Table of Contents
THE CONTEXT: Recently, during India’s G20 presidency, the G20 leaders said they would prioritise tackling Antimicrobial Resistance (AMR) following the ‘One Health’ approach through research and development, infection prevention and control.
MORE ON THE NEWS:
- The Delhi Declaration during India’s G20 presidencysaw a commitment to strengthen the global health architecture by building more resilient and inclusive health systems.
- It aims to implement the One Health approach to enhance pandemic preparedness and strengthen existing infectious diseases surveillance systems.
- It aims to prioritise tackling Antimicrobial Resistance (AMR) through research and development (R&D), infection prevention and control, as well as antimicrobial stewardship efforts within respective National Action Plans (NAPs).
- A pledge to facilitate equitable access to safe, effective and affordable vaccines and other medical countermeasures, especially in Low- and Middle-Income Countries, Least Developed Countries was also undertaken.
- One Health approach emphasizes collaboration between human health, animal health, and wildlife sectors to enhance disease surveillance, prevention, and control.
WHAT IS ANTIMICROBIAL RESISTANCE (AMR)?
- AMR is the ability of microorganisms such as bacteria, viruses, fungi, and parasites to evolve to become resistant to antimicrobial drugs such as antibiotics, antivirals, antifungals, and antiparasitic.
- AMR is an urgent global public health threat across human, animal, and plant health sectors, and is often referred to as a silent pandemic.
- It is one of the top 10 global health threats facing humanity, according to the World Health Organization (WHO).
- The Food and Agricultural Organization (FAO) estimates that antibiotic consumption in global agriculture is between 63,000-240,000 tonnes per year.
CAUSES OF AMR
- Over the counter use of antibiotic: There is unnecessary and injudicious use of antibiotic fixed dose combinations that is leading to emergence of bacterial strains resistant to multiple antibiotics. Some of the reasons include self-medication and access to antibiotics without prescription, as there is a lack of knowledge about when to use antibiotics.
- Genetic mutation of microbes: Genetic mutations aretaking place at the level of bacterial chromosome inducing the resistance to antibiotics and leading to rising cases of AMR.
- Poor infection control: There is poor infrastructure of infection control which is one of the leading causes of rising cases of AMR. Wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
- Lack of investment in R&D: There is a lack of investment in R&D to tackle AMR. Declining private investment and lack of innovation in the development of new antibiotics are undermining efforts to combat drug-resistant infections.
ISSUES ARISING OUT OF AMR
- High rate of resistance in commonly used drugs:The Indian Network for Surveillance of Antimicrobial Resistance (INSAR) also found a high rate of resistance to commonly used drugs such as ciprofloxacin, gentamicin, co-trimoxazole, erythromycin, and clindamycin, underscoring the importance of taking steps to combat AMR.
- Large number of deaths: Various researches have shown that antimicrobial resistance (AMR) is a leading cause of death around the world, with a magnitude at least as large as major diseases such as HIV and malaria. An estimated 4.95 million deaths were associated with bacterial AMR, and 1.27 million deaths were directly attributed to bacterial AMR.
- Adds burden to communicable disease: AMR adds to the burden of communicable diseases which affects the health systems. Such as the rising levels of antimicrobial resistance threaten not only public-health gains in the field of infectious diseases but also jeopardises cancer treatment, transplants etc.
- Absence of leadership: There is sub-optimal implementation of policies and programmes for AMR because of the absence of leadership and resources. Unlike TB and HIV/AIDS programs, where civil society organisations (CSO) engagement led to major advancement in increasing coverage of the programs, little CSO engagement has been seen for AMR containment in India.
STEPS TAKEN TO ADDRESS AMR BY G20
- The G20 introduced AMR as a key issue in the 2016 Hangzhou, China summit. The 2017 Hamburg Summitresolved to “maximise the impact of existing and new antimicrobial basic and clinical research initiatives as well as product development”.
- The 2022 Bali Summitcommitted to a multi-sectoral One Health approach and to enable global pathogen surveillance to implement the International Health Regulations (2005).
- G20 member countries have well-developed National Action Plans (NAP) to tackle NAPs. However, there are gaps and variability in NAP as in the maturity of NAP development and operationalisation in terms of policy, medicines management and prescribing systems, and patient and public engagement and involvement.
- Indonesia has developed national surveillance plans, Australia prioritised animal health and committed to reducing antibiotic use in livestock. Brazil has shown a reduction in antibiotic use in humans, and the UK and the US are investing in research to develop new diagnostics, drugs and vaccines. India has also taken steps in the right direction.
STEPS TAKEN BY INDIA
- India has always accorded top priority to One Health and AMR and was one of the first few countries to develop a comprehensive National Action Plan on AMR (NAP AMR) in 2017. Subsequently, the formulation of state action plans was prioritised.
- The National Action Plan on AMR (2017-21) emphasised the effectiveness of the government’s initiatives for hand hygiene and sanitation programmes such as Swachh Bharat Abhiyan.
- The Food Safety and Standards Authority of India (FSSAI) banned the use of antibiotics and several pharmacologically active substances in fisheries. The government has also capped the maximum levels of drugs that can be used for growth promotion in meat and meat products.
- 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.
- There has been a special focus on surveillance and research, both for innovative, affordable interventions and for implementation research, with emphasis on intersectoral connections between human, animal, and plant health and the environment.
THE WAY FORWARD:
- Global and local effort: There is a need for concerted global and local effort to translate the Delhi declaration into implementable action. There is need to work with developing countries to create regional AMR action plans and bring uniformity. Most G20 countries have well-developed NAPs, but their efficacy varies with policy, planning, performance and patient and public engagement.
- Increase surveillance and awareness: There is a need to expand the scope of existing surveillance and monitoring networks currently limited to a few tertiary care hospitals. Another area that requires attention is promotion of responsible behaviour among citizens by educating people on the dangers of overusing antibiotics.
- Involving academia and Civil society Organizations: Academia can help understand the environmental dimensions of AMR better, develop new technologies and provide training and education to healthcare professionals. CSOs can raise awareness and advocate for policy changes.
- Funding and R&D: G20 countries should consider promoting an international funding mechanism that focuses on AMR R&D. Efforts should be made to promote patent reforms for fostering innovation and ensuring affordability in new antibiotics. Dialogue among developing countries to explore models like the Medicines Patent Pool will be useful.
There are rising cases of Antimicrobial Resistance which cause concerns worldwide including in India. Addressing AMR is highlighted as a top priority by the G20 in the Delhi Declaration. Thus, there is a need to develop policies, invest in research and build the ecosystem to reduce the burden of AMR.
PREVIOUS YEAR QUESTION
Q. Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (2014)
MAINS PRACTICE QUESTIONS
Q.1 Antimicrobial Resistance (AMR) is a silent and invisible pandemic that cannot be overshadowed by other competing health priorities. Comment.
Q.2 What are the causes of Antimicrobial Resistance (AMR)? How can India ensure that AMR remains high on the global public health agenda? Explain.Spread the Word