ANTI
MICROBIAL RESISTANCE – SCIENCE
News:
A manifesto for tackling
the silent pandemic of AMR
What's
in the news?
●
Most countries understood in 2020 the
clear and present danger of COVID-19, forcing governments, including India's,
to respond with speed and accuracy. The
rapidly rising AMR rates also need an accelerated, multi-sectoral, global and
national response.
●
As the current G-20 president and as a
vulnerable country, India has a key role in ensuring that AMR remains high on
the global health agenda.
Key
takeaways:
●
Microbial resistance to antibiotics has
made it harder to treat infections
such as pneumonia, tuberculosis (TB), blood-poisoning (septicaemia) and several
food-borne diseases.
●
AMR also imposes a huge health cost on the patient in the form of longer
hospitalisation, health complications and delayed recovery.
●
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.
●
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).
●
AMR adds to the burden of communicable diseases and strains the health systems of a
country. 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.
Muscat
Ministerial Manifesto on AMR:
●
Third
Global High-Level Ministerial Conference on Antimicrobial Resistance
(November 24-25, 2022) held in Muscat, where over 30 countries adopted the
Muscat Ministerial Manifesto on AMR.
●
The Muscat Manifesto recognised the need
to accelerate political commitments
in the implementation of One Health action for controlling the spread of AMR.
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It also recognised the need to address the
impact of AMR not only on humans but also on animals, and in areas of
environmental health, food security and economic growth and development.
●
The conference focused on three health targets such as
a.
Reducing the total amount of
antimicrobials used in the agri-food system at least by 30-50% by 2030.
b.
Eliminating the use in animals and food
production of antimicrobials that are medically important for human health.
c.
Ensuring that by 2030 at least 60% of
overall antibiotic consumption in humans is from the WHO "Access"
group of antibiotics.
●
The manifesto encourages countries to
prioritise their national action plans for AMR keeping the One Health approach.
a.
The One Health approach requires all
stakeholders to work together towards an integrated programme linking
challenges of humans, terrestrial and aquatic animals, plant health, food and
feed production and the environment.
b.
This approach will enable the world to
effectively prevent, predict and detect the health crisis induced by AMR.
●
Tackling AMR requires constant monitoring of antibiotic consumption,
identifying the types and quantities of antibiotics being used.
●
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.
Antimicrobial
Resistance:
●
Antimicrobial Resistance is the resistance acquired by any microorganism
(bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs that are
used to treat infections.
●
Microorganisms that develop antimicrobial
resistance are sometimes referred to as “superbugs”.
●
It occurs when a microorganism changes
over time and no longer responds to medicines making infections harder to treat
and increasing the risk of disease spread, severe illness and death.
●
The World Health Organisation (WHO) has
identified AMR as one of the top ten
threats to global health.
Reasons
for the Antimicrobial Resistance:
1.
Antibiotic consumption in humans:
● Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics.
2.
Social factors:
●
Include self-medication.
●
Access to antibiotics without
prescription.
● Lack of knowledge about when to use antibiotics.
3.
Cultural Activities:
● Mass bathing in rivers as part of religious mass gathering occasions.
4.
Antibiotic Consumption in Food Animals:
● Antibiotics which are critical to human health are commonly used for growth promotion in poultry.
5.
Pharmaceutical Industry Pollution:
● The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
6.
Environmental Sanitation:
● Untreated disposal of sewage water bodies - leading to contamination of rivers with antibiotic residues and antibiotic-resistant organisms.
7.
Infection Control Practices in Healthcare Settings:
●
A report on hand-washing practices of
nurses and doctors found that only 31.8% of them washed hands after contact
with patients.
Impacts
of AMR:
|
Global efforts |
Indian efforts |
|
Global Action Plan on Antimicrobial
Resistance (GAP): Globally,
countries committed to the framework set out in the Global Action Plan1 (GAP)
2015 on AMR during the 2015 World
Health Assembly and committed to the development and implementation of
multisectoral national action plans.
Tripartite Joint Secretariat on
Antimicrobial Resistance: Tripartite joint secretariat (FAO, OIE and WHO) has been established and is hosted by WHO to
drive multi-stakeholder engagement in AMR.
Interagency Coordination Group (IACG) on
AMR: It
was convened by the Secretary-General of the United Nations after the UN
High-Level Meeting on Antimicrobial Resistance in 2016. The
IACG brought together partners across the UN, international organizations and
individuals with expertise across human, animal and plant health, as well as
the food, animal feed, trade to formulate a plan for the fight against
antimicrobial resistance.
World Antimicrobial Awareness Week
(WAAW):
WAAW was previously called the World Antibiotic Awareness Week. From 2020, it
will be called the World Antimicrobial Awareness Week. It
is a global campaign that aims to raise awareness of antimicrobial resistance
worldwide.
Global Antimicrobial Resistance and Use
Surveillance System (GLASS): WHO launched it in 2015 to continue
filling knowledge gaps and to inform strategies at all levels. GLASS
has been conceived to progressively incorporate data from surveillance of AMR
in humans, surveillance of the use of antimicrobial medicines, AMR in the
food chain and the environment.
Global Antibiotic Research and
Development Partnership (GARDP): A joint initiative of WHO and the Drugs
for Neglected Diseases Initiative (DNDi), GARDP encourages research and
development through public-private partnerships. By
2025, the partnership aims to develop and deliver five new treatments that
target drug-resistant bacteria identified by WHO as posing the greatest
threat. |
●
To prevent the Over the counter sales of
antibiotics, the Central Drug Standard
Control Organization (CDSO) prohibits medical stores from selling 24 key
antibiotics without a doctor's prescription.
●
India’s Red Line
campaign:
Which demands that prescription-only antibiotics be marked with a red line,
to discourage the over-the-counter sale of antibiotics– is a step forward.
●
National Health
Policy, 2017,
terms antimicrobial resistance as one of the key healthcare issues and
prioritizes the development of guidelines regarding antibiotic use and check
on restricting the growth of antibiotics.
●
The National
Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 has
assigned coordinated tasks to multiple government agencies involving health,
education, environment, and livestock to change prescription practices and
consumer behaviour and to scale up infection control and antimicrobial
surveillance.
●
FSSAI has set certain
guidelines limiting the antibiotics in food products such as fish and honey. |
WAY
FORWARD:
●
AMR
was a serious global health threat and could not be "overshadowed by other
competing public health priorities".
●
India has committed to strengthening surveillance and promoting research
on newer drugs. 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 (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.
●
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 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.
●
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
as follows.
○
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 and special focus on combating TB and
drug-resistant TB.