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Antimicrobial resistance (AMR)

2023 JUL 13

Mains   > Social justice   >   Health   >   Diseases


  • Four multilateral agencies have launched a priority research agenda 2023 to better advocate for increased research and investment in antimicrobial resistance (AMR).
  • The ‘Quadripartite’ — comprising the United Nations (UN) Food and Agriculture Organization (FAO), the UN Environment Programme (UNEP), the World Health Organization (WHO) and the World Organisation for Animal Health (WOAH) — released the One Health Priority Research Agenda on Antimicrobial Resistance.
  • On similar lines, WHO also launched a global research agenda for AMR in human health. The agenda prioritises 40 research topics for evidence generation to inform policy and interventions by 2030.


  • Antimicrobial resistance happens when infection-causing microbes (such as bacteria, viruses or fungi) evolve to become resistant to the drug designed to kill them.
  • Microorganisms that develop resistance to antimicrobials are sometimes referred to as “superbugs”.


Based on estimates from 204 countries and territories, the Global Research on Antimicrobial Resistance (GRAM) report published in the Lancet provides the most comprehensive estimate of the global impact of AMR so far.

  • Its headline finding is that as many as 4.95 million deaths may be associated with bacterial AMR in 2019. In South Asia, over 3.8 lakh people died as a direct result of AMR in 2019.
  • Lower respiratory-tract infections were the most common infectious syndrome. These include pneumonia, bronchitis, and tuberculosis.
  • The six leading pathogens for deaths associated with resistance were Escherichia coli (E-coli), Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
  • The report also shows that 70% of deaths that resulted from AMR were caused by resistance to antibiotics often considered the first line of defence against severe infections.


  • 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.
    • Eg: 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.



  • 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 mortality:
    • Global antimicrobial resistance could make everyday bacterial infections untreatable. By some estimates, AMR could cause 1 crore deaths per year by 2050. This would overtake cancer as a leading cause of death worldwide.
  • Increase healthcare expenditure:
    • The cost of health care for patients with resistant infections is higher than care for patients with nonresistant infections due to longer duration of illness, additional tests and use of more expensive drugs.
  • 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.



  • Global Action Plan on Antimicrobial Resistance (GAP-AMR)
    • Developed by WHO in 2015, the goal of the plan is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way and accessible to all who need them.
    • The objectives of the plan include improving awareness on AMR, strengthening knowledge through surveillance and research, reduce the incidence of infection, optimize the use of antimicrobial agents and increase investment in new medicines and diagnostic tools.
  • Interagency Coordination Group (IACG) on AMR:
    • The objective of the Group will be to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance.
    • It comprises of high-level representatives of UN agencies, other international organizations, and individual experts across different sectors, including animal health, agriculture, environment, and others.
  • Global Antimicrobial Resistance and Use Surveillance System (GLASS)
    • WHO developed the Global Antimicrobial Resistance Surveillance System (GLASS) in 2015. GLASS collects and reports data on AMR rates aggregated at the national level.
    • The system enables comparison and analysis of data and aids in informed decision-making.
  • Global Antibiotic Research and Development Partnership:
    • The GARDP is a not-for-profit organization created by the WHO and Drugs for Neglected Diseases initiative (DNDi) for developing new treatments for drug-resistant infections that pose the greatest threat to health.
  • Quadripartite Joint Secretariat on AMR (QJS):
    • QJS consolidates cooperation between FAO, UNEP, WHO and World Organisation for Animal Health (WOAH) to coordinate the global One Health response to AMR.
  • Global High-Level Ministerial Conference on AMR:
    • It aims to accelerate countermeasures for antimicrobial resistance at the national, regional and global levels and boost international cooperation in this issue.
    • The Muscat Ministerial Manifesto on AMR, which has been agreed upon at the 3rd conference, outlines three global targets:
      • Reducing the total amount of antimicrobials used in agrifood systems by at least 30 to 50 per cent by 2030.
      • Preserving critically important antimicrobials for human medicine and ending the use of medically important antimicrobials for growth promotion in animals.
      • Ensuring that ‘Access’ group antibiotics (a category of antibiotics that are affordable, safe and have a low AMR risk) represent at least 60 per cent of overall antibiotic consumption in humans by 2030.
  • World Antimicrobial Awareness Week (WAAW):
    • 18th to 24th November is World Antimicrobial Awareness Week. It is a global campaign that aims to raise awareness of antimicrobial resistance worldwide.
    • WAAW was previously called the World Antibiotic Awareness Week. From 2020, it was called the World Antimicrobial Awareness Week.


  • National Action Plan on Antimicrobial Resistance (NAP-AMR):
    • Focusing on One Health approach, it was launched in April 2017 with the aim of involving various stakeholder ministries/departments.
    • Delhi Declaration on AMR– an inter-ministerial consensus was signed by the ministers of the concerned ministries pledging their support in AMR containment.
    • Six strategic priorities have been identified under the NAP-AMR:
      1. Improving awareness and understanding of AMR through effective communication, education and training
      2. Strengthening knowledge and evidence through surveillance
      3. Reducing the incidence of infection through effective infection prevention and control
      4. Optimizing the use of antimicrobial agents in health, animals and food
      5. Promoting investments for AMR activities, research and innovations
      6. Strengthening India’s leadership on AMR
    • The Union health ministry is now preparing the National Action Plan on AMR 2.0 converging the ongoing initiatives.
  • State level initiatives:
    • In the line with NAP-AMR three states have launched their state action plan: Delhi, Kerala and Madhya Pradesh.
  • National Anti-Microbial Resistance Research and Surveillance Network:
    • ICMR has established AMRSN to generate evidence and capture trends and patterns of drug resistant infections in the country.
  • AMR Research & International Collaboration:
    • ICMR has taken initiatives to develop new drugs through international collaborations.
    • Eg: ICMR along with Federal Ministry of Education and Research (BMBF), Germany has a joint Indo-German collaboration for research on AMR.
  • National programme on AMR containment:
    • Launched during 12th FYP in 2012-17, under this programme, AMR Surveillance Network has been strengthened by establishing labs in State Medical College.
    • The network of labs is being expanded in a phased manner and currently includes 35 state medical college labs in 26 States/UTs.
  • Initiatives to control overuse or misuse of antibiotics:
    • The Red Line campaign, launched in 2016, began marking prescription-only antibiotics with a red line to curb their irrational use and curb over-the-counter sale of antibiotics without prescription.
    • On the recommendations of ICMR, several fixed dose combinations (FDCs) which were found inappropriate were banned by the DGCI.
    • ICMR worked in collaboration with Indian Council of Agriculture Research, Department of Animal Husbandry, Dairy and Fisheries and the DCGI to ban use of Colistin as growth promoter in animal feed in poultry.
  • National One Health Program for Prevention and Control of Zoonoses:
    • This scheme aims to operationalize “One Health” mechanisms for prevention and control of Zoonoses by strengthening coordination among all stakeholders.
  • Other efforts:
    • The National Health Policy 2017 identifies antimicrobial resistance as a problem and calls for effective action to address it.
    • ICMR worked in collaboration with Indian Council of Agriculture Research, Department of Animal Husbandry, Dairy and Fisheries and the DCGI to ban use of Colistin as growth promoter in animal feed in poultry.
    • Various activities like public conclave, poster and quiz competitions, videos and radio jingles have been developed to create awareness about AMR.


  • Enhance surveillance: Greater action towards monitoring and controlling infections, globally, nationally and within individual hospitals.
  • Improve access to basic services such as clean water, sanitation and vaccines. 
  • Rationalise the use of antibiotics through efforts like red line campaign.
  • Adopt new practices like Combination therapy: This involves using several drugs in combination, rather than one drug on its own. This makes it more difficult for bacteria to evolve resistance, while still successfully treating an infection.
  • Increase funding for developing new antimicrobial drugs, while ensuring that they are affordable to the world.


Q. Antimicrobial resistance (AMR) is considered one of the most significant challenges faced by India. Analyse.