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.”


Syrian refugees remain skeptical about return

Updated 15 December 2018
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Syrian refugees remain skeptical about return

  • There are currently about 1 million Syrian refugee children of school age in the country

ANKARA: While Moscow and Damascus urge the repatriation of Syrian refugees based on improving living conditions in the country, their call seems largely unheard by Syrians who think that the conditions on the ground are not yet encouraging enough for them to return.
Just in November 2018, some 10,232 Syrians have been caught by Turkish border troops crossing illegally into Turkey.
Experts underline that the repatriation process should be carried out voluntarily and with consideration for the socio-economic, political and security risks during the restoration process of the country. Otherwise, it may be premature.
The Syrian regime recently set up a coordination committee for the repatriation of displaced Syrian nationals to their original cities and towns.
Moscow also prepared a plan in July for coordinating the return of Syrian refugees to safe areas in their homelands. The plan was based on the establishment of working groups with Amman and Beirut, with the presence of US and Russian officials.
The reopening of the Nassib border crossing between Syria and Jordan in mid-October has also encouraged Assad government to issue calls for the Syrian nationals to return home.
Following the seven-year-long civil war, about 5.6 million Syrians are believed to have fled abroad to neighboring countries, mostly to Turkey, Lebanon and Jordan, while some preferred to set off for a new life in Europe.
About 114,000 of them have been repatriated this year, according to data announced by Moscow.
The risk of facing maltreatment when they return to government-held areas also caused concern among Syrian refugee communities.
The UK-based Syrian Observatory for Human Rights (SOHR) has announced that since October more than 700 returnees, mostly from Turkey, Lebanon and Jordan, have been arrested and 230 of them were detained in government-controlled parts of Syria.
Omar Kadkoy, a Syrian-origin researcher on refugee integration at Ankara-based think tank TEPAV, thinks that conditions for repatriation aren’t ripe yet.
“Many Syrians link the return to political change, but status quo has the upper hand. Plus the risk of being drafted to military, the non-functioning economy, and the lack of safety despite all the recent developments create unappealing conditions for return,” he told Arab News.
To encourage the return of Syrians, Assad regime has recently offered an amnesty for army deserters who will allegedly not be punished but will still have to serve the mandatory two years of military service.
However, those who joined opposition groups against regime forces are exempted from the amnesty, sparking concerns that it aims to attract only Assad supporters home.
According to Kadkoy, who has been living in Ankara for four years, the tempo of life is faster and harder in Turkey, but better compared to where Syrians come from and Syrians are getting used to this complex environment.
“This means they’re settling down after seven years and building their future: Kids in schools and universities, parents filling different layers of the labor market, and flourishing businesses,” he noted.
Syrian entrepreneurs in Turkey established 151 new companies in October mainly in the wholesale sector. Concentrating their activities in Istanbul, they invested about 34 million Turkish liras (about $6.3 million) and opened employment opportunities to many.
On the other hand, thousands of Turkish families reportedly began filing requests to adopt orphan Syrian children in Turkey. There are currently about 1 million Syrian refugee children of school age in the country.
According to Kenneth Roth, executive director of Human Rights Watch, there are three major factors preventing many Syrian refugees from feeling that it is safe for them to return home.
“First, the Assad government is continuing to seize and demolish homes in areas that had been held by anti-government forces, meaning that for many Syrian refugees there is no home to return to,” Roth told Arab News.
Second, Syrian prisons remain full of people vulnerable to torture and execution.
“Few will want to return home if they face a serious risk of detention,” Roth noted, adding that the Assad government has not accounted for the thousands who have “disappeared” in its prisons, many of whom have been killed or died due to horrible treatment.
Roth also said that there has been no accountability whatsoever for the Assad government’s deliberate strategy of bombing or besieging and starving civilian areas.
“Few will have any confidence that such atrocities will not resume if there has been no justice for the senior officials who directed them,” he added.
Ammar Hamou, a Jordan-based Syrian journalist, thinks that although Syria and Russia are trying to send assurances to Syrian refugees to encourage them to return, in fact the policy of the Syrian regime is contrary to official statements.
“The country is still in the grip of security, arrests are present, and reserve recruitment exists. One of my friends is a refugee in Jordan. He visited Syria two weeks ago, and when he decided to return he was surprised that he was wanted for military service,” he told Arab News.