakistan slams US claims on missile program as ‘unfounded’ and ‘irrational’

Updated 21 December 2024
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Pakistan slams US claims on missile program as ‘unfounded’ and ‘irrational’

  • A senior US official this week said Pakistan was developing long-range missiles that could threaten the US
  • The statement came after Washington said it was imposing new sanctions related to Pakistan’s missile program

ISLAMABAD: Pakistan’s Foreign Office on Saturday dismissed as “unfounded” and “devoid of rationality” the allegations by a senior United States (US) official that its missile program posed a threat to the United States.
The Foreign Office statement came in response to comments made by US Deputy National Security Adviser Jon Finer, who said nuclear-armed Pakistan’s development of long-range ballistic missiles could potentially target the US.
The statement came after the US said it was imposing new sanctions related to Pakistan’s missile program, including on the state-owned defense agency that oversees the program. The sanctions freeze any US property belonging to the targeted entities and bars Americans from doing business with them.
The Foreign Office said that Pakistan had made it abundantly clear that its strategic program and allied capabilities were meant to thwart a “clear and visible existential threat from our neighborhood” — a reference to arch-foe India — and should not be perceived as a threat to any other country.
“The alleged threat perception from Pakistan’s missile capabilities and delivery means, raised by the US official are unfortunate. These allegations are unfounded, devoid of rationality and sense of history,” the Foreign Office said in a statement.
“Since 1954, Pakistan and the US have enjoyed a positive and broad-ranging relationship. The recent spate of US allegations toward a major non-NATO ally would be unhelpful for the overall relationship, especially in the absence of any evidence in this regard. Pakistan has never had any ill-intention toward the US in any form or manner, and this fundamental reality has not changed.”
Finer’s statement underscored how far the once-close ties between Washington and Islamabad had deteriorated since the 2021 US troop withdrawal from Afghanistan. It also raised questions about whether Pakistan has shifted the objectives of nuclear weapons and ballistic missile programs long intended to counter those of India, with which it has fought three major wars since 1947.
But the Foreign Office said Pakistan’s strategic capabilities were solely meant to defend its sovereignty, highlighting Pakistan’s long history of cooperation with the US, particularly in the counter-terrorism domain.
“We wish to reiterate that Pakistan’s strategic capabilities are meant to defend its sovereignty and preserve peace and stability in South Asia,” it said.
“Pakistan cannot abdicate its right to develop capabilities that commensurate with the need to maintain credible minimum deterrence as well as evolving and dynamic threats.”
Relations between the US and Pakistan have seen significant ups and downs. The countries collaborated during the Cold War and in the fight against Al-Qaeda after 9/11.
However, ties have been strained due to coups in the South Asian country by Pakistan’s military, support for the Taliban’s 1996-2001 rule in Afghanistan, and over the nuclear weapons program.


Islamabad urges Afghanistan to boost border security as infiltration attempt kills five

Updated 21 December 2024
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Islamabad urges Afghanistan to boost border security as infiltration attempt kills five

  • Military says four TTP fighters and a soldier were killed as militants tried to enter Pakistani territory
  • Statement comes after media reported a deadly attack on a military outpost that killed 16 soldiers

ISLAMABAD: The Pakistan military on Saturday urged the Taliban administration in Kabul to ensure robust border management after a group of militants tried to infiltrate from Afghanistan, leading to a skirmish that left four infiltrators and a soldier dead.
Relations between Islamabad and Kabul have deteriorated in recent years as militant violence surged in Pakistan, fueled by attacks from Tehreek-e-Taliban Pakistan (TTP) militants in the northwestern Khyber Pakhtunkhwa province.
Pakistani officials blame the TTP for the escalating violence, accusing the Afghan authorities of turning a blind eye to militants using their territory to launch cross-border attacks.
However, Kabul denies these allegations, insisting that Pakistan’s internal security is its own responsibility.
“On night 19/20 December, movement of a group of khwarij [TTP militants], trying to infiltrate through Pakistan-Afghanistan border, was picked up by the security forces in general area Rajgal, Khyber District,” the military’s media wing, Inter-Services Public Relations, said in a statement. “Own troops effectively engaged and thwarted their attempt to infiltrate. Resultantly, four Khwarij were sent to hell.”
The statement noted that one of the soldiers, Sepoy Amir Sohail Afridi, also lost his life amid intense exchange of fire.
“Pakistan has consistently been asking Interim Afghan Government to ensure effective border management on their side of the border,” it continued. “Interim Afghan Government is expected to fulfil its obligations and deny the use of Afghan soil by Khwarij for perpetuating acts of terrorism against Pakistan.”
The ISPR statement comes after media reported a deadly attack on a military outpost in Khyber Pakhtunkhwa which was targeted by 30 militants from three sides. According to anonymous intelligence sources, the attack left 16 soldiers dead. The TTP claimed responsibility for targeting the outpost in a statement that described the attack as a retaliation to the recent killings of its top commanders.
The Pakistan military reiterated in its statement it remained committed to securing the borders. It added that its soldiers would also fight to eliminate the menace of militant violence.