How Animal Medications Are Fueling Drug Resistance In Humans

ITS 10:00 in the morning and a Harare man walks into one of the Agroshops licensed as Veterinary Medicine General Dealers in the central business district enquiring of a possible remedial solution for his dying chickens.

By  Kudakwashe Pembere

Panting heavily and with a sad look, he tells the cashier the symptoms. Even though the attendant advises that the man takes the dead chickens for a post mortem, he proceeds to dispense some Oxytetetracycline which he says could cure the birth flue and get rid of the bacterial infection.

He does not even ask for a prescription from a veterinary expert. The man hurriedly leaves the shop with a beaming smile on his face.

Out of curiosity, this journalist asks him if it was permissible to sell livestock antibiotics  over the counter without consulting veterinary. The attendant responds that one can get them without any questions asked. Just buying them over the counter.

“You can just walk in and buy them,” said the worker who requested anonymity.

Many Zimbabweans over the years have ventured into animal husbandry with poultry farming being on the rise where almost one in every ten high density households is engaged in a poultry business one way or the other. A tour around the downtown streets of Harare’s central business district especially along Kenneth Kaunda Street and Simon Muzenda Street better known as Fourth Street shows a bustling trade of agroshops.

Available in these agroshops are medicines for animals and even vegetables. However in these shops are medicines which are not supposed to be sold over the counter. It seems most if not all of them are dispensing antibiotics like the over the counter medication.

However, a local veterinary surgeon argues this should not be the case. Dr Brian Chikodze says MCAZ regulates the dispensing of antibiotics like Amoxicillin. He explains that animal antibiotics are dispensed the same way as those for the public.

Amoxyl cannot be sold like we do sweets or toilet paper. One consults with a doctor who prescribes the accurate dosage. Now the same science is applicable to even animal diseases because those that are infectious are treated using antibiotics.

“If an animal is suffering from pain after being hit by an object, if you give it an antibiotic, you are misusing the drug because you need a pain killer instead. It’s not an infection. Antimicrobial use has to be regulated to prevent misuse of antibiotics,” says Dr Chikodze.

He explains that in other jurisdictions, countries do not allow someone to walk in and buy animal antimicrobials without a prescription from the veterinary.

“If you go to any other country, walking into a shop that sells antibiotics for animals, you cannot the medication without a prescription. This guarantees that the animal was observed by a veterinary who is qualified to diagnose and prescribe medication for the animal.

“The animal owner can go with that prescription to the pharmacist in this case being the Agro-shops who dispenses the medicine. In Zim, Amoxicillin is a form of penicillin which is sold over the counter in most of these shops yet it requires a prescription as if a packet of sweets. That is the way it is,” he said.

As MCAZ are the custodians of regulation of medicine use in Zimbabwe, the Vet Surgeon states the top brass of which are pharmacists, their major, if not sole thrust, is dispensing of human medicines.

“The regulations and enforcement thereof are tighter with respect to human medicine but a bit more lax with veterinary medicinal preparations. Perhaps understandably so, as human health is more important than animal health.

“Their concern is public health. When we talk about animal diseases as vets, to a pharmacist these issues are neglected. If resistance develops in dogs so what, they say. Especially in our African environment, if a dog, so what? But now we are introducing a new level of science that is happening globally,” says Dr Chikodze.

Simply put, the One Health Concept could be said to be looking at the food chain.

“We are living in an environment. We are sharing an environment and we are interfacing with animals. The interaction we have with animals makes it incumbent for us look at the whole scope without sidelining animals and environment.

“It affects us all. If the environment is contaminated, let’s say mercury spills onto grass, animals graze that grass and get poisoned. When people it that meat, they are going to be poisoned as well. Even kids playing within that mercury poisoned grass might get affected,” he said.

He gives an example of how people contract anthrax from cattle meat.

“Let’s take for example anthrax an animal disease. People are contracting it from animals. As per tradition, we are not to eat animals that are not slaughtered. Animals that die on their own. But nowadays, not because of poverty or otherwise, when people see the animal sick, they kill the animals.

“The principle was that animals that died own their own from diseases were not to be eaten so as not to expose ourselves from the diseases. Or the unscrupulous people just cull the cattle and sell to unsuspecting animals. Yet the meat is infected with anthrax leading to how the Veterinary services department identifies the cases,” he says.

The Vet surgeon bemoans that MCAZ is relaxed when looking at academic qualifications one requires to operate a VMGD (veterinary medicines general dealer) which sell antimicrobial agents like ocytetracycline sulphonamides over the counter and give medical advice to farmers/animal owners on use of veterinary medicinal preparations. He said the regulator had to address the issuance of permits to hold and use narcotics (dangerous drugs) to layperson for use in veterinary medicines.

“This is unlike anywhere else in SADC, Africa or the world. Narcotics are the highest regulated medicines on earth!!!,” he said. Are there any deterrent/punitive measures imposed by MCAZ for medicine dealers who flout the regulations?” he quizzes.

Veterinary Services Department chief director Josphat Nyika had not responded to questions sent to him by the time of going live.

MCAZ is responsible for protecting public and animal health by ensuring that all medicines are safe, effective and of good quality.

“Through the Evaluations and Registration Division, MCAZ assesses applications for registration of medicines for animal use. MCAZ also issues Veterinary Medicines General Dealers (VMGD) Permits to those willing to distribute approved veterinary medicines and conducts inspections of these facilities to ensure that only approved medicines are sold from approved premises. This monitoring of the supply chain helps to reduce infiltration of substandard or falsified veterinary medicines therefore reducing the risk of antimicrobial resistance,” the Authority explains its role in animal medicine regulation.

Adds MCAZ, “MCAZ also participates in various technical working groups and initiatives focusing on AMR such as the One Health Initiative on AMR. The Authority participated in AMR National Action Plan policy formulation and has active participatory roles in the National AMR Core Group, a multi-sectorial governance structure together with the Ministries of Health and Child Care; Agriculture, Lands and Rural Settlement and that of Environment, water and climate.

“The MCAZ monitors use of all antimicrobials (medicines used to treat infections caused by microorganism infections e.g. antibiotics) use annually through collection of import data and recording quantities used in food and non-food producing animals.”

On the question whether medicines used to treat bacterial infections in animals are supposed to be sold over the counter in VMGDs, MCAZ replied that through the Veterinary Committee they classify veterinary medicines into prescription preparations and non-prescription preparation based on its regulations, and other scientific considerations of the molecule (medicine) of concern.

“Most antimicrobial preparations are classified under prescription preparation. If a veterinary medicine has been classified under prescription preparation, farmers or animal owners are required to visit a veterinary surgeon or animal health expert and have their animal examined before issuance of a prescription with the appropriate veterinary medicine.

“These prescription medicines are only accessed through veterinary hospitals, surgeries, clinics, pharmacies and wholesalers. Over the counter agroshops should only sell non-prescription medicines,” said MCAZ.

MCAZ noted with concern the a rise in cases were agro-shops are stocking prescription veterinary medicines or even counterfeits sourced from illegal places.

“As such, the MCAZ and other Law Enforcement Departments such as ZRP CID often work together during blitz inspection in order to stop these culprits from endangering the public and our animals,” said the Authority.

In 2016, Zimbabwe adopted the One Health Approach. The following year, Zimbabwe launched the One Health Antimicrobial Resistance National Action Plan 2017- 2021. This plan is based on the “One Health” concept, which has found the health of animals, the health of people, and the viability of ecosystems to be inextricably linked.

“For instance, the Central Veterinary Laboratory has detected some resistance in E. coli and Staphylococcus aureus to some antimicrobials such as penicillin, tetracycline, lincomycin, ampicillin, cloxacillin, erythromycin, and sulphamethoxazole,” reads part of the Action Plan.

According to the World Health Organisation, the high volume of antibiotics in food-producing animals contributes to the development of antimicrobial-resistant bacteria, particularly in settings of intensive animal production.

“In some countries, the total amount of antibiotics used in animals is 4 times larger than the amount used in humans. In many countries much of the antibiotics used in animals are for growth promotion and prevention of disease, not to treat sick animals,” says the UN Health Body.

Says WHO, “These bacteria can be transmitted from animals to humans via direct contact between animals and humans, or through the food chain and the environment. Antimicrobial-resistant infections in humans can cause longer illnesses, increased frequency of hospitalization, and treatment failures that can result in death.

“Some types of bacteria that cause serious infections in humans have already developed resistance to most or all of the available treatments and we are running out of treatment options for some types of infection. WHO recommends an overall reduction in use of antibiotics in food-producing animals to help preserve their effectiveness for human medicine.”

 

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