Recently, the Drug Control Authority under the Ministry of Health Malaysia issued a circular on the cancellation and product recall of pholcodine, an opioid medicine that is used in adults and children for the treatment of non-productive or dry cough. It is also used in combination with other active substances for the treatment of symptoms of cold and flu.
In Malaysia, you’ll need a doctor’s prescription to obtain pholcodine.
According to Lim En Ni, this recall is due to a possible drug interaction with neuromuscular blocking agents.
WAIT, WHAT ARE NEUROMUSCULAR BLOCKING AGENTS?
These are medications that are commonly used for general anaesthesia during medical surgeries.
There are a few types of neuromuscular blocking agents, but generally, they prevent normal transfer of information through nerves at your neuromuscular junction.
This keeps you from moving the skeletal muscles connected to the affected neuromuscular junction, hence the use of these medications as anaesthesia.
SO, WHAT DOES PHOLCODINE HAVE ANYTHING TO DO WITH THESE AGENTS?
Lim En Ni explains that people that take pholcodine-containing products in the past 12 months are at risk of experiencing anaphylaxis should they also receive neuromuscular blocking agents.
“Anaphylaxis is a serious, life-threatening allergic reaction,” she says.
ANAPHYLAXIS IS A SERIOUS MATTER
It can occur within seconds or minutes of exposure to something you’re allergic to.
When you experience anaphylaxis, your immune system will release chemicals that can cause your blood pressure to experience a sudden drop. Also, your airways to block and you will experience problems breathing normally. You will also typically experience weak blood pulse, skin rashes, nausea, and vomiting.
You will need an injection of epinephrine to stabilize your condition and then immediately proceed to an emergency room for quick treatment. Delays in getting treatment can lead to death!
WHAT YOU CAN DO ABOUT THIS MATTER
En Ni advises the following:
If you have purchased the medication but have not consumed it, you can return it to the pharmacy or healthcare facility that you obtained the medication from.
If you have used pholcodine in the last 12 months, visit a pharmacy and ask the pharmacist to help you prepare a medication list to show your surgeon or doctor should you need to undergo surgery.
If you’re not sure whether you have taken pholcodine or your medicine contains pholcodine, consult a pharmacist for help.
BLOCKCHAIN TECHNOLOGY UNBLOCKS LIMITATIONS IN MANY INDUSTRIES
Created in 2008, blockchain technology is a decentralized ledger that can be used to verify and trace multi-step transactions in healthcare, retail, supply chain, financial industries, and more.
Having reduced compliance costs and speed-up data transfer processing, users can also confirm secured transactions using this technology without the requirement for a central clearing authority.
Closer to home, Malaysia started its efforts in blockchain technology in 2015, with the Securities Commission (SC) and Bank Negara Malaysia (BNM) as important parties in the movement.
Moving forward, the Malaysian Industry-Government Group for High Technology (MIGHT) has said that Malaysia would be adopting blockchain by 2025 and many banking institutions are requested to explore and adopt this technology into their financial systems.
CURRENT PROBLEMS IN THE POST-COVID-19 HEALTHCARE SECTOR
Privacy issues when it comes to medical data
From a healthcare perspective, every healthcare institution treats medical data as a highly privacy-sensitive element. The thought of giving patients control of access to their records and the exchange of health data between institutions raises the risks of data exposure and opens up issues around trust and security.
However, currently the problems of the medical record system include a lack of security, difficulty in transferring medical records between multiple healthcare institutions due to system complications, human errors when recording, storing, and transferring patients’ data, and unwanted tampering of data.
Indeed, post-COVID-19, Malaysia for one has been dealing with issues related to the healthcare system. MySejahtera turned into a national scandal after the Public Accounts Committee (PAC) revealed that the COVID-19 contact tracing mobile application had been developed for the government without a contract with the application developers.
Inefficiencies of an outdated medical record system
When medical records are mixed-up, not up to date or stored incorrectly, this can severely endanger the well-being and health of a patient.
Hence, the inefficiency of an antiquated medical record system will surely jeopardize the patient’s transfer process between different medical institutes due to complications with the patient’s medical data exchange.
These issues can lead to more serious issues down the line
These issues can become a stumbling block that contributes greatly to even bigger, unfavourable problems such as heavy monetary losses to healthcare institutions due to complications with patient’s medical data, which can lead to legal consequences.
HOW BLOCKCHAIN TECHNOLOGY CAN ADDRESS THESE ISSUES
Ensures medical data integrity and privacy
Blockchain’s distributed ledger technology in healthcare makes it easier to:
Transfer patient medical records securely
Improve healthcare data security
Control the medication supply chain
Aid genetic code study in the medical field
It is known that the MySejahtera application had infused blockchain technology into its system during its conceptualization. The application could have functioned better had it covered the whole process ranging from user registration, vaccines supply-chain, contact to Pusat Pemberian Vaksin (PPV), medical officers, and more.
Help address major shortages in medications
The private general practitioner (GP) clinics, pharmacies, and hospitals in Malaysia suffered major shortages of various prescription and over-the-counter medications since last May, due to COVID-19 lockdowns in Shanghai, China, and Russia’s war in Ukraine.
More than an acute problem, the extraordinarily severe drug shortage in Malaysia this year revealed the need to boost the country’s medicine security for future international issues in the global pharmaceutical supply chain, as Malaysia is a net importer of pharmaceutical products.
Blockchain technology can help with medicine shortages through proper analysis at hospitals. Through this data analysis with untampered data, it can help to solve the issue in the pharmaceutical supply chain by establishing proof of ownership. Before reaching patients, drug ownership changes from the manufacturer to the distributor, and then to the pharmacist by easily cloning Radio Frequency Identification (RFID) tags. Using blockchain’s ability, more features can be periodically added to the chain.
Aid in improving overwork and toxic working culture in hospitals
The issue on the over workload and toxic working culture in public hospitals also can be solved if the Ministry of Health integrates digital innovation into its systems. Many manual processes can be automated and data transfer from one doctor to another can be updated timely at their fingertips, fostering a favourable environment between patients and doctors.
There are several processes and new regulatory procedures related to blockchain that need to be standardized and coordinated.
As a catalyst for change, Malaysia should look into this as a core pillar to move the needle forward. Blockchain technology is ready, and so are we.
In conjunction with International Women’s Day, the Mental Illness Awareness and Support Association (MIASA) hosted a half-day event at Royale Chulan, The Curve (Kuala Lumpur) on March 11, 2023.
TRANSCENDING ALL BOUNDARIES: BE REVOLUTIONARY
The theme of International Women’s Day this year, ‘Transcending All Boundaries: Be Revolutionary’, calls for the championing of efforts that will empower women in spite of continuing challenges faced across many sectors of society.
The Founder and President of MIASA, Puan Anita Abu Bakar, outlines the different barriers faced by women due to various cultural and societal norms, which are further compounded and exacerbated for those who have a particular disability or struggles with their mental health.
“When women find it hard to talk about difficult feelings, they tend to internalize them,” she says. “This can lead to depression, eating disorders, and self-harm.”
She shares that past statistics indicated that around 1 in 5 women faces a mental health challenge such as depression and anxiety.
“So, today, we want to let every woman know that there is help, there is support, there is recovery when facing mental health issues. No one has to struggle alone. You don’t have to struggle alone,” she asserts.
BREAKING DOWN BARRIERS ACROSS ALL GENDERS, BECAUSE MENTAL HEALTH ISSUES DON’T DISCRIMINATE
While MIASA champions and supports the efforts to empower women across various social and political sectors of life in Malaysia, the association also is well aware that mental health issues do not discriminate based on one’s gender.
Hence, to achieve the goals and objectives of the association, Puan Anita highlights that broad discussions of gender stereotypes and gender equity should not be restricted to only barriers faced by women.
“In our work within the mental health field in particular, we have a front-row seat to witness the harmful effects gender stereotypes can have not only on women but men too, namely when it comes to expressing one’s feelings. For example, we know that many young boys are implicitly taught to believe that they need to ‘man up’ and that crying is a sign of weakness for example,” she explains.
“So let’s take this opportunity to acknowledge those barriers and boundaries as well, and ensure that all of us, man and woman alike, work harmoniously together to ensure gender equity from all sides,” she concludes.
LAUNCH OF YOUNG ADVOCATES FOR MENTAL HEALTH PROGRAMME TO ACHIEVE GENDER EQUITY THROUGH A ZERO-STIGMA GENERATION
This inaugural programme from MIASA will build on the importance of building a generation free of stigma and discrimination—the zero stigma generation.
The MIASA Young Advocates for Mental Health programme is a 6-month programme that provides a platform for young people to:
Learn about mental health and mental health conditions
Understand the stigma and discrimination around mental health
Acquire qualities and skills of an effective advocate
Receive access to the different resources that support people struggling with mental health issues.
“It is a programme that also goes beyond acquiring knowledge; it provides participants hands-on experience with mental health peers through the shadowing sessions,” Puan Anita further elaborates.
For more information on MIASA and its mental health services as well as programmes, you can visit their website by clicking here (link opens in a new tab).
As we welcomed 2023, China reported a huge spike in daily COVID-19 cases during the end of year holiday seasons 2022.
After a period of pandemic fatigue and indifference, the event sparked sudden and short-lived fear and caution among the global as well as Malaysian community.
The news triggered some Malaysians to be up in arms, calling for a ban on travellers from China and reinforcement of pandemic SOPs such as the mandatory wearing of mask in public areas.
Nonetheless, the interest soon died down as other headlines made their way in the news.
It appears that it is only when crises are about to hit our shores that we react.
In fact, as highlighted by the World Health Organisation (WHO), we need to always be prepared and cannot afford to be reactive.
On January 27, 2023, it announced and reminded member countries that COVID-19 remains a public health emergency of international concern.
WHO compared 28-days data between Dec 5, 2022 to Jan 1, 2023 and Jan 2 to Jan 29, 2023.
It found that although the number of cases reported decreased by 78%, the number of deaths increased steeply by 65%.
This result is mainly due to the large wave of cases and deaths in the Western Pacific Region, especially in China.
WHO further states that the numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.
STAY VIGILANT & PROTECT THE VULNERABLE
3 years into the pandemic, Malaysia has reported more than 5 million cases and over 36,000 deaths.
In 2021, it became the main cause of death in Malaysia, overtaking heart disease.
The risk of death is higher among:
Those above 60 years
Individuals with underlying health conditions
According to MOH data between Jan 1, 2022 to July 31, 2022, 75% of COVID-19 deaths were among individuals 60 years and above, and 86% of deaths were among those with at least one underlying health condition .
Compared to the first year of pandemic, we are now more prepared to curb COVID-19 due to advancement in preventive measures, rapid diagnoses, and management tools such as vaccination, rapid test kits (RTK) as well as early treatment with antivirals.
These tools are important particularly to prevent severe COVID-19, keeping individuals especially those with risk factors away from hospitalization, intensive care unit (ICU) admissions and ultimately death.
Nonetheless, these tools will only be useful if they are being utilized optimally.
While Malaysians were quick on the uptake of primary COVID-19 vaccination doses, the uptake of booster doses are very poor with only 49.7% uptake of the 1st booster and a mere 1.6% of the 2nd booster (as of Feb 7, 2023) .
While no concrete data is available, there are good reasons to believe that due to pandemic fatigue, people are now less likely to test and seek treatment for COVID-19.
It is also important to note that antiviral treatment needs to be taken within the first 5 days of symptom onset. Thus, speed is of the essence.
We cannot risk another surge of COVID-19 globally or locally as it would put a toll on our healthcare system and risk overwhelming it.
As it stands, we are currently experiencing overcrowding in Emergency Departments.
Hence, it is crucial that we answer the calls of WHO and the Ministry of Health Malaysia to continue urging the public especially those who are in the high-risk groups (older persons, individuals with underlying medical conditions) to take precautions against COVID-19.
The Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia (FMSA) and Malaysian Medical Association (MMA) are organising an educational campaign themed COVID-19: QUICKLY TEST & TREAT.
This campaign aims to urge the public especially individuals who are at high-risk as well as their family members to continue protecting themselves and others from severe COVID-19 by:
Getting primary and booster doses
Testing immediately upon onset of symptoms
Seeking early treatment, within the first five days of symptoms
Our campaign’s panel of experts
Dr Alif Adlan Mohd Thabit Infectious disease physician
Dr Ang Peng Peng Infectious disease physician
Dr Suriani Sulaiman Family medicine specialist
Dr Balachandran S Krishnan General practitioner
THIS IS A PUBLIC COMMUNITY MESSAGE BROUGHT TO YOU BY
WORDS DR SAPNA SHRIDHAR PATIL & ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN
Recently, our Ministry of Health detected SARS-CoV-2, the virus responsible for COVID-19, during wastewater surveillance at airports in the country. It was also reported that China has begun SARS-CoV-2 wastewater surveillance for selected cities after the cessation of the country’s zero COVID policy.
WASTEWATER SURVEILLANCE EXPLAINED
In wastewater surveillance, samples of untreated sewage from selected communities and institutions are routinely collected and sent to laboratories for identification and quantification of virus content and testing for different or new virus variants.
Benefits of wastewater surveillance
It provides a rapid real-time ‘snapshot’ of the disease prevalence in the community where the wastewater was sampled from.
Wastewater surveillance also addresses challenges of disease under-reporting due to asymptomatic infections, self-home treatment, and delayed or absent notifications from medical practitioners.
Information from wastewater surveillance can be used to monitor disease burden patterns, reintroduction or emergence of a new pathogen/variant, and even evaluate the impact of community behavioural campaigns such as masking and physical distancing.
An example of the importance of wastewater surveillance is the detection, in 2022, of wild polio virus in sewage samples during routine testing in London and New York before any clinical cases were reported. This prompted the local health authorities to implement immediate measures to enhance the coverage of primary polio vaccination together with polio boosters in at-risk communities.
Limitations of wastewater surveillance
However, wastewater surveillance cannot replace the existing disease notification system and clinical testing as the wastewater comes from pooled community sewage samples and cannot be used for individual diagnosis.
Apart from this, technical and logistic challenges can also affect the accuracy of the results of wastewater surveillance.
Nonetheless, the information from an effective wastewater surveillance system can greatly complement existing notification system, as it provides an early warning alert for local health authorities to implement prompt targeted interventions in the communities at risk.
WASTEWATER SURVEILLANCE & COVID-19 DETECTION
Since the emergence of the COVID-19 pandemic in 2020, there has been ongoing research into the transmission dynamics and ways to curb the disease spread.
It is known that the SARS-CoV-2 virus spreads mainly through oral and nasal secretions. However, the virus is also shed in stools for prolonged periods of time. Individuals infected with the virus can shed the virus in their stools, irrespective of whether they have symptoms of COVID-19.
Wastewater surveillance has been implemented in many countries as an environmental monitoring tool to rapidly detect the presence of the SARS-CoV-2 virus in a community and enable local health authorities to be aware of the transmission risk factors, emergence of new variants, and the impact of community preventive measures.
Hong Kong detected the delta variant in the sewage samples since the end of December 2020 and strengthened public health interventions by informing the public about the common symptoms, and the importance of continuing physical distancing and masking, in addition to hand hygiene and respiratory etiquette.
In July 2022, California researchers reported that sampling of community wastewater in San Diego detected the presence of the alpha, delta, epsilon, and omicron COVID-19 variants up to 14 days before they started appearing on nasal swabs. This implies that wastewater surveillance applied to transportation-based sanitation systems can serve as an early indicator of possible community transmission.
SO, SHOULD WE BE WORRIED ABOUT COVID-19 IN OUR WASTEWATER?
The general public need not be alarmed by the news regarding the detection of the SARS-CoV-2 virus in human waste.
As COVID-19 has now become endemic across most countries around the world, the detection of the SARS-CoV-2 virus in sewage samples is not an unusual finding.
From the Ministry of Health’s initial reports, the variants isolated are already in circulation in Malaysia and the risk posed to human health and the environment is minimal.
However, being aware of such a system enables all of us to be better receptive of updated information shared by the Ministry of Health from time to time.
On January 17, 2023, Malaysian Osteoporosis Society (MOS), the Academy of Medicine Malaysia, and our Ministry of Health launched their jointly-published 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis.
In the media briefing held in conjunction with this launch, our Director General of Health Tan Sri Dato’ Seri Dr Noor Hisham Abdullah shares that:
Malaysians are now growing older and living longer. As a result of this, many of us will be affected by age-related non-communicable diseases, which includes osteoporosis.
Osteoporosis results in bone fractures, which are associated with disability and premature death.
WHY IS OSTEOPOROSIS SUCH A CONCERN?
A 2020 study revealed that all people with hip fractures, upon treatment and discharge from the hospital, need walking aids.
6 months later, only 24% (that’s about 1 out of 4 people) regain their mobility and their ability to live independently.
Another 26% die within one year after the fracture.
Tan Sri Dato’ Seri Dr Noor Hisham Abdullah voices his concern that osteoporosis is a serious disease that requires early detection, intervention, and management even at later stages.
This is especially relevant, as the incidence of hip fractures is projected to rise from 5,880 in 2018 to 20,893 in 2050, a 3.6-fold increase!
THE KEYSTONES TO IMPROVING THE AWARENESS OF & TREATMENT OUTCOME OF OSTEOPOROSIS
Dr Yeap Swan Sim, the current President of the Malaysian Osteoporosis Society, states that the cornerstone principles in ensuring that Malaysians can age healthily and gracefully while minimizing the threat of osteoporosis are:
Understanding the disease
Taking preventive measures
Good management of osteoporosis
Knowing the appropriate surgical options, should these options become necessary
FRACTURES & OSTEOPOROSIS ARE NOT “NATURAL” AGEING PROCESS, SO TAKE THEM SERIOUSLY!
Dr Terence Ong Ing Wei points out that osteoporosis usually happens in older people and is almost as common as diabetes. “Diabetes evokes fear and concern, yet most people wouldn’t give osteoporosis a second though,” he muses.
Many people often assume that bones weaken and falls and fractures become more common because all these are a ‘natural’ part of ageing.
Dr Terence disagrees, stating that there is nothing natural about osteoporisis.
In fact, it is actually a very complex condition influenced by many factors. “Some things that we do not think too much about in our everyday lives have a huge impact on our bone health. These include physical inactivity, fad diets, cigarette smoking, and age-related hormonal changes such as oestrogen in ageing women and testosterone in men. All these increase the rate of bone loss at a time when strong bones are most needed.”
DIAGNOSIS AT LATE STAGE OSTEOPOROSIS FORCES DOCTORS TO RULE OUT IDEAL TREATMENT OPTIONS
Dr Yeap says, “We usually only see osteoporosis at its late stages—after a fracture has occurred. By then, the patient would have incurred significant amounts of bone loss. At that stage, it is no longer possible to offer treatments to replace the lost bone, which is the ideal scenario. Instead, treatment options will instead attempt to minimize the detrimental effects of a fracture experienced by the patient.”
“Clearly, we should be giving more emphasis to screening and early detection, followed by suitable interventions so that we can protect the most vulnerable persons from this terrible illness,” she adds.
EARLY DETECTION CAN ALLOW FOR EARLY PREVENTIVE MEASURES
Professor Emerita Chan Siew Pheng concurs with the other experts. “This is because mainly because you don’t even realise osteoporosis is there until you suffer from a fracture. So, the only way to know if you have osteoporosis before a fracture occurs, is by going for a bone density scan, also called dual-energy x-ray absorptiometry, DEXA or DXA.”
More about bone density scan Prof Chan explains that the bone density scan is a quick and painless X-ray procedure that allows doctors to find out whether osteoporosis is present.
It also allows doctors to predict the risk of future fractures in order to provide timely and suitable treatment. “This would save you so much trouble in the future!” she says.
According to Prof Chan, women aged 65 years or older and men 70 years or older should have a DXA scan done every two years.
Younger individuals may also need to be screened if they have certain conditions such as diabetes, thyroid disorders, nutritional malabsorption, eating disorders, rheumatoid arthritis, or are taking certain medications (like steroids) long term.
If you fall into any of these categories, you should consult your doctor for more information as to how you can benefit from a DXA scan.
With the right steps at the right time, osteoporosis can be effectively managed
Prof Chan explains: “There are effective medicines that can be tailored to suit all sorts of patients based on their disease stage and lifestyle. Moreover, whenever pharmacological treatment is necessary, the medications that are available in Malaysia can reduce the risk of fractures from 15% up to 70%!”
She adds that these anti-osteoporosis medicines are generally well-tolerated and effective.
THIRD-EDITION CLINICAL PRACTICE GUIDELINES LAUNCHED TO IMPROVE SCREENING, DIAGNOSIS, & TREATMENT OF OSTEOPOROSIS
Dr Yeap Swan Sim shares that this clinical practice guidelines, meant for healthcare professionals in Malaysia, consists of evidence-based statements intended to assist healthcare providers in optimizing patient care.
“We must first recognize the fact that osteoporosis is a multi-factorial condition,” she says. “Nutrition, age, hormone, lifestyle and the presence of pre-existing disease are some of the aspects that can affect bone health. All these requires not only input from one profession but multiple of them in order to provide patients with proper and effective care.”
She adds: “As such, the clinical practice guidelines had to be written by a panel of experts from all the related disciplines, such as nutrition, geriatrics, endocrinology, orthopaedic surgery, obstetrics and gynaecology, rheumatology, primary care and pharmacy. The wide variety of expertise involved in the writing of the clinical practice guidelines ensures extensive coverage so that the guidelines will be able to inform all types of healthcare professionals who would be involved in the screening, diagnosing and treatment of osteoporosis.”
The 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis was the fruit of the labour of the CPG Working Group comprising:
Dr Yeap Swan Sim (Chairperson)
Dr Terence Ong Ing Wei (Co-chairperson)
Associate Professor Dr Lim Lee Ling (Co-chairperson)
Professor Emerita Dr Chan Siew Pheng
Professor Datuk Dr Sabarul A Mokhtar
Interested healthcare professionals can download the 3rd Clinical Practice Guidelines (CPG) for the Management of Osteoporosis by clicking here. This link will open in a new tab.
Alpro Pharmacy hosted an industry roundtable, called Safe Medication Disposal Practices in Malaysia–Past, Present & Future, on 15th December 2022 at Monash University Malaysia.
HIGHLIGHT #1 THE NEED FOR PROPER DISPOSAL OF MEDICINES
According to Foon Hwei Foong from Malaysian Community Pharmacy Guild, unwanted medications disposed into landfills are reabsorbed by water streams. This means that these medications eventually leads back to the water that we drink.
Dr Saw Pui San, a lecturer from Monash University Malaysia’s School of Pharmacy, cited how irresponsibly discarded contraceptive medicines ended up in our waterways and caused the sterilization of fishes.
Antibiotics are strictly regulated prescription medication, and many efforts were made to prevent antibiotic resistance. However, another often overlooked possible cause of antibiotic resistance is the leakage of improperly discarded antibiotics into our water systems.
HIGHLIGHT #2 THE POLICY IS THERE, BUT THE AWARENESS AMONG THE PUBLIC IS LACKING
Amrahi Buang, President of the Malaysian Pharmacists Society, stated that laws and policies are in place across all access points of medication distribution in this country, with the Malaysian National Medicines Policy (MNPP) clearly stating the measurements and governance in place for medication safety.
He opined that health and medication literacy is still lacking within the Malaysia public, hence the need for an pharmaceutical industry medium to act as an education platform for the public.
Furthermore, he stated that pharmacists are strongly encouraged to start working collaboratively with their colleagues as well as other key players in the pharmaceutical industry to educate on, implement, and practice safe medication disposal.
Ostwin Paw, the CEO of Alpro Foundation, called for leaders in the industry to kickstart the conversation on the impact and risks of unsafe medication disposal methods on the environment.
HIGHLIGHT #3 ALPRO PHARMACY HELPS TO LEAD THE WAY
Lim En Ni, the Chief Pharmacist of Alpro Pharmacy, shared that Alpro Pharmacy launched the Safe Medication Disposal campaign in 2021 in a joint effort with several key pharmaceutical companies in the country.
To date, the initiative has safely disposed more than 1,000 kg of medication waste as well as garnered more than 100,000 signatures from the community pledging their support within 3 months since July 2022.
One of the key initiatives of the Safe Medication Disposal campaign is the placement of dedicated medication disposal bins at all Alpro Pharmacy outlets nationwide to collect excess medicines for proper and ethical disposal. For more information on this as well as on proper medical disposal, click here to visit the Safe Medical Disposal Campaign webpage (link opens in a new tab).
WORDS PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
Infectious Disease Professor
University Malaya Medical Centre (UMMC)
As Malaysia and most of the world transitioned to the endemic phase of COVID-19, it’s easy to forget that just two years ago, the pandemic had led to millions of lives lost, rise in unemployment rates, and the near-collapse of healthcare systems due to the tsunami of cases. Today, thanks to the quick development of medical innovations such as COVID-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth.
Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis—antimicrobial resistance, which continues to rise to alarming levels across the world .
A SILENT PANDEMIC
Over the years, antimicrobial resistance has become an urgent health challenge on a global scale. This is because microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.
Antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by antimicrobial resistance.
During the COVID-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate.
The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance leading to a lasting consequence of the COVID-19 pandemic .
Apart from overprescribing of antibiotics unnecessarily, the increased risk of antimicrobial resistance is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public .
It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.
CONCERNING IMPACTS OF ANTIMICROBIAL RESISTANCE
Development of new antibiotics may not be fast enough to replace those that have become less effective due to antimicrobial resistance
The discovery of antibiotics was a turning point in human history, revolutionizing medicine and increasing the survival rates of infected patients over time.
However, the growing burden of antimicrobial resistance threatens the return to a world with a scarcity of effective treatments for even common bacterial infections such as urinary tract infection, pneumonia, skin infection, and surgical site infections.
As the effects of antimicrobial resistance continue to increase today, the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR.
There is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.
Patients should be prescribed antibiotics only when needed, at the right dose, frequency, and duration. Otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness .
Antimicrobial resistance can also result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care
Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants .
WHAT CAN WE DO TO REDUCE & PREVENT ANTIMICROBIAL RESISTANCE?
We should only take antibiotics when prescribed by a doctor and correctly follow the prescription directions.
Don’t demand for antibiotics and buy medication without a prescription, or share or take leftover antibiotics.
Maintain strict infection prevention measures such as hand hygiene to reduce the spread of antimicrobial resistance organisms.
There is now increasing evidence that certain vaccines currently available for infectious diseases can decrease the risks of AMR by preventing bacterial and viral infections. Keeping up to date on vaccination schedules. particularly for children and elderlies, may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections.
A CALL TO STAKEHOLDERS TO RISE UP & REDUCE THE SPREAD OF ANTIMICROBIAL RESISTANCE
Besides creating awareness among consumers and healthcare professionals, combatting antimicrobial resistance also requires action from governments, policymakers, and industry players to really address the crux of the issue.
Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.
We must learn from the COVID-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of COVID-19—from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and COVID-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.
The same urgency is needed so that we can prevent the next public health crisis.
The theme of World Diabetes Day in 2022 is Education to Protect Tomorrow, which calls for the need for better access to quality diabetes education for healthcare professionals and people living with diabetes.
During the recent World Diabetes Day (WDD) 2022 celebration in Putrajaya, which was jointly organized by the Endocrine Institute of Putrajaya Hospital, the Malaysian Endocrine & Metabolic Society (MEMS), and Novo Nordisk Pharma Malaysia, the experts present reflected on the need to raise public awareness among Malaysians on diabetes.
After all, the latest National Health and Morbidity Survey reported 1 in 5 adult Malaysians has type 2 diabetes!
EFFORTS NEED TO BE DOUBLED TO STOP RISING PREVALENCE
Dato’ Dr Asmayani Khalib, the Deputy Director-General (Medical), Ministry of Health Malaysia, said: “The rising number of people affected by diabetes is putting added strain on healthcare systems. Healthcare professionals require quality diabetes education on how to detect and diagnose the condition early and provide the best possible care; while people living with diabetes need access to ongoing education to understand their condition and carry out the daily self-care essential to staying healthy and avoiding complications.”
Datuk Dr. Zanariah bt Hussein, the Head of the Endocrinology Subspecialty Service of the Malaysian Ministry of Health, felt that, as more Malaysians are diagnosed with diabetes, current efforts need to be doubled to stop this rising number from escalating further.
“Access to quality diabetes education is a goal we must all strive in, to educate and empower not only patients and the community but also family members who are providing support and care,” she said.
DIABETES EDUCATION KEY TO SUSTAINABLE LONG-TERM DIABETES CARE
“The focus on access to diabetes education is a critical aspect that will enable sustainable long-term care, with both healthcare providers and people living with diabetes receiving quality diabetes education,” said Richard Abela, the Vice President and General Manager of Novo Nordisk Pharma Malaysia. “This is an essential component of diabetes care as we develop a patient-centric approach in care, that is sustainable for lifelong chronic disease management.”
ALTY Orthopaedic Hospital
FORMATION OF A LONG-TERM PARTNERSHIP BETWEEN PUBLIC & PRIVATE HEALTHCARE
Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.
There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.
GREATER FOCUS ON AN AGEING SOCIETY
These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.
Here, the government should consider partnering the many physio and home care organisations to ensure patients have good compliance to post hospital care, including physio, wound care and others.
An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.
Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.
INNOVATION IN HEALTHCARE WITH ROBOTICS, 3D PRINTING & OTHER NEW TECHNOLOGIES
The government should consider encouraging the adoption of such technologies especially in healthcare.
Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.
For example, 3D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.
COMPETITIVE & FACILITATIVE IMMIGRATION POLICIES
Competitive and facilitative immigration policies, for healthcare travellers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.
Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.
Thus, they are able to invest in technology such as proton beam, as fee-paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.