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.”


White House Mideast team holds talks with Jordanian king

King Abdullah of Jordan (L) and Jared Kushner. (AFP)
Updated 20 June 2018
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White House Mideast team holds talks with Jordanian king

  • The US has been trying to rally support for projects to rescue Gaza’s economy, which has been weakened by an Israeli-Egyptian blockade, while continuing to isolate Hamas
  • Jared Kushner’s team plans stops in Israel, Egypt and Saudi Arabia. No talks with the Palestinians are scheduled, though the Americans have left the door open to meeting with them

AMMAN: President Donald Trump’s senior adviser and son-in-law, Jared Kushner, kicked off a swing through the Middle East on Tuesday, meeting with Jordan’s king as part of a broader effort to lay the groundwork for an expected Israeli-Palestinian peace plan.

Kushner and White House envoy Jason Greenblatt held talks with Jordan’s King Abdullah, a key US ally.
A White House statement said the talks focused on US-Jordan cooperation, the humanitarian situation in the Gaza Strip and the US efforts “to “facilitate peace between the Israelis and Palestinians.”
US officials have said their peace plan is near completion and could be released this summer. But it faces resistance from the Palestinians, who have cut off ties since Trump recognized contested Jerusalem as Israel’s capital last December and moved the US Embassy in Israel to the holy city last month. The Palestinians, who seek Israeli-annexed east Jerusalem as their capital, accuse the US of siding with Israel in the most sensitive issue of their decades-long conflict.
Kushner’s team also plans stops in Israel, Egypt and Saudi Arabia. No talks with the Palestinians are scheduled, though the Americans have left the door open to meeting with them.
The Palestinians seek all of the West Bank, east Jerusalem and Gaza Strip for an independent state. Israel captured the territories in the 1967 Mideast war. It withdrew from Gaza in 2005, and Hamas militants seized control of the territory two years later.
The US has been trying to rally support for projects to rescue Gaza’s economy, which has been weakened by an Israeli-Egyptian blockade, while continuing to isolate Hamas. The US, Israel and Western allies shun Hamas as a terrorist group. Details of the plan have not been released, but Palestinians fear they will get little more than a symbolic foothold in Jerusalem. They also fear that aid to Gaza will help strengthen Hamas’ control over the territory.
Jordan also has a stake in east Jerusalem, serving as the custodian of major Muslim and Christian shrines there. Jerusalem’s walled Old City, captured and annexed by Israel in 1967, is home to Muslim, Christian and Jewish holy sites.
Abdullah has also rejected Trump’s moves in Jerusalem. Israeli Prime Minister Benjamin Netanyahu refuses to relinquish any part of the city.
Netanyahu traveled to Amman on Monday for a surprise meeting with Abdullah, telling the king that Israel remains committed to the status quo of the holy sites in Jerusalem.
Abdullah told Netanyahu that the fate of Jerusalem must be determined in Israeli-Palestinian negotiations, and that a solution should be based on establishing a Palestinian state, with east Jerusalem as its capital, on lands Israel captured in 1967.
Palestinian officials fear the Trump administration plan will leave them with a mini-state in the Gaza Strip, parts of the West Bank and a foothold in Jerusalem. Palestinian leader Mahmoud Abbas has said he will reject any plan being floated by the Trump team, arguing that the US has forfeited its role as mediator because of decisions seen as pro-Israel.