While the world emerges from the acute phase of the COVID-19 pandemic, the very harmful but invisible epidemic of antimicrobial resistance (AMR) is unfortunately here to stay. Most countries understood the clear and present threat of COVID-19 in 2020, forcing governments including India to respond with speed and precision. Rapidly increasing AMR rates also require a rapid, multi-sectoral, global and national response.
In recent decades, while new drugs have revolutionized human health care, health experts have struggled with disease-causing microbes that have become resistant to drugs. The growing misuse and overuse of antibiotics in humans and animals is threatening the global public health response.
Microbial resistance to antibiotics has made it difficult to treat infections such as pneumonia, tuberculosis (TB), blood poisoning (septicemia) and many foodborne illnesses. AMR also imposes heavy health costs on the patient in the form of prolonged hospitalisation, health complications and delayed recovery. This puts patients undergoing major surgery and treatments such as chemotherapy at greater risk. Many times, patients recover with advanced medical procedures but succumb to untreated infections.
In 2019, AMR was linked to an estimated 4.95 million human deaths. A 2018 report by the Organization for Economic Co-operation and Development (OECD) warned of an unprecedented increase in resistance to back-up antibiotics (second and third line) by 2030.
AMR adds to the burden of communicable diseases and strains the country’s health systems. A study by the Indian Council of Medical Research (ICMR) in 2022 showed that the resistance level to broad-spectrum antimicrobials is expected to increase by 5% to 10% every year. An Indian Network for the Surveillance of Antimicrobial Resistance (INSAR) study indicated high rates of resistance to commonly used drugs such as ciprofloxacin, gentamicin, co-trimoxazole, erythromycin and clindamycin.
India and Muscat Conference
As the current G-20 Chair, and as a country vulnerable to this silent pandemic, India’s role in ensuring that AMR remains high on the global public health agenda is crucial.
India’s commitment was evident at the 3rd Global High-Level Ministerial Conference on Antimicrobial Resistance (November 24-25, 2022) held in Muscat, where more than 30 countries adopted the Muscat Ministerial Declaration on AMR.
The Muscat Manifesto recognized the need to accelerate political commitments in the implementation of One Health Action to control the spread of AMR. It also recognized the need to address the impact of AMR not only on humans but also on animals, and in the areas of environmental health, food security, and economic growth and development.
The conference focused on three health goals: reducing the total amount of antimicrobials used in the agri-food system by at least 30–50% by 2030; Eliminating the use in livestock and food production of antimicrobials that are medically important to human health; and ensure that by 2030 at least 60% of total antibiotic consumption in humans is from the WHO “Access” group of antibiotics.
In his address, India’s Union Minister of State for Health and Family Welfare, Dr. Bharti Praveen Pawar, said that AMR was a serious global health threat and could not be “undermined by other competing public health priorities”.
India is committed to strengthen surveillance and promote research on new drugs. It also plans to strengthen private sector engagement and reporting of data to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other standardized systems.
high level of resistance
The World Health Organization has expressed concern about the countries alarmingly high levels of antibiotic resistance among patients. Take the example of ciprofloxacin, an antibiotic commonly used to treat urinary tract infections. According to WHO, resistance to ciprofloxacin varies from 8.4% to 92.9% for Escherichia coli (E. coli) and from 4.1% to 79.4% for Klebsiella pneumoniae (a bacteria that causes life-threatening complications such as pneumonia and intensive care unit Can cause infection- related infection). The global epidemic of TB is severely affected by multidrug resistance – patients are less than 60% likely to be cured.
The Muscat Declaration seems to respond to the AMR crisis by setting out these three important goals. The declaration encourages countries to prioritize their national action plans for AMR by taking a one health approach. The one health approach requires all stakeholders to work together towards an integrated program linking challenges to humans, terrestrial and aquatic animals, plant health, food and feed production and the environment. This approach will enable the world to effectively prevent, predict and detect AMR induced health crisis. Tackling AMR requires ongoing monitoring of antibiotic consumption, identifying the types and amounts of antibiotics being used.
There is also an urgent need to reduce the use of antimicrobials in the agri-food system. Scientific evidence suggests that the fewer antimicrobials that are used, the less likely it is for drug resistance to emerge. Countries such as the Netherlands and Thailand have reduced their use by about 50%. In China, there has been a sharp decline in the consumption of antibiotics in the agricultural sector. The use of antibiotics in healthy animals has also been reduced in many countries over the past decade to promote growth.
From policy to ground level
The National Action Plan on Antimicrobial Resistance (2017-21) emphasized the effectiveness of government initiatives for hand hygiene and sanitation programs such as the Swachh Bharat Abhiyan, Kayakalp and Swachh Swasth Sarvatra. The government has also attempted to raise community awareness about healthy and better food production practices, especially in the animal feed industry. The National Health Policy 2017 offered specific guidelines regarding the use of antibiotics, limiting the use of over-the-counter medicines and banning or restricting the use of antibiotics to promote growth in livestock. offered to do. It also called for a prescription test to assess antibiotic use among hospitals and doctors. Everything in these policies now needs strong implementation on the ground.
The various G-20 health summits spanning 2023 provide an opportunity for India to ensure that all aspects of AMR are addressed and countries commit to progress. Some key areas for action are: surveillance – both phenotypic and genotypic – of priority pathogens and sharing of data, including through WHO’s Glass platform; regulatory and policy action to prevent the use of antibiotics critical to human health in animals; No use of antibiotics to promote growth in animals; greater government investment in research and innovation for new antibiotics; exploring the use of vaccines to prevent certain infections caused by AMR organisms in humans and animals; Special focus on combating TB and drug resistant TB.
Dr Soumya Swaminathan is former Chief Scientist at the World Health Organization