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)
Short Url
Updated 27 January 2024
Follow

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. 


Pakistan joins Muslim world in sending condolences ahead of Pope’s funeral on Saturday

Updated 8 sec ago
Follow

Pakistan joins Muslim world in sending condolences ahead of Pope’s funeral on Saturday

  • Over 128,000 people have already paid last respects to Francis, whose coffin will be closed at 1800 GMT in ceremony attended by senior cardinals
  • Francis will be interred in the ground, his simple tomb marked with just one word: Franciscus, people will be able to visit the tomb from Sunday morning

ISLAMABAD: Pakistan joined the Muslim world in sending condolences as the Vatican made final preparations Friday for Pope Francis’s funeral and the last of the huge crowds of mourners filed through St. Peter’s Basilica to view his open coffin.
Over 128,000 people have already paid their last respects to Francis, whose coffin will be closed at 8:00pm (1800 GMT) in a ceremony attended by senior cardinals.
Many of the 50 heads of state and 10 monarchs attending Saturday’s ceremony in St. Peter’s Square, including US President Donald Trump and Ukrainian leader Volodymyr Zelensky, are expected to arrive later Friday in Rome.
“Pakistan conveys its heartfelt condolences on the passing of His Holiness, Pope Francis, a revered spiritual figure and a worldwide advocate for peace, interfaith dialogue and compassion,” the foreign office said. 
“His Holiness demonstrated unwavering commitment to fostering unity among world religions, advocating for the oppressed and promoting the inherent dignity of all humankind. Pakistan deeply values his tireless efforts to enhance mutual respect and understanding among diverse cultures and faiths.”
The foreign office said the pope’s legacy was marked by “profound humility, selfless service and a unifying vision for humanity,” which would serve as an inspiration for generations to come. 
“At this moment of profound sorrow, Pakistan stands in solidarity with our Catholic brothers and sisters worldwide and with all those touched by the extraordinary life of service.”
Italian and Vatican authorities have placed the area around St. Peter’s under tight security with drones blocked, snipers on roofs and fighter jets on standby. Further checkpoints will be activated on Friday night, police said.
Vast crowds of people on Friday morning packed Via della Conciliazione, the wide avenue leading to the Vatican, for the third and final day of the pope’s lying-in-state.
For a second night in a row, the Vatican kept St. Peter’s open past the scheduled hours to accommodate the queues, only closing the doors between 2:30am (0030 GMT) and 5:40am Friday.
Cardinal Kevin Farrell, Camerlengo of the Holy Roman Church, will preside at the Rite of Sealing of the Coffin of the late Pope Francis on Friday, April 25, at 8:00 PM, ahead of the papal funeral on Saturday morning.
The Catholic Church’s first Latin American pope died on Monday aged 88, less than a month after spending weeks in hospital with severe pneumonia.
The Argentine pontiff, who had long suffered failing health, defied doctors’ orders by appearing at Easter, the most important moment in the Catholic calendar.
It was his last public appearance.
Condolences have flooded in from around the world for the Jesuit, an energetic reformer who championed those on the fringes of society in his 12 years as head of the world’s 1.4 billion Catholics.
He used his last speech to rail against those who stir up “contempt... toward the vulnerable, the marginalized, and migrants.”
After the funeral, Francis’s coffin will be driven at a walking pace to be buried at his favorite church, Rome’s papal basilica of Santa Maria Maggiore.
The hearse will pass down Rome’s Fori Imperiali – where the city’s ancient temples lie – and past the Colosseum, according to officials.
Big screens will be set up along the route on which to watch the ceremony, Interior Minister Matteo Piantedosi said.
Francis will be interred in the ground, his simple tomb marked with just one word: Franciscus.
People will be able to visit the tomb from Sunday morning, as all eyes turn to the process of choosing Francis’s successor.
With inputs from AP


Families heartbroken as Pakistan closes airspace for Indian planes, land border shut

Updated 14 min 14 sec ago
Follow

Families heartbroken as Pakistan closes airspace for Indian planes, land border shut

  • Militant attack in Indian-administered Kashmir has triggered diplomatic crisis between Islamabad and New Delhi
  • Diplomatic relations between Pakistan and India were weak even before the latest measures were announced

KARACHI: A 79-year-old Pakistani man, Ali Hasan Baqai, lamented about not being able to meet his siblings living in India as he sat with his wife and grandchildren at his house in Pakistan’s Karachi, hours after Pakistan closed its air space for Indian airlines on Thursday.
The move came in retaliation to a raft of actions by India after a deadly militant attack on tourists in Indian-administered Kashmir that New Delhi says Pakistan is involved in. Pakistani officials have rejected the accusations.
The latest diplomatic crisis was triggered by the killing of 26 men at a popular tourist destination in Indian-administered Kashmir on Tuesday, in the worst attack on civilians since the 2008 Mumbai shootings. The tit-for-tat announcements took relations between the nuclear-armed neighbors, who have fought three wars, to the lowest level in years.
Whenever relations deteriorate between Pakistan and India, elderly Baqai is besieged with a feeling of longing for his siblings and his birthplace on the other side of the border with India.
“I was planning to visit India. My sisters there were also planning to travel to Pakistan. But all of a sudden this attack happened. We could not even think of it. The situation was absolutely normal but suddenly the situation turned bad,” Baqai told Reuters Television.
Ali was born in 1946 in Delhi, India, a year before the partition of the subcontinent in 1947. He was last able to visit Delhi in 2014. Two of his sisters, along with his mother, passed away in the subsequent years. His three brothers died in India last year.
“If we don’t get a chance and the borders are closed for a long time, the only way left is we go to Dubai and meet each other there,” he said.
“You can’t meet your relatives. We can neither go there, nor can they come. It has become a mockery now. There is no hope left.”


Roadside blast kills three paramilitary troops in Pakistan’s volatile southwest

Updated 25 April 2025
Follow

Roadside blast kills three paramilitary troops in Pakistan’s volatile southwest

  • The blast appeared to target bomb disposal personnel of the Frontier Corps paramilitary force in the Marget coalfield
  • No group immediately claimed responsibility for the attack but suspicion is likely to fall on Baloch separatist militants

QUETTA: A roadside blast killed three paramilitary troops and injured four others in Pakistan’s southwestern Balochistan province on Friday, a local administration official said.
The blast in Margat area, home to coal mines and located some 60 kilometers from the provincial capital of Quetta, appeared to target the Frontier Corps paramilitary force’s bomb disposal personnel when they were clearing the route.
Balochistan, which shares a porous border with Iran and Afghanistan, has been the site of a decades-long insurgency by Baloch separatists who have targeted security forces protecting mining fields, laborers and truckers transporting minerals.
“An improvised explosive device (IED) was planted along the route being used for the transportation of coal from the Marget coalfield which exploded when the bomb disposal wing of the Frontier Corps was busy in security clearance of the route,” Quetta Deputy Commissioner Saad bin Asad told Arab News.
“Three soldiers of the BD wing were killed and four wounded in the attack.”
No group immediately claimed responsibility for the attack, but suspicion is likely to fall on ethnic Baloch separatist militants, who frequently target security forces, Chinese nationals, ethnic Punjabi commuters and laborers in the restive province.
The separatists accuse Islamabad of exploiting the province’s natural resources, such as gold and copper. Successive Pakistani governments have denied the allegations and said they only worked for the uplift of the region and its people.
The latest attack comes a day after three people, including two women, were killed when a vehicle was hit by a powerful explosion in Balochistan’s Kalat district. Last month, the Baloch Liberation Army separatist group hijacked a train with hundreds of passengers aboard near Balochistan’s Bolan Pass, which resulted in the deaths of 23 soldiers, three railway employees and five passengers. At least 33 insurgents were also killed.
Pakistan accuses the neighboring Afghanistan and India of supporting separatist militants in Balochistan, an allegation denied by New Delhi and Kabul.


Pakistan, Afghanistan agree to enhance trade and connectivity in push to reset ties

Updated 25 April 2025
Follow

Pakistan, Afghanistan agree to enhance trade and connectivity in push to reset ties

  • Ties with Kabul have been strained over a spike in militancy and a deportation drive against Afghan nations
  • Pakistani deputy PM and special envoy to Kabul visited Islamabad last week in an attempt to resolve issues

ISLAMABAD: Pakistan and Afghanistan have agreed to enhance trade and connectivity during a visit to Kabul by top officials from Islamabad, the foreign office said on Friday, amid a push by the two neighbors to reset soured relations.
Pakistan-Afghanistan relations have been strained by a spike in militancy in Pakistan’s western regions that border Afghanistan, following the Taliban’s takeover of Kabul in 2021. Islamabad says anti-Pakistan militants carry out cross-border attacks using safe havens in Afghanistan, a charge Kabul denies.
Another source of tension has been Pakistan’s decision to expel undocumented Afghans and those who had temporary permission to stay, saying it can no longer cope. Since November 2023 when Islamabad first launched the deportation drive against illegal foreigners, over 900,000 Afghans have left the country. The Afghan government has condemned the “unilateral measures” to forcibly deport tens of thousands of Afghans. Afghans have also reported weeks of arbitrary arrests, extortion and harassment by authorities as Islamabad has accelerated the deportation drive since April, a charge officials deny.
Amid these tensions, Pakistani Deputy Prime Minister Ishaq Dar and special envoy to Kabul, Ambassador Mohammad Sadiq, went to Afghanistan on a one-day visit last week widely seen as an attempt to resolve outstanding issues of contention.
“During the visit, the deputy prime minister [and] foreign minister held meetings with the acting Afghan prime minister, acting Afghan deputy prime minister and acting Afghan foreign minister,” Shafqat Ali Khan, a Pakistani foreign office spokesperson, told reporters at a weekly news briefing in Islamabad.
“Both sides held extensive discussions on a range of issues including peace and security, people-to-people contacts and agreed to enhance bilateral trade and economic cooperation to the mutual benefit of people of both countries.”
Pakistan remains at loggerheads with two of its main neighbors, India and Afghanistan, while Islamabad’s relations with Iran have also seen friction in recent weeks over the killing of eight Pakistani laborers in Iran’s Sistan-Baluchestan province. Both Pakistan and Iran last year exchanged strikes against what they called militant hideouts, but quickly moved to de-escalate tensions.
This week, an attack on tourists in India’s Himalayan territory of Kashmir has sparked a new crisis between nuclear armed neighbors India and Pakistan, with New Delhi blaming militants with “cross-border linkages” for the killings, which Islamabad denies. Both nations have announced tit-for-tat measures to downgrade ties in the aftermath of the violence.
The tensions have come as Pakistan navigates a tricky path to economic recovery, seeking to boost trade by enhancing connectivity with regional countries and attract foreign investment from allies in the region and beyond.
In this regard, Dar on Thursday held a telephonic conversation with Uzbekistan Foreign Minister Seyedov Bakhtiar Odilovic and apprised him of his discussions with Afghan officials about a tri-nation railway line project involving Uzbekistan, Pakistan and Afghanistan.
“The deputy prime minister shared his discussions in Kabul regarding Uzbekistan-Afghanistan-Pakistan railway line project and hoped that the three countries would soon sign the framework agreement for this important regional connectivity project,” the foreign office spokesman said at the briefing.
The project is part of Pakistan’s efforts to position itself as a key trade and transit hub, connecting the landlocked Central Asian states to the global market.


‘Out of the question’ Pakistan’s Nadeem will attend Bengaluru meet, Indian javelin hero Chopra says

Updated 25 April 2025
Follow

‘Out of the question’ Pakistan’s Nadeem will attend Bengaluru meet, Indian javelin hero Chopra says

  • Chopra had earlier announced world’s top throwers, including Olympian Nadeem, had been invited to first Neeraj Chopra Classic on May 24
  • Tuesday’s attack in Kashmir prompted heavy criticism of Chopra’s decision to invite Nadeem even though he was unlikely to attend

NEW DELHI: India’s Olympic javelin gold medalist Neeraj Chopra said it was now “completely out of the question” that rival Arshad Nadeem of Pakistan will attend his meet in Bengaluru next month following Tuesday’s deadly militant attack in Indian-administered Kashmir.
Relations between nuclear-armed neighbors India and Pakistan have plummeted to their lowest level in years after the killing of 26 tourists on Wednesday.
A day before the attack, Chopra had announced that the world’s top throwers, including Paris Olympics champion Nadeem, had been invited to the first Neeraj Chopra Classic on May 24, an event he hoped would pave the way for a Diamond League meet in India one day.
However, the attack in Kashmir prompted heavy criticism of Chopra’s decision to invite Nadeem, even though it was unlikely the Pakistan thrower was going to attend.

“There has been so much talk about my decision to invite Arshad Nadeem to compete in the Neeraj Chopra Classic, and most of it has been hate and abuse,” Chopra, who won gold in Tokyo and silver in Paris, said in a social media post on Friday.
“The invitation I extended to Arshad was from one athlete to another — nothing more, nothing less. The aim of the NC Classic was to bring the best athletes to India and for our country to be the home of world-class sporting events.
“After all that has taken place over the last 48 hours, Arshad’s presence at the NC Classic was completely out of the question.”
Media reports said Nadeem, Pakistan’s first individual Olympic gold medalist, had opted not to attend the Bengaluru meet, which clashed with his training schedule for the Asian Championships in South Korea next month.
The soured relations between the two countries also spilled over to the sports world earlier this year when India’s cricket team refused to travel to Pakistan for the Champions Trophy and played all their matches, including the March 9 final, in Dubai.