Typhoid ‘superbug’

EDITORIAL: The explosion of typhoid cases in northern Pakistan, especially cases of extensively drug-resistant typhoid (XDR-typhoid), threatens to make the disease incurable once again; not just here but also in other countries where its variants are now being found. It turns out that XDR typhoid is a strain of “suberbug” that emerged in Pakistan in 2016. It is resistant to almost all antibiotics that are supposed to treat the disease, limiting options for cure and increasing the death rate.

Now, of the roughly nine million people that contract typhoid fever across the world every year, the vast majority are infected by a drug-resistant strain. Yet at home we know what the reasons are, and the big worry is that not nearly enough is being done to control the spread even as the government knows very well what needs to be done.

Firstly, we have all the conditions for spreading diseases just like typhoid. Many of the country’s 100 million children have not had access to childhood vaccines that prevent typhoid. Then they grow up drinking contaminated water (thought to be the reason for 80pc of diseases in the country). And their systems have become resistant to antibiotics because of their over-use, which of course is only possible because of their over-the-counter availability without any sorts of prescriptions whatsoever.

So, it’s not just that quacks that litter the rural landscape easily prescribe antibiotics for the mildest diseases when they are not needed – which, also, is very much the case – it is also that countless people self-medicate; that is, they just stop at the nearest pharmacy and pick up antibiotics often at the slightest hint of discomfort. And that, as is to be expected, has caused viruses to mutate and become resistant to strong drugs, making them all but incurable in some cases.

XDR-typhoid is just one example of the consequences. According to reports, it began in this country and then quickly became an international phenomenon because of travel to nearby, and then distant, countries. Now it’s got the whole world worried about a superbug in a disease that was considered easily curable a long time ago. At this stage simply preventing over-the-counter sale of antibiotics will not eliminate it, of course, but it is the right point to start.

Efforts must, of course, be made to ensure clean drinking water and living conditions for millions and millions of households across the country, but the problem that triggered this variant, and which must be fixed first, is the deregulated medical sector that is responsible for such malpractice on such a large scale. A country with the highest poverty and illiteracy rates in the world is bound to suffer more than its fair share of medical problems, and such problems are compounded when so-called doctors prescribe remedies that ultimately strengthen viruses, making them drug-resistant.

Typhoid is also a contagious disease; hence the news about a few boys falling sick in some district of Peshawar quickly leading to much of their school being compromised. A few years ago, it would not have taken more than a few pills to cure them and send them back to their studies. But now they are forced into hospitals housing 4-5 sick children per bed, with few signs of things getting better anytime soon.

Such situations require very serious attention from the state. They result from the cocktail of problems that are typical of poor, third-world countries with extremely high population, poverty and illiteracy levels. The poorest suffer the most, of course, and since have the least resources, such problems come with a powerful multiplier effect. Still, it is the government’s responsibility to get a handle on these things at the end of the day. And that element has been missing from the reaction to the typhoid surge so far.

Copyright Business Recorder, 2024