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Sirajul Hoque

What was your experience working in the pharmaceutical sector during COVID-19?
I have been working with Renata Limited Bangladesh, a pharmaceutical company, since 1984 and I have a science background in organic chemistry. My personal experience is that my wife and I were infected with Covid-19 and I had to stay isolated in a hospital for 15 days. Our situation in Bangladesh with Covid-19 was varied. Many, especially people living in the slums, are exposed to the sunlight and hot humid weather throughout the day. Those people were most infected with Covid-19, as they live in very closed quarters. However, despite being infected, they had no symptoms—they were symptom-free. We suspect that due to the high exposure to sunlight, their immunity was heightened. The ICDDRB published a survey in the slum area and found 74% of people living in slums had antibodies of Covid-19 and were asymptomatic.

Covid-19 is a mixed experience for the pharma industry. Many companies ran short of active pharmaceutical ingredients (APIs) and had to stop operating entirely. My company ran short of stock for one and a half months. We needed oxy-tetracycline in powder form, tablet form, and injectable form and we always import these compounds from China. We were most affected at the beginning of the pandemic, in which China stopped shipping its products for two months. As a result, many companies shut down due to limited essential stock. On the other hand, industries that had local manufacturing weren’t affected. Regarding companies in the rural area, distribution didn’t change and nobody really minded Covid-19. But those relying on China and other foreign medicine producers for their APIs had to shut down.

What is your experience around antimicrobial resistance (AMR)?
AMR is a big issue for our country. In my experience, I can pass a visit to the pharmacy, say what I want, and no one asks me questions. I say, “I need 10 antibiotic tablets please”, and it is no problem, no one asks why or for what. No one asks questions.

The major problem with AMR is that people know that antibiotics are not good. If you ask Bangladesh people, they will reply to you that antibiotics are not a good thing. This is what happens—when they feel sick, they purchase over-the-counter pills. Then they consume their 7-day dose for 3-4 days. When they feel better, they throw the rest out. A 7-day prescription should be taken for 7 days, not 3-4 days. There is a misconception on finishing the dose because individuals know that antibiotics are not good. This contributes heavily to AMR. There needs to be increased awareness that even when you feel better, you need to finish the dose.

There are laws and regulations around the overuse of antibiotics. The Bangladesh government issued a law in 2018 regulating the sales of antibiotics, in which you cannot buy medication without a prescription. However, since the pandemic began, the law has not been implemented seriously. Since Covid-19 has taken priority on our agenda, the government’s focus is no longer on AMR. As a result, there are regulations that no one can buy antibiotics without a prescription, but it is not enforced seriously.

What about laws around increasing resistance in agriculture and aquaculture?
Recently our government has banned the use of antibiotics in poultry feed and this has been implemented very strictly. Today, no poultry feed can contain antibiotics. Furthermore, the rules around the restriction of antibiotics for poultry also exist for exported fish.

Today, we are number four globally in total fish production and farmers who export this fish have to follow the rules. The meat that is exported to the EU and rich countries is maintained with probiotics, not antibiotics. This is because when farmers export their meat, they must show a certificate that the meat was raised without antibiotics. If authorities find antibiotics, they will not purchase the food and the farmers will make no income.

Antibiotic-free exported fish is not what people eat. They eat the cheaper meat, with antibiotics of course. Those who are aware of antibiotic-raised fish typically purchase sweet water fish. It is costly, but it is antibiotic-free. As I am aware of the supply chain, when I go to the market, whichever fish is exported to the EU, I buy that fish.

How is the industry working towards preventing AMR?
It isn’t pharma that insists on selling antibiotics, it is the farmers. There are two reasons. The first is that the farmers think they are the doctors. Despite the restrictions and available alternatives, farmers use antibiotics because they think it is better for fish and meat.

The second reason is that farmers are struggling because they have to bear the cost. Managing fish ponds with probiotics or other alternatives has a cost. If farmers want to shift to this alternative, they suffer. For instance, tilapia fish is considered a premium product. People do not want to give money for premium products, but they want it for the lowest price. If consumers do not want antibiotics in their premium product, but they also don’t want to pay the costs, then this isn’t possible for the farmers. We must assist farmers to shift to alternatives, or else they will continue to use antibiotics because they cannot afford the loss of income.

As a representative for Renata for many years, I am witnessing the shift from selling antibiotics to probiotics. One way we are advocating against AMR is by organizing meetings with farmers on how to reduce antibiotic overuse. We are now training them on probiotics and demonstrating to the farmers how to keep a clean farm environment, manage water and oxygen level to enhance their quality of food.

Finally, and interestingly from an economic standpoint, as people increase their income, they are more willing to buy antibiotic-free products at a higher price. Besides, the portion of buyers who want good quality products is slowly increasing in the local market. Things are changing! This is why we are advocating for probiotics. So more people can purchase better, antibiotic-free food.

- Sirajul Hoque, Director of Animal Health Division, Renata Limited, Bangladesh

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