Wise drug choices

In 1998 it joined forces with the Independent Practice Associations and the Pharmacy Guild to tackle a growing issue of concern to health professionals – the misuse of antibiotics.

Antibiotics are used to attack potentially harmful bacteria, but as part of their normal defence against this attack the bacteria can become
‘used to’ or resistant to particular antibiotics.

That sees the antibiotics lose their effectiveness.

“It’s very easy to say with all these new infections, we just need new antibiotics. No, we make sure that the antibiotics we’ve got we use well,” says PHARMAC’s former medical director, Peter Moodie.

In 1998 the Ministry of Health sounded the alarm about growing antibiotics resistance, convening a national committee to look into the issue.

A particular area of concern was the overuse of antibiotics during the winter months, when doctors were prescribing them unnecessarily for patients with colds and influenza, which are viral infections. Those who were taking antibiotics often weren’t completing their prescribed regime, exacerbating the problem further.

“It is time to explode the myth that antibiotics are a cure-all for winter ailments. They are not,” said Prime Minister Jenny Shipley in May of 1999 as she launched the Wise Use of Antibiotics national campaign.

"The misuse of these drugs actually reduces their effectiveness, meaning people need increasingly potent and expensive antibiotics to cure simple ailments.”

The Prime Minister had put her finger on a key issue for PHARMAC, which spent tens of millions of dollars a year on purchasing antibiotics. If antibiotic resistance grew, the agency would need to fund increasingly expensive pharmaceuticals to treat a whole host of resulting health ailments.

PHARMAC took a leading role in what was to become an annual campaign that initially centred on doctor practices, with posters, leaflets and media coverage. Over the years, the Wise Use of Antibiotics broadened to appeal to the general public and crystalised around three key messages:

• Antibiotics don’t do colds and flu.
• Take the lot, no matter what.
• If in doubt, check it out.

Advertisements aired on TV and radio and in newspapers and magazines.

“Do not deploy until you have identified your target!” shouts the stern general in front of his battle-ready battalion of antibiotics in the cartoon advert that aired through the winter of 2007.

“Antibiotics, never forget that bacteria are your only target! Cold and flu are viral, not bacterial infections. A virus is unaffected by antibiotics!”

The funding and other resources PHARMAC contributed to the campaign soon paid dividends. People got the message.

“Evidence from previous campaigns shows very high support for the
campaign by both clinicians and the public, with an overall reduction in antibiotic prescribing of nearly 14.8% (1999 compared with 2000 data), and a reduction in public expectation of receiving antibiotics for colds and flu from 80% to 50% (Colmar Brunton research),” noted PHARMAC’s 2001 Annual Review.

The Wise Use of Antibiotics campaign was to run annually for nearly two decades, with PHARMAC managing it for a decade, and its success informed other advocacy campaigns developed by PHARMAC over the years.

He Rongoā Pai – He Oranga Whānau began as a wānanga for hauora kaimahi who work in Māori communities. It is aimed at improving knowledge and providing information to whānau about the safe and effective use of medicines and includes a component on rongoā Māori.

The Space to Breathe childhood asthma pilot was developed to promote appropriate use of inhaled corticosteroids and self-management education to improve health outcomes for children with asthma and address ethnic disparities in morbidity.

Making a Difference in Dementia was a pilot programme based at two aged residential care facilities in the Wellington region. It explored methods to ensure antipsychotics were prescribed at the lowest effective dose, for the shortest possible time and only for the specific indications in which they had proven benefit.

“Over time we started to think more broadly about public health and pharmaceuticals and how we could help patients avoid having to take pharmaceuticals altogether,” says Wayne McNee, PHARMAC’s general manager at the time Wise Use of Antibiotics was launched.

These campaigns and pilot programmes would define PHARMAC as more than just a pharmaceutical management agency.