Exclusive: Kiwi war on superbugs downsized

"We are falling behind our international commitments," officials warned of the antimicrobial resistance action plan. Photo / 123rf.com

The rise of so-called superbugs that are resistant to antibiotics could make infections untreatable and medical treatment like chemotherapy unsafe.

Briefings to the Health Minister - obtained by the Herald - show New Zealand's official response hit problems soon after its launch.

Deadly "superbugs" resistant to antibiotics are spreading but efforts to protect New Zealanders have been cut back because of a lack of funding.

Documents obtained by the Herald show a five-year "antimicrobial resistance action plan" floundered amidst a $10 million a year funding shortfall. Milestones were missed and it has now been scaled down.

The rise of microorganisms that have become resistant to drugs could make common infections untreatable, and surgery and medical treatments increasingly unsafe. They also pose a huge threat to agriculture, and New Zealand industry is worried climate change could worsen the problem.

Already, about 700,000 people worldwide die each year because of drug-resistant infections.

The World Health Organisation (WHO) estimates that toll could rise to 10 million within 30 years, as poor sanitary conditions and the misuse of antibiotics given to both people and animals turbo-charges the threat.

There have been recent non-fatal cases at Middlemore Hospital's burns unit and the neonatal wing of Wellington Hospital.

In August 2017 the National-led Government launched the landmark antimicrobial resistance action plan, with key milestones including improving infection control and public education. Progress is reported to the WHO, but problems emerged almost immediately.

"We are already scaling back the AMR action plan after its first year implementation and we are falling behind our international commitments," officials told Health Minister David Clark in an October 2018 briefing.

Time had mostly been spent on trying to coordinate the various agencies involved, the briefing noted, with other critical activities scaled back or pushed to outlying years "which will negatively impact on overall delivery of the action plan". Those included a survey on susceptible bacteria in animals, now done over three years rather than in the first year.

In the same briefings, officials repeatedly stressed the risk posed by antimicrobial resistance.

"If we do not successfully address this threat now, there are likely to be wide-ranging impacts for New Zealand. The ability to treat infections in humans, animals and in the wider agriculture sectors will affect all New Zealanders, but the most vulnerable will be Maori and Pacific peoples, children, the health-impaired and the elderly.

"Within the primary industries sector, there is also increasing concern regarding the potential interplay between climate change impacts and AMR. Rising temperature results in an increase in the prevalence of certain diseases, both in animals and plants."

The action plan is funded from within existing budgets of the Ministry of Health and Ministry for Primary Industries. Both agencies were soon making clear $10m a year was needed "to ensure effective implementation".

Extra funding does not appear to have been given, and in March this year Clark was told the plan had been "refined" to "deliverables that are achievable within existing resources".

"We anticipate there may be some concern expressed with the proposed revisions, particularly the reduction in expected number of activities for year two and three," the Ministry of Health advised.

In releasing the documents, Clark's office said the first year of the action plan "emphasised the need to tailor the objectives for the New Zealand context and ensure that the relevant issues are being addressed".

That includes more focus on surveillance efforts to determine if resistance is developing in New Zealand, or is mainly imported. The plan is being updated and will be published soon, Clark's office said.

"While some milestones in the five year plan have been deferred, a range of AMR related activity is ongoing. This includes surveillance activity undertaken by the Institute of Environmental Science and Research."

New Zealand hospitals have recorded cases of so-called superbugs. Photo / Michael Craig

Further questions were referred to the Ministry of Health. Dr Caroline McElnay, the ministry's deputy director of public health, said it was working with MPI and others to "refine, prioritise and deliver efforts to minimise AMR over the coming years".

Steps taken so far include developing guidelines to prevent and control the Carbapenemase-producing Enterobacteriaceae (CPE) superbug, promoting proper use of antibiotics, and contributing to a standards review relating to antimicrobials and infection control.

"AMR is a global public health threat and we, like other countries, are treating it as a global health priority."

Asked if the $10m needed to properly implement the plan had been delivered, or any extra funding, McElnay said the ministry "has dedicated resource", but the action plan was part of its existing budget and work programmes.

"The Ministry of Health, Ministry for Primary Industries, DHBs and other interested stakeholders continue activities working towards minimising AMR and the impact of resistant organisms in New Zealand."