Silent pandemic of Antimicrobial Resistance

In Context

• The rapidly rising Antimicrobial Resistance rates need an accelerated, multi-sectoral, global and national response.

About the Antimicrobial Resistance

• About:
  • Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. 
• Difference between Antibiotic & Antimicrobial resistance:
  • Antibiotic resistance refers specifically to resistance to bacteria. Antimicrobial resistance refers to resistance to bacteria, viruses, fungi and parasites.
• Causes:
  • Antibiotic resistance occurs when bacteria evolve to evade antibiotics. Overuse and misuse of antibiotics are the biggest drivers of resistance. 
    • That means that the more we use antibiotics, the worse the problem of antibiotic resistance becomes.
  • Other drivers of antimicrobial resistance include: 
    • The lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, 
    • Poor infection and disease prevention and control in healthcare facilities and farms, 
    • Poor access to quality, affordable medicines, vaccines and diagnostics, 
    • Lack of awareness and knowledge.

Issues

• Difficulty in treating infections:
  • Microbial resistance to antibiotics has made it harder to treat infections such as pneumonia, tuberculosis (TB), blood-poisoning (septicaemia) and several food-borne diseases. 
• Rising health cost:
  • AMR also imposes a huge health cost on the patient in the form of longer hospitalisation, health complications and delayed recovery. 
  • AMR adds to the burden of communicable diseases and strains the health systems of a country. 
• Other patients also at risk:
  • It puts patients undergoing major surgeries and treatments, such as chemotherapy, at a greater risk. Many times, patients recover from advanced medical procedures but succumb to untreatable infections.
• Antimicrobials in the agri-food system:
  • There is also an urgent need to reduce the usage of antimicrobials in the agri-food system. Scientific evidence suggests that the less antimicrobials are used, it is less likely that there will be an emergence of drug resistance. 

Various report findings on AMR

• OECD:
  • In 2019, AMR was associated with an estimated 4.95 million human deaths. 
  • A 2018 report by the Organisation for Economic Co-operation and Development (OECD) warned of a phenomenal increase, by 2030, of resistance to back-up antibiotics (second and third-line).
• ICMR study:
  • An Indian Council of Medical Research (ICMR) study in 2022 showed that the resistance level increases from 5% to 10% every year for broad-spectrum antimicrobials. 
• INSAR study:
  • Indian Network for Surveillance of Antimicrobial Resistance (INSAR) study indicated a high rate of resistance to commonly used drugs such as ciprofloxacin, gentamicin, co-trimoxazole, erythromycin and clindamycin.
• WHO findings:
  • WHO has increasingly expressed concern about the dangerously high levels of antibiotic resistance among patients across countries. 
  • Take the example of ciprofloxacin, an antibiotic commonly used to treat urinary tract infections. 
    • According to WHO, resistance to ciprofloxacin varied from 8.4% to 92.9% for Escherichia coli (E. coli) and from 4.1% to 79.4% for Klebsiella pneumoniae (a bacteria that can cause life-threatening infections such as pneumonia and intensive care unit- related infections). 
  • The global epidemic of TB has been severely impacted by multidrug resistance as patients have less than a 60% chance of recovery.

India’s efforts against AMR

• Surveillance & research:
  • India has committed to strengthening surveillance and promoting research on newer drugs. 
• Data reporting and private sector engagement:
  • It also plans to strengthen private sector engagement and the reporting of data to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other standardised systems.
• The National Action Plan on Antimicrobial Resistance:
  • The National Action Plan on Antimicrobial Resistance (2017-21) emphasised the effectiveness of the government’s initiatives for hand hygiene and sanitation programmes such as Swachh Bharat Abhiyan, Kayakalp and Swachh Swasth Sarvatra. 
• Food production:
  • The government has also attempted to increase community awareness about healthier and better food production practices, especially in the animal food industry. 
• The National Health Policy guidelines:
  • The National Health Policy 2017 also offered specific guidelines regarding use of antibiotics, limiting the use of antibiotics as over-the-counter medications and banning or restricting the use of antibiotics for growth promotion in livestock. 
  • It also called for scrutiny of prescriptions to assess antibiotic usage in hospitals and among doctors. 
• Everything in these policies now needs strong implementation on the ground.

Way ahead

• As the current G-20 president, and as a country vulnerable to this silent pandemic, India’s role is critical in ensuring that AMR remains high on the global public health agenda.
  • The various G-20 health summits spread through 2023 offer 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 stop use of antibiotics that are important for human health in animals; 
  • No use of antibiotics for growth promotion in animals; 
  • More government investment in research and innovation for new antibiotics; 
  • Explore use of vaccines to prevent certain infections due to AMR organisms in humans and animals; 
  • Special focus on combating TB and drug-resistant TB.