The re-emergence of diseases long thought to have been conquered the world over presents as a major public health challenge over the next decade. Diseases like tuberculosis, malaria and other vector borne diseases along with the rise of multi-drug resistant pathogens present a major challenge to the health and wellbeing of communities the world over, especially in low and middle-income economies. Diseases that afflict humans, typically fall under what may be referred to as the O.N.E. triad, i.e., the old diseases – vector borne, communicable and largely those that have been tackled through public health initiatives over the last quarter of a century. New diseases - lifestyle and non-communicable diseases, which while having existed for centuries, have emerged as a significant health challenge for the world in the past quarter of a century. And lastly, the Emerging diseases – primarily viral in origin, mutations of existing diseases or a new class of diseases that may pose significant challenges for public health over the coming quarter century. Diseases like Zika, Ebola, Yellow fever and West Nile Virus all fall under this category. These diseases, by no means cover the entire spectrum of health challenges posed by pathogens, diseases of genetic origin or those caused due to a longer living population; but do constitute in terms of disease burden, the most significant challenge to public health at large.

 The rise of the old diseases in the past few years has been particularly worrisome. The past quarter century had seen an unprecedented collaboration the world over, with countries, communities and citizens coming together to stem the tide of diseases like tuberculosis, polio, malaria, and infectious diseases. The development of drugs and vaccines, especially antibiotics, their wider distribution along with development of health infrastructure and delivery and better access to sanitation and clean drinking water all contributed in registering wins in our collective battle against diseases. Take for example, smallpox. A disease that has a millennia old history of scourge against humans killed more than 2 million people and afflicted another 10-12 million people in 1967. Concerted action and a wide-ranging vaccine program in that decade ensured that the world was declared Smallpox free in 1979. Similarly, the eradication of polio from the world remains one of the most significant stories of human achievement. The World Health Organization estimates that Polio cases have decreased by over 99% since 1988. From an estimated 350,000 cases then to 74 cases in 2015, the united efforts of the global community helped children and citizens from the crippling clutches of a once dreaded disease. While these notable victories are significant, a new challenge has emerged over the past few years.

 Antibiotic resistance poses the second significant threat to the world. The past few years has seen the rise of mutated forms of common diseases that have developed significant immunity against antibiotics. A recent study in the British Medical Journal on paediatric urinary tract infections by E. Coli, a very prevalent disease causing bacteria, revealed a high level of antibiotic resistance by the bacteria. More worrisome was the higher prevalence of resistance in non-OECD, i.e., low- and middle-income countries. The World Health Organization has called antibiotic resistance an “increasingly serious threat to global public health that requires action across all government sectors and society.” High proportions of resistance by bacteria that cause common infections like urinary tract infections, pneumonia and bloodstream infections have been reported the world over. Similarly, many hospital-acquired infections have been attributed to drug resistant variants of bacteria like Staphylococcus aureus and other Gram-negative bacteria.

The rise of antibiotic resistance can be broadly linked to two emerging patterns in global health. One, the availability and distribution of medicines, especially antibiotics, have had a major impact in improving the health of the world. In many ways, we have become a victim of our success. The easy availability of over-the-counter medications, non-adherence to antibiotic protocols and over prescription has all contributed to the rise of drug resistance the world over, especially in the developing and near-developed world. Second, the changing nature of the bacteria itself has rendered many drugs useless. Significant mutations have been seen in a whole host of bacteria, which shall need newer weapons in our armamentarium to conquer.

Given these challenges, the need for Governments and the pharmaceutical industry to work towards the next generation of antibiotics will be critical. New drug discovery and development shall need to be accelerated. The availability of prescription medication, with punitive control measures would need an effective implementation. Better disease surveillance and the use of technology for treatment compliances are imperative. Educating a whole population on the rise of the diseases of the old would be the most daunting yet widely effective method. On most counts, the Government in India has been laying emphasis on all of these. What is required is for the Government to help create incubators for new drug development, which can lead the charge against drug resistance for the world. Encouraging scientists and industry to work closely together will be a step in the right direction. More needs to be done in curbing the availability of higher generations of antibiotics across the country. Using technology like 2D barcodes or RFID from ‘cleanroom-to-chemist’ to track prescription, sale, administration, and consumption of higher generation antibiotics is a must. Improving the quality of hospitals and civic sanitation will help curb healthcare acquired and community acquired infections. But most importantly, the solution to tackle the diseases of old lies with lay citizens. With rising awareness on the subject, we must do more as a society to ensure that a source for good, the wide availability of medicines, does not become an existential challenge for future generations.