In line with the recommendations made by the World Health Organisation (WHO) in 2021, the Department of Drug Administration (DDA) has issued a directive against the use of 103 types of antibiotics and combination antibiotics, and manufacturers, importers and distributors are expected to comply with it. The step is aimed at minimising the overuse and misuse of antibiotics, which contribute to the development of anti-microbial resistance, thus reducing the effectiveness of drugs. The DDA has said it would neither register these antibiotics nor allow their use. It is not that these antibiotics are harmful, but there is no rationale for encouraging their use, according to the DDA. Further studies need to be carried out to see if these non-recommended drugs are indeed harmful. Of the 103 antibiotics drugs not recommended by WHO, 14 types are currently registered with the DDA. The DDA has given drug-stores six months, after which the antibiotics not recommended by WHO must be removed from the shelves.

Antibiotics form the most commonly prescribed medication to cure diseases caused by bacteria – both minor and life-threatening infections. However, anti-microbial resistance caused by excessive use has been a matter of concern for health professionals and the consumer at large. And there is evidence to prove this. India, for instance, has the second highest overall antibiotics consumption in the world, and it also has one of the highest rates of antibiotic resistance in the world. Just like India, Nepal too sees haphazard sale and consumption of such drugs, driven by the over the counter availability of cheap antibiotics due to weak compliance and enforcement of prescription-only regulations. Anti-microbial resistance (AMR) is a major threat to human health, causing an estimated 70,000 deaths worldwide and a loss estimated to cost one trillion dollars by 2030.

The extent of the devastation caused by bacterial AMR could be as big as malaria or HIV with the highest burden in low income countries. Thus, it is wise of the DDA to link its directive with the National Action Plan on AMR to reduce deaths from AMR and economic loss that patients suffer from unnecessary prescription.

To prevent the use of those antibiotics not recommended by WHO, the DDA has already directed the concerned government agencies not to renew letters of credit for importing them. Manufacturers will also not be allowed to import raw materials for the manufacture of these 103 types of antibiotics. However, given the open border with India, where as many as 57 of these antibiotics are marketed, people living along the border can avail themselves of these banned drugs in the Indian market. Thus, if doctors, especially those practicing medicine in the towns close to the border, did not prescribe these antibiotics, the patients would not buy them. The government has the onus to strictly monitor the drug stores, especially operating along the border points, to see that the banned drugs are not sold. However, the government alone cannot do all this. Other stakeholders, like importers and distributors, have equal responsibility to remove these 103 types of antibiotics from the shelves of the drug-stores over time.

Why to Ramarosan?

The federal, provincial and local levels are clueless about the flocking of hundreds of foreign tourists from 10 countries in the remote Ramarosan area of Achham district, where they are going to hold an 'international conference'. There is no official confirmation of the conference being held in the remote part of the district. Neither government officials are in the know about the said conference nor has anyone published details about their motive. The Ramarosan area is not a very popular tourist destination, nor are there any basic amenities to accommodate hundreds of foreign tourists.

Considering the fishy motives of the visiting tourists, the Achham district administration has stopped them at the entry points, seeking clear directives from the Ministry of Home Affairs in Kathmandu. All the tourists, except Indian nationals, have valid passports and visas to visit the country. But it is unclear whether they need special permits to visit the less-travelled Ramarosan area, which has also not been declared off-limits to foreign tourists. All of them arrived in Achham via India using land routes. It appears that the government's intelligence agencies have failed to gather information about their intended visit to the area.

A version of this article appears in the print on September 20, 2023, of The Himalayan Times.