India suspects that an international conspiracy to damage its multi-billion dollar medical tourism industry is behind the global scare triggered by a report on an antibiotic-resistant superbug originating from South Asia.
The superbug dubbed New Delhi metallo-ß-lactamase-1 or NDM-1 has been detected in British Columbia, Alberta and Ontario in addition to over 100 cases being reported in Pakistan and India.
A Belgian man became the first known fatality from NDM-1 earlier this. The unnamed man had been hospitalised in Pakistan for a leg injury caused by a car accident, and died after being repatriated to a hospital in Belgium.
France said this week that it will start start screening patients treated in foreign hospitals, especially in Asia, for the NDM-1 bacterium after the alarm was sounded by a British journal, The Lancet Infectious Diseases.
Researchers said they had identified dozens of cases among Britons who had travelled to South Asia for medical tourism.
Health tourists risked infection and the superbug could spread, they warned.
Canadian doctors have so far played down the dangers of the superbug spreading saying those infected can be treated with a cocktail of antibiotics, as was the case of a patient in Brampton, Ontario this week, who reportedly has recovered.
Dr. Dylan Pillai, a medical microbiologist with the Ontario Agency for Health Protection and Promotion, has been studying evolution and movement of NDM-1 since it was first discovered in New Delhi a few years ago.
He told the Toronto Star that the enzyme’s appearance is likely linked to patterns of antibiotic usage. The problem stems from certain areas overusing antibiotics, prompting bacteria to evolve and produce resistant enzymes like NDM-1.
Some people infected with the bacteria can be treated by a cocktail of antibiotics, but for others the infection will simply run its course and disappear, said Pillai.
Either way, people concerned they been infected should consult a doctor.
The World Health Organisation this week urged national governments to “be alert to the problem of antimicrobial resistance and take appropriate action.”
Without naming India, the WHO said, “Countries should be prepared to implement hospital infection control measures to limit the spread of multi-drug resistant strains and to reinforce national policy on prudent use of antibiotics, reducing the generation of antibiotic resistant bacteria.”
The WHO mentioned the Lancet article and said that it had raised awareness about the serious issue of antimicrobial resistance (AMR), the ability of micro-organisms to find ways to evade the action of the drugs used to cure the infections they cause.
The governments must focus control and prevention efforts in four main areas, the WHO said. The most important aspect is ban on over-the-counter sale of anitibiotics as is prevalent in India.
The study on superbug New Delhi metallo-ß-lactamase-1 in the journal Lancet had led to a huge controversy in India and the Indian government had dismissed the report as an attack on medical tourism in the country.
India had also objected to the superbug, which has been identified as closely linked to the Indian subcontinent, being named as NDM-1 (New Delhi Metallo-1).
New Delhi said there was need to find out whether some “ulterior motives” were behind the claim and added that a major pharma company had funded the study.
“It (superbug) is universal and is found in the intestine of humans and animals. It is wrong to say that it is found only in India and Pakistan. They say it was found in patients who visit India and Pakistan. The study nowhere mentions if the bacteria were found even before those persons visited India,” Health Minister Ghulam Nabi Azad said.
Pointing a finger at pharmaceutical companies, Azad said: “The study was funded by a pharma company which is one of the biggest antibiotics maker in the world.”
Minister of State for Health Dinesh Trivedi said India cannot take the reports lying down and should get to the bottom of it.
“We are all concerned about it. The superbug is a global phenomenon. It is not area or country specific. I can tell you this with all the responsibility under my command,” he said.
With Kumarswamy Kartikan, one of the co-authors of the report, disassociating from the report, Trivedi said: “Obviously, we have to find out if there are some kind of ulterior motives or not of some pharmaceutical industries as well. I personally feel that sometimes, some things are commercially motivated.”
In an attempt to counter any adverse effects of the study, the tourism ministry sought to reassure that India is a “safe and preferred medical tourism destination”.
An official spokesman of the tourism ministry stated: “India is fast emerging as a global medical health care destination because of its world class medical facilities which are manned by highly qualified doctors and paramedics. Almost all Indian hospitals servicing medical tourists are accredited either by Joint Commission International (JCI) or National Board for Accreditation of Hospitals and Health Care and follow international safety standards.”
The members of the Hospital Infection Society India (HISI) and Indian Association of Medical Microbiologists (Delhi Chapter) said that the study needs to be critically analysed in the light of the fact that it has been funded and sponsored by a pharma company.
According to HISI all major hospitals in India have well defined Hospital Infection Control programmes. Moreover, in many hospitals of India the infection indices are now monitored using National Healthcare Safety Network (NHSN) data as a benchmark tool as per international standards.
“India is emerging as a hub for providing quality medical care at an affordable cost. It appears the study is economically motivated to prevent people from indulging in medical tourism in this region, besides promoting the antibiotic,” said T.S. Jain, president, HISI.
India’s booming global medical tourism industry, which is estimated at $100-billion competes with more than 35 countries including Mexico, Cuba, Thailand and Singapore that are also promoting their own medical systems to foreigners.
Canadians account for about 7 per cent of the global medical tourism market, according to a recent study by McKinsey & Co. The bulk of Canadian’s medical tourism travel is to the U.S.