[MUSIC] This presentation is about ethical issues associated with EMR. Antimicrobial drugs are medicines that are active against a range of infections such as those caused by bacteria, antibiotics, viruses, antivirals, fungi, antifungal and parasites, including anti malarials. Antimicrobial resistance or AM arises when the microorganisms which cause infection. For example, bacteria, viruses, fungi and parasites survive exposure to the medicine that would normally kill it, kill them or stop them from growing. AMR is one of the greatest public health emergencies of our age. Examples of diseases associated with EMR include tuberculosis, typhoid, fever and malaria. More generally, the total annual number of deaths due to drug resistant infections has been estimated to be around 700,000. Why does bioethics matter in AMR? Bioethics has been described as the scrutiny of ethical issues raised by medicine and biological scientists, ethical issues deal with what is right and wrong, what is just and unjust. Some ethical issues raised by medicine and biological sciences include how to treat private and sensitive medical data, how to allocate scarce medical resources. AMR is an important topic for bioethical analysis, Why? Not only human actions cause or perpetuate drug resistance, but our inactions as well doing nothing. It's not an option, status quo is not an option. Inaction will almost inevitably lead to these undesirable [SOUND] consequences. First, we might no longer have effective means of treating civil infections. Second, medicine's achievement that require effective antimicrobials such as organ transplantation, cancer, chemotherapy, chemotherapy. And major surgery, or even minor surgery may no longer be available. The consequences for health and well being, are inequitably distributed. Populations were already worse off, such as those who live in poverty, living in crowded conditions, poor sanitation and have poor access to healthcare will be most impacted. Also, antibiotics are seen as a common good. These types of goods are special. They're defined among other things by the fact that the individual, each individual who enjoys them contributes to their erosion. What this means is that, the more antimicrobials are used, even if they are therapeutically necessary, the more resistance there will be. It is now widely accepted that the use of antibiotics is the single most important factor leading to antibiotic resistance around the world. So simply using them causes resistance, even when the use is medically indicated to treat infections. Now, what about policies that mitigate AMR? There are also many ethical considerations. Any policies need to balance the interests of today's people and the interests of future generations. Actions or inactions of today's people will impact future generations. These leads to questions about intergenerational justice. And our responsibility today for the well being of future generations. Is it fair to leave future generations without effective antibiotics? How are future generations taken into account in decision making today? This line of questioning sounds familiar. It is the same line of questioning as another major issue now which is climate change. There is a need to balance individual interests and collective interests, which is the interest of everyone. The larger community that is, by preserving the effectiveness of antimicrobials. An important part of ethics is prioritization of other values over one self interest Policies mitigating AMR, most likely limit individual autonomy. The principles of proportionality, necessity and least infringement are important here. The aim is to ensure that the anticipated harms of these policies are justified by the relative anticipated benefits which is proportionality. The infringements of individual liberty are appropriately justified. Necessity and the infringements on liberty are minimized to the greatest extent possible. While still in achieving its aims, least infringement. The emergence of multi drug resistant and extensively drug resistant infections exhibit traditional ethical challenges of infectious diseases control. There are many examples of this in public health measures, including those of COVID, such as mandatory mask wearing and quarantining. Wealthy countries need to think carefully about the obligations to the wider global community, especially those in low resource settings. We are seeking to curb overall antimicrobial usage, but in fact more people die of lack of access to high quality antimicrobials. In low income countries, then die from AMR. Are in high income countries. Hence there is a need to balance access to essential medications, particularly in low and middle income countries. Where the burden of diseases, infectious diseases likely still outweighs the burden of drug resistant infections. In those countries, there is a significant unmet need for antibiotics. What might be some of the ways forward? There are some suggestions here. An author proposed taxing certain use of antibiotics, namely when antibiotics are required to treat minor and self limiting infections such as respiratory drug infections in otherwise healthy individuals, especially in high income settings. Taxation would allow a reduction in consumption. Given certain behavioral economics assumptions [INAUDIBLE]. Could create incentives for people to refrain from taking drugs in the case of mild and self limiting infections. And has the additional benefit of providing financial resources, which could be put to use for the purposes of innovation and conservation of antimicrobials. A specific strategy to combat anti malarial resistance, is to introduce triple combination Artemisinin Therapy Attacked TACT. Artemisinin based combination therapies are currently used for the treatment of uncomplicated malaria. Uncomplicated falciparum malaria in all malaria endemic countries. But, there is an increasing resistance to them. Recent about the emergence of Artemisinin resistance, as well as its partner drug resistance. And leading to subsequent failure in Southeast Asia and the independent of emergence of Artemisinin. Resistance in Africa is worrisome. In response, triple artemisinin based combination therapies attacked are being developed to mitigate the risks associated with these. With this increasing resistance, There is also a need to engage and consult with communities and the public, in any proposed am our mitigation solutions. Including in national action plans Engagement will ensure that we include the voices of communities and individuals impacted by these policies. This will also help improve the ethics of these policies. One example is a project called AMR Dialogues in Thailand, that I'm leading. In conclusion, the approach to any policy should be multidisciplinary, including using a public health ethics lens, which is part of my ethics. While the driving forces of AMR biological, the global societal challenge of AMR, is the result of human and societal practices. And values initiatives to curb these challenges therefore, quickly meet with complex societal, social, political, economic and underlying all these ethical challenges. Therefore, any approach to any policy to mitigate the problem of AMR should be multidisciplinary and include the social, political and ethical dimensions of AMR. I leave here with with these references here. Thank you very much. [BLANK_AUDIO [MUSIC]
