Food security

Time to revise our overuse of antibiotics

Antibiotic End Game: Some Implicationss

By Glenn Ashton · 26 May 2014

Antibiotic resistant bacteria have brought humanity to the dawn of a new era of medical uncertainty and risk. This has emerged through a simple evolutionary trend, where some of the most basic organisms on earth have managed to thwart our ingenuity over the course of slightly more than half a century.

Recent medical and scientific progress has extended human longevity well beyond the traditional biblical time-span of 70 years, across many parts of the world. One of the most important medical interventions of the last 70 years was the widespread availability of antibiotics to cure previously untreatable infections.

At the end of the Second World War there were less than 2.5 billion people. Today the earth is home to over seven billion. Besides improved nutrition and vaccines, a significant proportion of this growth can be attributed directly to antibiotics. Yet these wonder drugs are increasingly being outsmarted by the simple bacteria they initially vanquished. How has this happened?

Bacteria multiply incredibly fast; one of the most common antibiotic resistant microbes Staphylococcus aureus, commonly known as staph, divides every half hour. In five hours, a single bacterium can formed a colony of over 1000; five hours later it will be over a million strong.

Evolution is driven by genetic mutation; this is how organisms adapt to their environment. Given the size of staph’s genetic code, we can expect about 300 mutations in the first ten hours. In less than a day and a half the genome theoretically has the potential to exhibit every single possible mutation in that new colony.

This is the consequence of the exponential power of rapid cell division and mutation. The result is the inevitable adaptation of bacteria to environmental pressures, which in the health field include antibiotics. We use antibiotics to extinguish dangerous bacteria that have infected our bodies. But once bacteria have adapted, the antibiotic becomes ineffective.

This basic explanation illustrates our vulnerability to these rapidly adapting organisms. More specifically it highlights how vulnerable we are to the over-use and abuse of these medicines that revolutionised health care over the past three human generations.

It is not a matter of if we are going to lose our existing antibiotics, it is when. Our careless misuse of these medicines illustrates our inability to deal with the perilousness of our situation. We are so blasé we casually feed them, at sub-therapeutic levels, to livestock in order to accelerate growth. The result is a slew of resistant bacteria emerging from these livestock production facilities, directly into the animal products we consume.

Antibiotics are also excessively prescribed. This is encouraged by the conservative medical approach of doctors, dogged by litigation, who wish to reduce risks wherever possible. Improper use, such as not completing a full course, further encourages resistance.

This has led to elevated infection rates through even relatively minor medical procedures. High human and animal population densities harbour and incubate increased bacterial loads. Today, as in the time of our grandparents, we are under a real threat of serious infection through something as innocuous as a scraped knee or an infected insect bite.

Antibiotics have saved my own life several times. A septic foot as a child, a particularly nasty tropical infection as an adult, a bad tooth abscess and an agonising gut infection were all treated by antibiotics. The same goes for most of us. Statistically, antibiotics are prescribed more than once a year to every resident in some parts of the USA.

What happened before we had antibiotics? Nearly one in three cases of pneumonia were fatal. One of nine skin infections. Half a percent of mothers giving birth. I would probably not be here to write this article.

How bad are things presently? Let’s examine our example of staph infections: In 1974 2% of US infections were methicillin resistant. By 1995 it was 22% and by 2004 it had reached 64%. By 2007 more people in the US were dying from staph infection than from AIDS. Combine HIV, AIDS, TB and resistant staph and other bacteria and you have a ticking time bomb. This is of particular interest to Sub-Saharan Africa, along with other developing regions.

HIV and AIDS compromise our immune systems. Antibiotics therefore effectively become a substitute defence mechanism. As this region lies at the global epicentre of the pandemic it is clearly essential not to compromise the utility of antibiotics.

The same goes for what is known as drug-resistant and multiple drug-resistant (MDR) TB. This emerged mainly through patients failing to complete the full course of antibiotics. This caused the tubercular bacillus to rapidly evolve resistance to almost every known antibiotic. Today MDR TB can only be treated in isolation, along with the monitored dosing of patients by astronomically expensive medications.

Health experts and the medical fraternity are profoundly concerned by the rapid evolution of antibiotic resistance. Steps have been taken to address the problem, yet our present antibiotic arsenal has limited and shrinking possibilities.

The reality is that we have to explore new alternatives. The pharmaceutical industry is reluctant to do so because of the expense and increasingly short-term usefulness of new antibiotics; bacterial resistance has evolved more and more rapidly to the most recent antibiotics. If drugs are not sufficiently profitable, big pharma is indifferent to developing them. Consequently a strong argument has been made for state intervention in the research for new antibiotics.

Promising new antibiotic resources have been isolated in soil meta-genomes. Some of these are associated with the rich biota of the Fynbos region of Southern Africa, along with other mega-biodiverse regions. Other useful discoveries have been made through analysing various marine organisms.

Such opportunities need urgent funding for research. It would be useful, in the case for South Africa, for the generous existing government subsidies to biotech research to focus carefully on research toward development of new antibiotics. These could be rolled out by leveraging similar finance streams as used with new HIV and AIDS drugs, which access both public and private funding and keep eventual costs low.

We urgently need to see this situation for what it is – an emerging global crisis with potentially catastrophic possibilities for humanity. There are solutions but we must explore novel, practical methods to deliver them into the public health system. This challenge demands our immediate attention.

This article was first published on SACSIS, the website of the South African Civil Society Information Service – http://www.sacsis.org.za
Should you wish to republish this SACSIS article, please attribute the author and cite The South African Civil Society Information Service as its source.
The article is licenced under a Creative Commons Attribution Licence:
http://creativecommons.org/licenses/by/2.5/za/

Revitalising Agriculture: Healing the Land, Feeding our Nation

Revitalising Agriculture: Healing the Land, Feeding our Nation

By Glenn Ashton · 30 Jun 2014

South Africa is a harsh country, a place of extremes. Producing sufficient food for our people has always been a difficult challenge.The new Minister of Agriculture, who can only be an improvement on the previous incumbent, is an interesting choice.

Senzeni Zokwana is the national chairperson of the South African Communist Party, as well as having headed up the National Union of Mineworkers. He has no background in agriculture, in common with his deputy, ex-Police commissioner Bheki Cele. He appears to be a capable and popular leader. Hopefully he will be able to focus clearly on addressing the serious shortcomings within the agricultural sector which remains essentially unchanged since 1994.
We are faced with two competing pressures in agriculture. On the one hand we continue to rely on an intensive, industrial farming model to produce most of our staple crops, dominated by maize. These crops are largely grown by white farmers who still control the majority of arable land. This model has serious impacts on both the land and our water resources.

Industrial farming is intrinsically linked to the dominant economic model: maximise profit while externalising impacts and costs. Instead of driving reform, this model has served to further concentrate land ownership amongst fewer owners while simultaneously failing to address the chronic levels of food insecurity. Jobs have declined and tenure has been eroded.

On the other hand there is increasing political pressure to reform the agricultural sector as a whole, while also redistributing and reforming land holdings. Agricultural sustainability and diversity are part of this reformation process.

It is the unenviable task of the government to manage this delicate balancing act and address these often competing requirements. Many feel that Minster Zokwana has been handed a poisoned chalice.

The departure of Minister Joemat-Pettersen is welcome given her inability to grasp the nettle of agricultural reform. Rather than dealing with core issues she fiddled with patronage based small-scale farming initiatives, which have yet to realise any significant or sustainable material gains toward food production, employment or land reform. The last five years have essentially been wasted.

While Zokwana has no agricultural background, his socialist roots may incline him toward addressing the gaping inequalities in our agricultural system, both in terms of access to sufficient land and in terms of allocating sufficient resources to produce food and livelihoods from that land. There is an innate irony that his present office can directly assist his retrenched colleagues from the mining industry, most of whom hail from rural, agrarian roots. However, translating his ideology into action is another matter.

The directorate of the Department of Agriculture was substantially restructured under the watch of the previous minister. It is top-heavy with administrators involved in pastiched programmatic structures while critical human resources like extension officers, who provide real, practical assistance to farmers, are by the department’s own admission, thin on the ground.

The Department’s Directorate of National Extension Services has a director of extension reform but no director of extension support. In other words the fundamental interface between the department and farmers is presently rudderless and poorly staffed, despite the department recognising that extension services are seriously compromised.

More worryingly, the department has considered reforming extension services along public private partnership lines. This would be a major retrograde step. This is one reason why the present minister has inherited a poisoned chalice – ideology and patronage have trumped sound policy formulation.

President Zuma’s recent State of the Nation Address explicitly recognised the importance of agriculture to the nation, both from the perspective of employment creation as well as from its essential role in providing food security.

Yet, since coming into office, his new government has been unable to make any sense of the competing agendas behind agricultural reform and production. Recent proposals to allocate shareholding to farmworkers appear to be little more than a side-show, which may incidentally compromise the investment climate.

More seriously, these kinds of proposals are incapable of tackling, let alone resolving the underlying land reform and restitution tensions. The spectre of food insecurity looms over vast swathes of the nation. This is exacerbated by the lack of a cogent national food security policy, either rural, or increasingly importantly, urban.

The neo-liberal policy paradigms inherent in GEAR, IPAP, ASGISA and the rest of the well-intentioned but acronym filled WEF-friendly jargon have stymied both land and agricultural reform over the first two decades of our democratic dispensation. Our economic obsession with remaining “investor friendly” has seen agricultural policy fixated on a large-scale, industrial farming model, which includes genetically modified crops and energy and chemical intensive inputs. All those have done is maintain the status quo.

On the other hand smallholder and subsistence farmers remain largely neglected or patronised. If and when assistance has been given, it has been fixated on misplaced attempts to leapfrog farmers into the industrial model, usually without suitable support. When inevitable failures occur, everyone except policymakers are blamed.

The government has recently become more sensitised to the critical role that small scale farmers play in ensuring food security, especially given our relationship with BRICS partners, who generally nurture their small farmer sector far more holistically.

Recent Brazilian research emphasises this reality: four out of five farms there are small, largely family run enterprises. They provide nearly 40% of total agricultural production, including most food consumed in both rural and urban areas. This all comes from less than one quarter of the total cultivated area. Similar patterns exist in India and China, which also have focused on linking small scale farmers to markets, as well as on the feminisation of agricultural production.

In 2003, the African Union resolved that governments should direct 10% of budget toward agriculture. South Africa still lags far behind the rest of the continent, disbursing less than one percent of the budget toward improving agricultural production. Our policy remains controlled by males, while women are central to smallholder production.

Where smallholder farmers have been assisted, insufficient marketing assistance has been given. If marketing assistance has been provided, for instance when government institutions purchase outputs, payment is often delayed.

Minister Zokwana has the unenviable task of fitting this jigsaw together. As a primary industry agriculture is indirectly responsible for around a quarter of GDP, through food production and downstream processing. All of the parts of this puzzle – land reform, smallholder farming, food security and production – need to be holistically re-evaluated.

The minister is fortunate that extensive research has been undertaken in this field by various focus groups over the past few decades. The Programme for Land and Agrarian Reform (PLAAS) at the University of the Western Cape, the African Centre for the Cities at the University of Cape Town and Stellenbosch University’s Sustainability Institute are just a few institutions which have re-examined the agricultural paradigm.

Agricultural policies and actions over the past 20 years have failed to fundamentally reform the sector. We are in an almost identical situation regarding food security and land tenure as we were in 1994.

Radical intervention holds both high risks and opportunities. We need two things: a national summit of agricultural reform, and coming out of this, a White Paper on how we are to meet these competing requirements while improving access to land and food for our people. It is time for the minister to cast aside the poisoned chalice and start anew, rather than continue to perpetuate the mistakes of the distant and recent past.

 

This article was first published on SACSIS, the website of the South African Civil Society Information Service – http://www.sacsis.org.za

Should you wish to republish this SACSIS article, please attribute the author and cite The South African Civil Society Information Service as its source.

The article is licenced under a Creative Commons Attribution Licence:

http://creativecommons.org/licenses/by/2.5/za/