Take Home Exam MGH4004:
Governing Health in a Global Context
Author: Juweriya Jamal Salah
Student number: i6245651
Course number: MGH4004
Number of words: 2942
Maastricht, 23 October 2020
, First Essay
Introduction
The rise of antimicrobial resistance (AMR) – bacteria, viruses, fungi, and parasites resisting
antibiotics, antivirals, antifungals, and antiparasitics (WHO, 2020a) – has become a serious
global health problem with nearly 700.000 death per year (Montfort, 2019). This specific
emerging threat is due to the rapid growth of antibiotic resistance (Howard et al., 2014),
which is caused by the incorrect use, overuse, or misuse of antibiotics (Ferri et al., 2017).
Depending on severity, AMR can increase the length of hospitalization, the chances of severe
medical complications, and the resource use and cost of healthcare (Cosgrove, 2006). It has
also become apparent that AMR is an economic concern, accumulating a cost of US$2.9
trillion by 2050 (Labonté & Ruckert, 2019). However, there is no easy answer to this
problem. The focus of this essay will therefore be the complexity of AMR as a global health
challenge as well as the challenges and solutions of the World Health Organization (WHO),
pharmaceutical companies, and local communities. Furthermore, the power dynamics will be
discussed when seeking to govern this global health problem.
AMR, its complexity and globalization patterns
The introduction of antibiotics in the 1940s is considered to be an important milestone in
human history. For the first time, deadly infectious diseases were no longer a threat to the
public health (Palmer & Call, 2013). These potent "miracle" drugs eliminated bacteria and
have saved millions of lives. The ultimate success of defeating bacterial infections paved the
way for achieving advances in medicine and surgery (Khanal et al., 2017). However, success
soon became a twist in international public health when bacterial resistance to antibiotics
increased rapidly (Ferri et al., 2017).
In contrast to the above-mentioned, the development of AMR is a natural process. This occurs
when microorganisms are exposed to antibiotic drugs. Under the selective pressure of
antibiotics, bacteria without natural resistance to drugs will be killed or inhibited. However,
bacteria that are naturally resistant or acquire it later (through mutation) will have a greater
chance to survive (Khanal et al., 2017). Because of this, bacteria that are repeatedly exposed
to antibiotics will develop immunity to drugs (Labonté & Ruckert, 2019). Ultimately leading
to ineffective treatments to infections that were once easy to treat (AMR Industry Alliance,
2017). Alas, the number of new antibiotics has been declining for the past 30 years (ISGlobal,
2018). In fact, only three new antibiotics have been approved causing the development
pipeline to ‘almost run dry’ (Khanal et al., 2017). On the other hand, extremely resistant
bacteria prove to be as contagious as any other bacterial infection; spreading from one person
to another (ISGlobal, 2018).
Consequently, aspects of globalization acerbated the AMR challenge (Labonté & Ruckert,
2019). According to Labonté and Ruckert (2019), globalization can be defined as a "process
of greater integration within the world economy through movements of goods and services,
capital, technology, and labor, which lead increasingly to economic decisions being
influenced by global conditions". For instance, increased global travel plays a crucial part in
the spread of AMR (Labonté & Ruckert, 2019), resulting the bacteria to be carried to even
remote communities of the world (Palmer & Call, 2013). Another possible route for spreading
AMR is international trade which is the lifeline of economic globalization. Operations that
trade in livestock often use aggressive infection methods to manage the rapid speed of
infectious diseases. This includes the preventive use of antibiotics that later carries resistant
bacteria presented in food. Similarly, to the increased mobility, trade-in medical tourism also
carries concern to the spread of AMR (Labonté & Ruckert, 2019). Beyond the impact on
2
Governing Health in a Global Context
Author: Juweriya Jamal Salah
Student number: i6245651
Course number: MGH4004
Number of words: 2942
Maastricht, 23 October 2020
, First Essay
Introduction
The rise of antimicrobial resistance (AMR) – bacteria, viruses, fungi, and parasites resisting
antibiotics, antivirals, antifungals, and antiparasitics (WHO, 2020a) – has become a serious
global health problem with nearly 700.000 death per year (Montfort, 2019). This specific
emerging threat is due to the rapid growth of antibiotic resistance (Howard et al., 2014),
which is caused by the incorrect use, overuse, or misuse of antibiotics (Ferri et al., 2017).
Depending on severity, AMR can increase the length of hospitalization, the chances of severe
medical complications, and the resource use and cost of healthcare (Cosgrove, 2006). It has
also become apparent that AMR is an economic concern, accumulating a cost of US$2.9
trillion by 2050 (Labonté & Ruckert, 2019). However, there is no easy answer to this
problem. The focus of this essay will therefore be the complexity of AMR as a global health
challenge as well as the challenges and solutions of the World Health Organization (WHO),
pharmaceutical companies, and local communities. Furthermore, the power dynamics will be
discussed when seeking to govern this global health problem.
AMR, its complexity and globalization patterns
The introduction of antibiotics in the 1940s is considered to be an important milestone in
human history. For the first time, deadly infectious diseases were no longer a threat to the
public health (Palmer & Call, 2013). These potent "miracle" drugs eliminated bacteria and
have saved millions of lives. The ultimate success of defeating bacterial infections paved the
way for achieving advances in medicine and surgery (Khanal et al., 2017). However, success
soon became a twist in international public health when bacterial resistance to antibiotics
increased rapidly (Ferri et al., 2017).
In contrast to the above-mentioned, the development of AMR is a natural process. This occurs
when microorganisms are exposed to antibiotic drugs. Under the selective pressure of
antibiotics, bacteria without natural resistance to drugs will be killed or inhibited. However,
bacteria that are naturally resistant or acquire it later (through mutation) will have a greater
chance to survive (Khanal et al., 2017). Because of this, bacteria that are repeatedly exposed
to antibiotics will develop immunity to drugs (Labonté & Ruckert, 2019). Ultimately leading
to ineffective treatments to infections that were once easy to treat (AMR Industry Alliance,
2017). Alas, the number of new antibiotics has been declining for the past 30 years (ISGlobal,
2018). In fact, only three new antibiotics have been approved causing the development
pipeline to ‘almost run dry’ (Khanal et al., 2017). On the other hand, extremely resistant
bacteria prove to be as contagious as any other bacterial infection; spreading from one person
to another (ISGlobal, 2018).
Consequently, aspects of globalization acerbated the AMR challenge (Labonté & Ruckert,
2019). According to Labonté and Ruckert (2019), globalization can be defined as a "process
of greater integration within the world economy through movements of goods and services,
capital, technology, and labor, which lead increasingly to economic decisions being
influenced by global conditions". For instance, increased global travel plays a crucial part in
the spread of AMR (Labonté & Ruckert, 2019), resulting the bacteria to be carried to even
remote communities of the world (Palmer & Call, 2013). Another possible route for spreading
AMR is international trade which is the lifeline of economic globalization. Operations that
trade in livestock often use aggressive infection methods to manage the rapid speed of
infectious diseases. This includes the preventive use of antibiotics that later carries resistant
bacteria presented in food. Similarly, to the increased mobility, trade-in medical tourism also
carries concern to the spread of AMR (Labonté & Ruckert, 2019). Beyond the impact on
2
