UAE tightens use of antibiotics amid superbug fears and rising health insurance costs

Dr. Amin Hussain Al-Amiri, assistant undersecretary for public policy and licensing at the Ministry of Health and Prevention. (Courtesy of UAE Ministry of Health and Prevention website)
Updated 02 March 2018
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UAE tightens use of antibiotics amid superbug fears and rising health insurance costs

ABU DHABI: Government-issued circulars are being sent to UAE doctors to curb over-prescription of antibiotics to prevent resistance to superbugs and tackle the cost to health insurance systems of antibiotic misuse.
Dr. Amin Hussain Al-Amiri, assistant undersecretary for public policy and licensing at the Ministry of Health and Prevention (MOHAP), said the circulars were part of a raft of measures urging doctors not to issue antibiotics as a first port-of-call.
“The impact of our rules and the circulars will firstly be for the protection of patients themselves,” he said. “But also this will lower health insurance costs because if unnecessary antibiotic prescriptions are avoided then this will minimize the bill which will be forwarded from health care facilities to insurance companies. It will minimize the costs to the UAE because government hospitals provide services free of charge to UAE nationals.”
Dr. Al-Amiri said that the measures will focus on clamping down on doctors who ‘“overdose’” patients by routinely prescribing drugs and pharmacies that issue antibiotics without a prescription.
The steps are in line with World Health Organization (WHO) reports that warn of rising resistance caused by changes that occur in bacteria and render antibiotics less effective.
“First of all, we released many circulars to physicians to not use antibiotics as the first option for the treatment of patients unless — and this is very important — it is absolutely indicated,” Dr. Al-Amiri said. “Once it is indicated there is no issue in prescribing antibiotics.”
This, he said, should mean doctors prescribing the lowest strength of antibiotics unless the patient did not respond to treatment.
“Next, which is very important, we are insisting that all pharmacies avoid issuing antibiotics without prescription which is illegal — this is against the rules and regulations of pharmaceutical law in the Emirates.”
Ministry of Health policy states that antibiotics should not be offered to patients by pharmacists without a doctor’s prescription. New legislation will further prevent pharmacy misconduct relating to antibiotic dispensation without a prescription.
Dr. Yasser Sadawey, internal medicine specialist at Al-Ain’s Medeor 24x7 International Hospital, welcomed the measures — but said it could have a less-than desirable effect on antibiotic sales in the UAE and wider region.
“It will be appreciated by insurance companies and individuals as it will reduce the insurance cost,” he said. “On the other hand, global pharmaceutical companies, which are the sole developers of new antibiotic medications, will have less revenue, which might affect the research programs. We had 65 antibiotics discovered during 1978-1998 and in the past 20 years we had just 15 new antibiotics.”
Dr. Sadawey said misuse was leading to medical practitioners losing their “first-line antibiotics.”
“If we don’t take action now, we may be back in an almost 19th-century environment where infections kill us as a result of routine operations,” he warned. “This is a global issue for governments, the medical profession, the pharmaceutical industry and individuals.”
Dr. Diab Kurdi, head of pharmacy at Abu Dhabi’s Burjeel Hospital, also welcomed the move to reduce antibiotic misuse.
“Doctors in the UAE have been issued with circulars that warn against using antibiotics as the first option for treatment if there is another potential solution,” he said. “If antibiotics are absolutely necessary, it’s recommended that doctors begin with the lowest dose possible. Measures like this are important in the UAE, as they are the world over, to prevent the overuse and potential eventual inefficacy of antibiotics.”
Dr. Kurdi said there was also a responsibility for patients, health care professionals and policy makers to tackle overuse.
“The industry itself needs to invest in research and the development of new antibiotics, vaccines and other tools; individual practitioners/physicians can take greater steps to limit the transmission of infection through cleaning of hands and equipment, and report antibiotic-resistant infections to surveillance teams. Patients must always follow guidelines for use and never share or use leftover antibiotics.”
Talal Bayaa, co-founder of the Dubai medical insurance technology start-up Bayzat, said traditionally insurers have acted as “independently managed control measures” against over-diagnosis and over-prescription of drugs such as antibiotics.
“They’ve done so by ‘rejecting’ cover for specific treatments and medications that are prescribed by medical service providers,” he said. “We as brokers, as well as insurance providers, have seen cases of antibiotic over-prescription for the treatment of conditions that can otherwise be treated by other medications that are significantly more affordable than antibiotics and have less impact on patient’s existing immunity, as well as other systems that may be affected by taking harsh antibiotics when not required.”
Bayaa said: “As it stands, given the volatile nature of how medical service providers prescribe treatments and medication, medical insurance premiums tend to be erratic in nature, and the fluctuation in year-on-year premiums is quite extreme.
“Given a more controlled and regulated prescription/diagnosis environment, we can expect medical insurance premiums to reach increased stability and predictability. However, it would take insurers at least a year to be able to properly assess and predict the levels of risk of claims in the region related to antibiotics.”


Jordan’s PM appeals for more aid as most Syrian refugees set to stay

Updated 20 February 2019
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Jordan’s PM appeals for more aid as most Syrian refugees set to stay

  • Jordan PM says most refugees not returning yet
  • Amman says funding crucial to keep economy afloat

AMMAN: Jordan’s Prime Minister Omar Al-Razzaz appealed on Wednesday to major donors to continue multi-billion dollar funding for Syrian refugees in the kingdom, saying most of those who had fled the eight-year conflict had no intention of returning any time soon.
Razzaz told representatives of major Western donors, UN agencies and NGOs that relatively few refugees had gone back since Syrian President Bashar al Assad’s army last summer regained control of southern Syria, where most had fled from.
“The number of refugees that so far returned voluntarily is low and most have no intention of going back any time soon,” Razzaz told a meeting to launch a UN-funded government plan that earmarks $2.4 billion in funding needs for 2019.
Officials say only around 10,000 refugees out of a total estimated at 1.3 million had left since the two countries opened the vital Nassib-Jaber border crossing last October.
Razzaz echoed the UN view that unstable conditions inside Syria, where large-scale destruction, fear of retribution and military conscription has made many reluctant to return.
“We are now entering a new phase of the Syrian crisis, however the impact is still ongoing. The conditions for their return are not present,” Razzaz added.
The prime minister warned against donor fatigue in a protracted crisis where the needs of refugees and vulnerable Jordanians were largely unchanged.
Maintaining funding that covers education, health and crucial services for tens of thousands of Syrian refugees and local communities was crucial to ease rising pressures on the debt-burdened economy, he added.
“Aid helped Jordan in staying resilient in a difficult regional setting,” Razzaz said, adding the refugee burden had strained meagre resources such as water and electricity, with a donor shortfall covered from state finances.
Jordan is struggling to rein in record public debt of $40 billion, equivalent to 95 percent of gross domestic product, under a tough International Monetary Fund (IMF) austerity plan.
Major donors say more than $6 billion had been extended to Jordan since 2015, which economists credit for rejuvenating once sleepy northern border towns, while refugee entrepreneurship brought a pool of cheap labor and new skills, triggering a property boom and higher productivity.
The kingdom received around $1.6 billion last year alone.
“The level of funding to Jordan that still remains is exceptional in global comparison,” said UN Resident and Humanitarian Coordinator Anders Pedersen, adding needs had evolved from the humanitarian aid required early in the conflict to development projects that benefit the economy.