Antibiotic resistance (ABR) arises when bacteria develop resistance to antibiotics. In other words, antibiotics are ineffective against them. It is a common myth that people or animals develop resistance to antibiotics, whereas, in reality, it is germs that become resistant antibiotics.

Vector illustration of superbugs.No gradients used. CMYK. Objects grouped for easy editing. Created with AI CS3.

When AMR becomes dominant in the health sphere of our daily life, it will pose a grave danger to the very existence of human and animal health. It is pervasive for us-humans and our domestic and wildlife animals to get sick due to different bacterial attacks and infections.

According to the UK Government-commissioned Review on Antimicrobial Resistance, by 2050, AMR might kill 10 million people each year. In 2019, an estimated 4.95 million fatalities were linked to bacterial AMR, and AMR caused an estimated 1.27 million deaths. The World Health Organization (WHO) has also raised its concerns about AMR, claiming that it might be the most serious threat to global human health and food security in the upcoming days.

To address this alarming issue, especially in the low-resource settings where community people have unrestricted accessibility to over-the-counter (OTC) antibiotics and have little or no knowledge regarding antimicrobial resistance, expansive community engagement is required.

ARK Foundation along with the University of Leeds has launched a new project titled “Community Solutions to Antimicrobial Resistance (COSTAR)” to address the alarming issue of AMR in Bangladesh. An online launching event was organized on March 13, 2022 to inaugurate the project. COSTAR, a joint initiative by the University of Leeds, ARK Foundation Bangladesh, HERD International Nepal, Chittagong Veterinary University (Bangladesh), Malaria Consortium, University of Liverpool, and the University of Western Australia, is being implemented in Bangladesh and Nepal. The project is being implemented with the support of UK Research and Innovation GCRF collective fund.

The aim of this project is to engage community through participatory approaches to tackle AMR.   The project has several interventions planned to exercise at the community level in Bangladesh and Nepal. The main component of the project is Community Dialogue Approach (CDA) which will be implemented based on two previously funded studies. to them.

Professor Rumana Haque, PhD, Executive Director of the ARK Foundation said in her welcome speech that Antimicrobial Resistance is a growing threat to both human and animal health. The irrational use of antibiotics among humans and animals further worsens the situation. Stressing on the economic impact of AMR, she mentioned a recent study that finds that Bangladesh can face almost BDT 788 thousand crores decrease in GDP by 2050 if AMR is not curbed now. She said that the COSTAR project would prevent antimicrobial resistance in Bangladesh through community dialogue approach (CDA) interventions.

Dr. A H M Enayet Hussain, Director General of Directorate General of Medical Education (DGME) Ministry of Health and Family Welfare, chaired the session. He expressed concerns over the misuse of antibiotics in Bangladesh and urged immediate multisectoral collaboration to tackle the growing antimicrobial resistance in Bangladesh

Dr. Khaleda Islam, Surveillance Lead of AMR Control Program, Fleming Fund, said that it is very important to trace the drivers and factors behind the irrational use of antibiotics at the household level and the decision-maker of using them. Dr. Tahmina Shirin, Director, Institute of Epidemiology, Disease Control and Researchstated that the trend of AMR is constantly rising all over the country for the past five years. The current data suggest that the AMR is rising not only in the hospitals but also in the communities. Motivating community people alone will not enable us to get rid of this problem. We need  revised and regulations to address the irrational use of antibiotic.  She stressed on the importance of increasing country wide effective surveillance mechanism in hospitals to address AMR.

Dr Abul Kalam from USAID addressed the importance of community engagement to solve issues like antibiotic resistance. He acknowledged the community involvement in achieving the country’s freedom in 1971 and said that community engagement has always been a great tool to Bangladesh’s armory. He hoped that COSTAR through its community engagement approach will succeed in tackling AMR in Bangladesh.

Dr. Nitish C Debnath, Country Lead, Fleming Fund, appreciated the multidisciplinary approach of the COSTAR project and hoped that this project will enable the researchers to generate better information.

Dr. Rebecca King, Principal Investigator of the COSTAR project said in her video message that COSTAR will  address the drivers of AMR in Bangladesh and globally in order to help protect antimicrobials and prevent deaths from preventable diseases for future generations.

Dr. Tim Ensor, Professor, University of Leeds, mentioned about the lack of evidence to design interventions to reduce the harmful consequences of AMR. The COSTAR project aims to understand what types of interventions through community engagement might help to address the health and the economic consequences of resistance.

All of the guests, the chair, and the chief guest applauded the initiative in the country and expressed that this project has the potential to become an impeccable example to follow for low-resource settings in the country.

Written by: Badruddin Saify, Research Assistant, ARK Foundation

News Links:

1. https://www.tbsnews.net/economy/corporates/ark-foundation-launches-costar-address-antimicrobial-resistance-384628
2. https://bangladeshpost.net/posts/concern-over-inefficacy-of-antimicrobials-in-bangladesh-81651
3. https://sharebiz.net/%E0%A6%85%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A8%E0%A7%8D%E0%A6%9F%E0%A6%BF%E0%A6%AE%E0%A6%BE%E0%A6%87%E0%A6%95%E0%A7%8D%E0%A6%B0%E0%A7%8B%E0%A6%AC%E0%A6%BF%E0%A7%9F%E0%A6%BE%E0%A6%B2%E0%A7%87%E0%A6%B0/

With 37.8 million adults consuming tobacco products, Bangladesh has one of the largest populations of tobacco users in the world. Although the overall prevalence of tobacco use among adults declined from 43.3 percent to 35.3 percent from 2009 to 2017, the overall prevalence of cigarette smoking is still very high and did not change at all over the period (GATS, 2017). According to the Global Adult Tobacco Survey (GATS) 2017, overall cigarette smoking prevalence is 14 percent among adults and 28.7 percent among men.

The high prevalence of tobacco use and cigarette smoking remains a major health concern for Bangladesh. As a part of its continuous effort to generate effective knowledge and evidence for advocating better tobacco policies, ARK Foundation, Bangladesh with the support of the Tobacco Control Capacity Programme (TCCP) organized a stakeholder engagement meeting to share research findings and gather further insights from the various stakeholders on the main research themes of the TCCP: Illicit trade in Tobacco for Bangladesh and Implementation of Article 5.3 of the Framework Convention on Tobacco Control (FCTC).

The workshop was helpful in circulating the recent evidences on the aforementioned issues and discussing possible interventions to reduce the illicit trade of such products. The workshop was attended by policymakers, health experts, development workers, academicians, policy advocates, and youths. They emphasized the importance of implementing evidence-based policies to reduce the prevalence of illicit trade and called for greater cooperation among all stakeholders to tackle industry interference in Bangladesh. The participants called for strengthened cooperation among all stakeholders and recommended stronger implementation of policies to achieve tobacco-free Bangladesh by 2041.

২৬ ডিসেম্বর আর্ক ফাউন্ডেশন নিম্ন এবংমধ্যম আয়ের দেশগুলোতে তামাকজনিত ক্ষতি কমানোর লক্ষ্যে গবেষণা সক্ষমতা বৃদ্ধি বিষয়ে একটি অংশীজন মতবিনিময় সভার আয়োজন করে। যুক্তরাজ্যের গ্লোবাল চ্যালেঞ্জস রিসার্চ ফান্ডের টোব্যাকো কন্ট্রোল ক্যাপাসিটি প্রোগ্রামের তত্ত্বাবধানে এই সভার আয়োজন করা হয়।

অধ্যাপক রুমানা হক তামাক কোম্পানীর অবৈধ হস্তক্ষেপ বিষয়ে তাঁর প্রবন্ধে বলেন, গবেষণায় অংশগ্রহণ করা অধিকাংশ মানুষ মনে করেন যে তামাক কোম্পানিতে সরকারের শেয়ার থাকা তামাক নিয়ন্ত্রণে বড় বাঁধা হয়ে দাঁড়াচ্ছে।

তিনি বলেন, বাংলাদেশে তামাক নিয়ন্ত্রণ করতে হলে আর্টিকেল ৫.৩ এর অতি দ্রুত বাস্তবায়ন প্রয়োজন এবং একই সাথে বাস্তবায়নকারী সংস্থার সক্ষমতা বাড়ানো প্রয়োজন সভায় অবৈধভাবে সিগারেট উৎপাদন এবং বিক্রি বিষয়ে আরো একটি গবেষণা প্রবন্ধ উপস্থাপন করেন ঢাকা বিশ্ববিদ্যালয় অর্থনীতি বিভাগের সহযোগী অধ্যাপক এবং আর্ক ফাউন্ডেশনের গবেষক এস এম আব্দুল্লাহ।

অনুষ্ঠানে বিশেষজ্ঞ আলোচক হিসেবে উপস্থিত ছিলেন জাতীয় রাজস্ব বোর্ডের সাবেক চেয়ারম্যান ডঃ নাসির উদ্দিন আহমেদ, স্বাস্থ্য অর্থনীতি ইউনিটের পরিচালক (গবেষণা) ড. মো. নুরুল আমিন ও সেন্টার ফর ল এন্ড পলিসি আফেয়ার্সের সেক্রেটারি এডভোকেট সৈয়দ মাহবুবুল আলম তাহিন।

Rumana Huque | Published:  August 26, 2021 21:17:50

Bangladesh is currently the eighth-largest tobacco market in the world. Cigarette production is increasing at a rate of 2 per cent per annum. Bangladesh is one of the largest tobacco consumers in the world with 37.8 million adults aged 15 years and above. It means about 35.3 per cent of the country’s population is consuming tobacco products, according to the Global Adult Tobacco Survey (GATS) 2017.

However, there is a lack of proper monitoring and evaluation in terms of regulating the tobacco industry. The tax structure for tobacco products is also riddled with loopholes. In this context, it is extremely crucial to shed light on the policy lapses in the tobacco industry. The revision of the existing policies and proper enforcement of the policies can bring the tobacco market under control.

REDEFINING TOBACCO TAXATION MECHANISMS:

The taxation mechanism of all types of tobacco products highly matters as it influences the prices of the tobacco products in the market which has implications on public health and government revenue. In Bangladesh, there exists a very complex multi-tiered ad valorem tobacco -tax system. The price of cigarettes is determined according to four-tier cigarettes categorised by the government — premium, high, medium, and low. The tax base and rates vary based on the tiers.  Unfortunately, this differential tax mechanism fails to keep the tobacco market in check as it opens opportunities for product substitution, that is, a person can easily switch from a high or medium-tier cigarette to a low one since the price does not increase similarly across all tiers of the cigarette.

Currently, the retail price that the consumers have to pay to buy cigarettes in Bangladesh is much lower compared to many developing countries. Historically, the tax base of tobacco products in the country has been very low. This is especially true in the case of the low-tier cigarettes and smokeless tobacco products (SLT) such as zarda and gul. The current market structure of cigarettes reveals that around 84 per cent of the total cigarettes supplied in the country comes from the “Medium” and “Low” price slab and the rest 16 per cent is attributed to “High” and “Premium” price slabs. However, there has not been any change in the proposed price (BDT 39) and supplementary duty (SD) of the low-tier cigarette (57 per cent of MRP) in the proposed budget for the year 2021/22. The price and SD of the medium-tier cigarettes also remains the same as last year.

Though the prices of high and premium-tier cigarettes have been increased marginally, there is no change in the SD (65 per cent) compared to last year. This will have a limited impact on the consumption of expensive cigarettes. The prices and tax rates of biri, zarda, and gul have also not been changed in the proposed budget. Such a situation does not do much to dissuade consumers from the consumption of tobacco products. The taxation proposed in the budget will not reduce consumption of low and medium-tier cigarettes as no price and tax change have been essentially proposed. It also keeps the option open for high and premium-tier cigarette consumers to easily switch on to a medium or low-tier cigarette. And when consumers switch to cheaper brands in such a manner, the government also loses high levels of revenue.

Sometimes, the tobacco companies use this tier system to evade taxes. For example, a tobacco company can easily shut down a brand of a medium-tired cigarette and release a similar product under a different brand name in low tier by just changing the price marginally so they have to pay lower taxes. Many tobacco companies are evading taxes by taking advantage of the multi-tiered taxation system and lack of proper monitoring by the government.

NECESSITY OF STRINGENT GOVERNMENT POLICIES:

The government of Bangladesh has its share in a multi-national tobacco company and a number of government officials hold positions on the board of the company. This poses a clear conflict of interest. It also violates the WHO Framework Convention on Tobacco Control of which Bangladesh is a signatory. After the independence of Bangladesh, there were plans to nationalise the big industries which resulted in acquiring shares in the cigarette company. But since no such plans exist now, there is no point in having a share or government presence in tobacco companies.  If we want to impose stricter taxation on tobacco products, there is no alternative to curbing the influence of the tobacco industry on the government. They must stop consulting the tobacco industry about tobacco leaf pricing, divest its shares in the tobacco industry, and ban all forms of tobacco-related CSR programmes. The honourable prime minister of Bangladesh has set a goal that Bangladesh will be tobacco-free by 2040. The government has also started to levy a 1 per cent health development surcharge (HDE) on all tobacco products. The government is committed to reaching that goal but they need to do more.

It is of absolute importance that the government move towards a uniform specific tax structure and reduce the number of tax tiers. This simplifies the tobacco tax-system and makes it easy to administer. With a specific tax system, a regular increase in the price of tobacco will reduce consumption and generate high revenues. The consumption of tobacco cannot be controlled without significantly increasing prices of all types of cigarettes and other SLTs. The government should digitise the monitoring system by adopting unique identifiers (i.e.: barcodes) on the cigarettes and also provide adequate training to the personnel involved in the monitoring. These steps can play a crucial role in reducing tax evasion by companies. Similarly, there should be strict regulation and monitoring of  Biri and SLT products so they can’t evade taxes. Besides, the relevant authorities should also strictly monitor advertising strategies that tobacco companies undertake in the name of CSR activities.

Tobacco cultivation also poses a serious threat to the environment and causes serious diseases to the farmers. But the good thing is that the government of Bangladesh has drafted a tobacco cultivation control policy to limit tobacco farming. The policy targets to increase the production of food crops and dissuade them from tobacco farming. They plan to do so by giving them easy loans and incentives for fertiliser, seeds, and other farm inputs and equipment so that transition can be done easily to the cultivation of other types of crops.

CRAFTING SMARTER ANTI-SMOKING CAMPAIGNS:

Although the tobacco industry cannot market its products openly in any form of media due to existing tobacco laws, they have found smarter ways to promote or encourage smoking. We can often see characters in the movies and television shows smoking. It results in encouraging young people to indulge in cigarette smoking. The anti-smoking awareness programmes in the country are very traditional and mostly limited to human chains, rallies, and webinars. There are pictorial warnings about health hazards in the cigarette box. But it does not help much since it is allowed to buy single sticks and most people do not buy whole boxes. As such, they do not come across the warnings. The organisers of the awareness programmes and campaigns need to rethink their approach to combat these issues. Advocacy campaigns should be conducted to discourage filmmakers from showing smoking onscreen. To build national consensus regarding the harmful effects of smoking, social media platforms should be widely and smartly used. Youth idols can be engaged in making people aware of the deadly consequences of smoking. There should also be programmes to assist smokers to break free from their addiction. They should also make the most use of social media to amplify their message.

Dr Rumana Huque is a Professor of the Department of Economics, University of Dhaka and the Executive Director of ARK Foundation, Bangladesh

rumanah14@yahoo.com

Originally Published in The Financial Express Bangladesh

Health systems in both developed and developing countries are now struggling to respond to the challenges posed by COVID-19. Ministry of Health and Family Welfare (MOHFW), Bangladesh has already taken several immediate actions to combat COVID-19. ARK Foundation proposes to develop a ‘Comprehensive National COVID-19 Response Management Policy’ under the leadership of MOHFW of Bangladesh, outlining short, medium and long-run action plans. The policy must adopt a whole-society approach, consider both preventive and curative measures, and strengthen the World Health Organisation’s six building blocks of the health system.

To strengthen the health service delivery to address COVID-19, ARK Foundation recommends:

Short term actions

1. Prioritise safety of health professionals, procure and distribute personal protective equipment (PPE) as per need
2. Update treatment protocols, guidelines and manuals to include new knowledge and evidence

Medium and long-run action

1. Develop ‘District level planning’ to assess the need of each district, and allocate resources based on need, develop the capacity of diagnosis and treatment at district and sub-district levels, and procure and distribute test kits as per requirement across the districts.
2. Plan for increasing the capacity of government hospitals at national, district and sub-district levels to diagnose and treat patients, including serious and critical patients, requiring mechanical ventilation and intensive care.
3. Adequately address mental health of the people.
4. Coordinate with other ministries and private health care providers for a comprehensive management of COVID-19.

Health service delivery is just one part of the comprehensive plan when considered the entire health system.

More upcoming. Stay tuned.

Read the full article here:

Effectiveness of tobacco control initiatives is subject to the status of trade regulations of a region. As a direct effect of trade liberalisation by many countries, the world has experienced stimulation in trade volume of tobacco and tobacco products in recent years. Reduction in trade barriers might increase possibility of tobacco marketing and reduce their price causing higher consumption of tobacco. This effect of liberalisation on consumption is more prominent in low and middle income countries (LMIC) than their high-income counterparts according to researcher Taylor and Bettcher.

Similar to licit trade of tobacco validated by trade openness among countries, presence of illicit trade in the sector also enhances easy accessibility of tobacco products by undercutting tobacco prices. The extent of illicit trade, therefore, possesses a complex and pressing challenge for effective control of tobacco in any country.

Empirical estimation of the extent of illicit trade in tobacco market often remains as an intricate task because of its stealthy nature. Tobacco researchers around the world quite often triangulate several methods to improve preciseness of measurement of magnitude of illicit trade.

In 24 November 2019, reputed researcher Dr. Rumana Huque, SM Abdullah (Faculty members at Department of Economics, the University of Dhaka) and Nahian Azad Shashi (Research associate at Bangladesh Institute of Development Studies) have written an editorial about illicit trade at business daily The Financial Express (Bangladeshi national English newspaper). Where they underlined to monitor in tobacco trade to reduce Illicit tobacco trade. And they also emphasize on tracking and tracing system for proper implementation of the FCTC protocol on illicit trade. Because it would be the key to addressing the concern over illicit supply of tobacco products. They think addressing underreporting of tobacco trade might help increasing fiscal revenue and making tobacco combat successful in Bangladesh.

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Underreporting in Bangladesh perspective