Why is Antimicrobial Resistance a Global Threat?

Antimicrobial resistance (AMR) is a significant threat to global health. It is estimated that around 700,000 people lose their lives to AMR-related diseases each year. If the current trends continue, it is projected that by 2050, AMR could cause the death of 10 million people annually, surpassing the mortality rate of cancer and road traffic accidents. Economically, AMR could decrease the global GDP by 2 – 3.5 %, with a fall in livestock production by 3 % to 8 %, resulting in a total cost of USD 100 Trillion globally.

In India, the challenge is two-fold. On one hand, diseases like Tuberculosis, Cholera, and Malaria are becoming increasingly resistant to drugs. On the other hand, the emergence of new multi-drug-resistant organisms presents new diagnostic and therapeutic challenges. The situation is further complicated by lower awareness about infectious diseases and limited access to healthcare.

Understanding Antibiotic and Antimicrobial Resistance

Antibiotic Resistance: Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria mutate in response to the use of these medicines. It's important to note that it's the bacteria, not humans, that become resistant to antibiotics.

Antimicrobial Resistance: This term is broader and includes resistance to drugs that treat infections caused by other microbes, such as parasites, viruses, and fungi.

What Triggers Antimicrobial Resistance?

1. One of the main causes of the AMR crisis is the uneven and unregulated use of antibiotics. In many developed countries, antibiotics are prescribed even for minor illnesses like the common cold. Implementing stronger regulations on antibiotic prescriptions could help mitigate resistance.
2. Inequalities in access to medicine, excessive use, and poor sanitation services further complicate the problem.
3. When farmers use antibiotics to accelerate the growth of livestock, drug-resistant germs find new ways to enter the environment.

How Can We Prevent Antimicrobial Resistance?

1. The World Health Organisation (WHO) has released guidelines on how to use each class of drugs to treat 21 of the most common infections.
2. Government bodies and Medical Associations must work together to tackle the antibiotic crisis. India's medical societies have adopted the Chennai Declaration to promote stewardship steps.
3. Implementing stricter regulations on over-the-counter sales of antibiotics can help control their misuse.
4. Reducing unnecessary antibiotic use in people and agriculture can prevent the development of resistant strains.
5. Prevent infections from happening in the first place by improving hygiene, access to clean water, infection control in healthcare facilities, and vaccination.
6. Improving the surveillance of superbugs is crucial. The UK has committed $ 300 Million to support microbiology surveillance capacity in developing countries.
7. Pharmaceutical companies and government agencies need to understand the role of vaccines and alternative therapies in reducing antimicrobial resistance.
8. The UK and China have agreed to establish a global research and development fund to attract $ 1.5 Billion in investment to reduce the spread of antimicrobial resistance.

Antimicrobial Resistance in India: An Overview

1. India is among the nations with the highest burden of bacterial infections.
2. It is estimated that pneumonia alone causes the death of 410,000 children aged five or under in India each year, accounting for almost 25 % of all child deaths.
3. The crude mortality rate from infectious diseases in India is 417 per 1,00,000 persons.
4. The Food Safety and Standards Authority of India (FSSAI) has banned the use of antibiotics and several pharmacologically active substances in fisheries. However, the poultry industry still lacks regulation, where many commercially available pre-mixed feeds come with added antibiotics.

Why is Antimicrobial Resistance a Concern in India?

The indiscriminate use of antibiotics in animal farms is a major issue. A 2017 report by the Centre for Science and Environment states that antibiotic misuse in food animal production is one of the main causes of Antimicrobial Resistance (AMR) in India. It spreads the resistant bacteria rapidly and carries it into human food streams. Industrial-scale food producers engage in intensive farming of animals, which involves rearing them in high stocking densities and using high chemical inputs. This leads to the rapid acceleration of resistance.

Certain experts believe that the rapid spread of colistin resistance in humans is not due to the indiscriminate use of antibiotics in hospitals but due to their misuse in farms to accelerate the growth of farm animals. Low doses of antibiotics are being fed to farm animals as growth promoters. This practice is cheap but very harmful as it leads to colistin resistance in humans. Animals don't need colistin, but for humans, it may be a lifesaver. China has banned the use of Colistin in farm animals, and the European Union has banned the use of antibiotic growth promoters in farm animals since 2006.

In response to the growing AMR crisis, the World Health Assembly requested the development of the Global Action Plan (GAP) on antimicrobial resistance in May 2014. The following year, the Sixty-Eight World Health Assembly endorsed the GAP-AMR to tackle antimicrobial resistance, including the most urgent drug-resistant trend – the antibiotic resistance.

Under the aegis of the National Centre for Disease Control (NCDC), the "National Programme on the containment of Antimicrobial Resistance" was launched. The program aims to establish a laboratory AMR surveillance system of 30 Network laboratories, generate quality data on AMR for pathogens of public health importance, strengthen infection control guidelines and practices, and promote the rational use of antibiotics in both healthcare providers and the community.

The Indian Council of Medical Research (ICMR) has established a national network on surveillance of antimicrobial resistance in laboratories based on tertiary care academic centers, targeting medically important index microbes that have been identified by WHO. The Antimicrobial Resistance Surveillance Research Network (AMRSN) established by ICMR started with six reference labs located in four tertiary care medical institutions. The network is being expanded to include 15 more medical colleges/corporate hospitals.

The Government has formed three committees/groups: the Intersectoral coordinating committee, the Technical Advisory Group, and the Core Working Group to address the AMR crisis.

National Action Plan on Antimicrobial Resistance

India released its National Action Plan on Antimicrobial Resistance (NAP-AMR) in 2017, two years after WHO released the Global Action Plan. Only two states, Kerala and Madhya Pradesh, have their State Action Plans.

The goal of NAP-AMR is to effectively combat antimicrobial resistance in India. It has three primary objectives: defining the timeline and allocating the budget to slow the emergence of AMR in India and to strengthen the coordination between various organizations, strengthening knowledge and evidence through surveillance, optimizing the use of antibiotics in all sectors, enhancing investments in AMR activities, research, and innovations, and monitoring and evaluating the NAP-AMR implementations.

The NAP-AMR has five strategic priorities: improving awareness and understanding of AMR through effective communication, training, and education, strengthening knowledge and evidence through surveillance, reducing the incidence of infection through effective infection prevention and control, optimizing the use of antimicrobial agents in health, animals, and food, promoting investments for AMR activities, research, and innovations, and strengthening India’s leadership on AMR.

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