Antimicrobial Resistance

SYLLABUS

GS 2: Social Justice: Health

REFERENCE NEWS

AMR Awareness Week:18-24th November:  Educating teachers and students on antimicrobial use and resistance. (Down to Earth)

WHAT IS ANTI-MICROBIAL RESISTANCE(AMR)?

• Antimicrobials are substances designed to eliminate or suppress the growth of microorganisms. This category encompasses antibiotics, fungicides, antiviral drugs, and agents targeting parasites.
• AMR occurs when microbes such as bacteria, viruses, parasites, and fungi become resistant to antimicrobial treatments to which they were previously susceptible.(UNEP)
• Microorganisms that develop resistance to antimicrobials are sometimes referred to as “superbugs”.

CURRENT STATUS OF AMR 

• A recent report from the Global Research on Anti-microbial Resistance (GRAM) project found that:
  •  In 2019, an estimated 4.95 million people suffered from at least one drug-resistant infection and AMR directly caused 1.27 million deaths. 
  • AMR is one of India’s major public health problems, directly contributing to about 30% of deaths due to neonatal sepsis across India. These are due to multidrug-resistant (MDR) hospital-acquired infections in many cases. 
  • Over 30% of the COVID-19 deaths in India could be attributed to our failure to treat the secondary bacterial infections caused by MDR pathogens with the appropriate antibiotics.

DEBUNKING THE MYTHS!

WHAT CAUSES AMR:

Natural evolution:

• Bacteria develop antimicrobial resistance naturally as part of co-evolution. As we get stronger, microbes will get stronger too.

Irrational use of antibiotics:

• Taking antibiotics unnecessarily or failing to complete a course of antibiotics enables the microbes that were initially able to avoid the effect of the antibiotics to attain resistance, multiply and thus pass their resistance on.

Use of antibiotics in livestock:

• Antibiotics are used in animals to treat infections, for growth promotion and for prophylactic purposes to prevent disease. Hence, there is high levels of antibiotic resistance in veterinary sectors, which can spread to humans.
• Ex: Colistin, a last line antibiotic meant for therapeutic purposes, was highly misused in poultry industry as a growth promoter. This was identified as one of the reasons for anti-microbial resistance in India and government banned its use in animals in 2019.

Weak infection prevention and control:

• Hospitalised patients are a major reservoir of resistant microbes. Poor water, sanitation and hygiene (WASH) in health care facilities can cause hospital-acquired infections that accelerate bacterial mutations.

Poor hygiene and sanitation:

• Contaminated wastewater from homes, hospitals, pharmaceutical industries and livestock farms finds its way into natural water sources, soil and crops. This hastens the spread of antibiotic-resistant pathogens, and increasing human antibiotic consumption.

Mass bathing rituals:

• Mass bathing as part of religious ceremonies is common in India. However, pollution levels are high along holy rivers like Ganga and can expose people to high levels of faecal coliform (E.coli) bacteria.

No new antimicrobial developments: 

• No new classes of antibiotics have made it to the market in the last three decades. This is a result of inadequate incentives for their development and production.
• A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies. 
• The exit of big pharma from antibiotic development coupled with a lack of investment from venture capitalists to support the commercial viability of antibacterial agents has pushed AMR into a global health crisis.

THREATS FROM AMR:

• Next pandemic: Antimicrobial resistance is spreading rapidly worldwide, and has even been likened to the next pandemic – one that many people may not even be aware is happening.
• Increase healthcare expenditure: Abundant capital would be required to manage the AMR crisis in future. As per an estimate it may cost up to US$ 100 trillion by 2050.(nih.gov)
• Affect curative healthcare: Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and surgeries like caesarean sections become very high-risk.
• Loss of Human Lives: It is responsible for upto 7 lakh deaths a year. E.coli and MRSA (MethicillinResistant Staphylococcus Aureus) are among the drug-resistant bacteria that led to most deaths. It is estimated that 10 million annual deaths would be caused by it post 2050.

Source: UNEP

STEPS TAKEN TO ADDRESS AMR

WAY FORWARD

1. Enhanced Environmental Governance: Strengthen the role of environmental authorities in all National Action Plans (NAPs). This involves formulating laws, best practice codes, and policy guidelines to curb environmental discharge of pollutants linked to AMR.
2. Data Collection and Analysis: Gather comprehensive data on antibiotic types, their usage patterns, and agricultural practices contributing to resistance. This foundational knowledge is essential for informed decision-making and effective interventions.
3. Improved Surveillance and Reporting: Enhance systems for monitoring, surveillance, and reporting of AMR to ensure timely and accurate information flow.
4. Adopting the 'One Health' Approach: Implement a holistic 'One Health' strategy to understand the environmental aspects of AMR. This approach integrates human health with that of animals, plants, and the broader environment, aiming for optimal public health outcomes.
5. Investment in Research and Development: Significantly invest in the research and development of new antibiotics, accessible diagnostics, and infection control methods. Utilize resources like the AMR Action Fund, which commits over $1 billion for developing new antibiotics and filling current funding gaps.
6. Responsible Use of Antimicrobials and Global Learning: Promote the prudent use of antimicrobial drugs. Learning from successful global initiatives can be pivotal, such as Peru's patient education to minimize unnecessary antibiotic prescriptions, and the EU's VALUE-Dx program, which has advanced the use of point-of-care diagnostics leading to more judicious drug consumption.

Addressing antimicrobial resistance requires a holistic, globally coordinated approach that transcends traditional boundaries, blending science, policy, and public engagement to safeguard future public health.

PRACTICE QUESTION

Q: "Assess the impact of Antimicrobial Resistance (AMR) on India's healthcare and suggest measures for enhancing the country's response, particularly through public health policies and environmental management."(15marks, 250words)