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.”


In Iraq, Angelina Jolie calls for focus on conflict prevention

Updated 20 June 2018
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In Iraq, Angelina Jolie calls for focus on conflict prevention

  • “I hope that we can find the strength to find a better way forward together," she said
  • This was Jolie’s third visit to the camp as UNHCR special envoy

IRBIL: Hollywood star Angelina Jolie called Sunday for a larger focus on conflict prevention rather than responding to its repercussions, during a visit to Iraq with the UN refugee agency.
“I hope that we can find the strength to find a better way forward together: so that we move into a new era of preventing conflict and reducing instability, rather than simply struggling to deal with its consequences,” Jolie told a news conference at the Domiz refugee camp in Iraq’s autonomous Kurdistan region.
It was Jolie’s third visit to the camp as UNHCR special envoy, after previous visits in 2012 and 2016.
The Domiz camp opened in 2011 and is home to 40,000 Syrian refugees who fled the seven-year civil war across the border.
“When UNHCR’s Syria response was only 50 percent funded last year, and this year it is only 17 percent funded, there are terrible human consequences,” Jolie said.
“We should be under no illusion about this,” she added.
Late last month, the UN made an “urgent and critical” appeal for donations to its main budget for Syrian refugees after contributions pledged in April failed to trickle in.
“When there is not even the bare minimum of aid, refugee families cannot receive adequate medical treatment, women and girls are left vulnerable to sexual violence, many children cannot go to school, and we squander the opportunity of being able to invest in refugees so that they can acquire new skills and support their families,” she said.
Her visit coincided with the third day of Eid Al-Fitr celebrations marking the end of the Muslim holy month of Ramadan.
On Saturday, Jolie visited western Mosul, held by Daesh terrorists for nearly three years until they were pushed out by Iraqi forces last summer.
During her visit, she walked through Mosul’s destroyed Old City, met with displaced families and spoke about reconstruction.
“This is the worst devastation I have seen in all my years with UNHCR,” Jolie said.
“It is deeply upsetting that people who have endured unparallelled brutality have so little as they try, somehow, to rebuild the lives they once had.”
The visit marked Jolie’s 61st mission — and fifth to Iraq — with the UN refugee agency since 2001.