Relevance: GS-2: Issues relating to the development and management of Social Sector/Services relating to Health,

Key phrases: AMR, bacteria, WHO, pathogens, over the counter drug, World Antibiotic Awareness Week, GRAM report.

Why in News?

• Antimicrobial resistance (AMR), or antibiotics becoming ineffective because pathogens such as viruses, fungi and bacteria become resistant to them, has long been recognised as a major threat to public health. However, there are few estimates on the scale of the problem and regional variations.

Global Research on Antimicrobial Resistance (GRAM) report:

• 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.
• Its headline finding is that as many as 4.95 million deaths may be associated with bacterial AMR in 2019.
• Estimates included that AMR is a leading cause of death globally, higher than HIV/AIDS or malaria.
• In South Asia, over 389,000 people died as a direct result of AMR in 2019. The death rate was the highest in Western sub-Saharan Africa, at 27.3 deaths per 100,000 and lowest in Australasia, at 6.5 deaths per 100,000.
• Lower respiratory-tract infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most common infectious syndrome.
• The six leading pathogens for deaths associated with resistance were Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
• They were responsible for 3.57 million deaths associated with AMR in 2019.

Drivers of Antimicrobial resistance in India:

• Lack of awareness about infectious diseases in the general masses and inaccessibility to healthcare often preclude them from seeking medical advice.
• This, more often than not, leads to self-prescription of antimicrobial agents without any professional knowledge regarding the dose and duration of treatment.
• Factors such as poverty, illiteracy, overcrowding and malnutrition further compound the situation.
• Among those who seek medical advice, many end up receiving broad-spectrum high-end antimicrobials owing to lack of proper diagnostic modalities for identifying the pathogen and its drug susceptibility.
• Low doctor to patient and nurse to patient ratios along with lack of infection prevention and control (IPC) guidelines favour the spread of MDR organisms in the hospital settings.
• Easy availability of over-the-counter (OTC) drugs, further contributes to AMR.
• The rise in the pharmaceutical sector has caused parallel rise in the amount of waste generated from these companies. With the lack of strict supervisory and legal actions, this waste reaches the water bodies and serves as a continuous source of AMR in the environment.
• Another important challenge could be the use of antimicrobial agents as pesticides and insecticides in the agriculture industry, although the evidence for the same is currently lacking.
• India has vast agricultural lands and farmers already face a lot of adversities at the hands of harsh weather, difficult terrain and natural calamities. They fall an easy prey to the lure of protecting their hard-earned field from pests and rodents by using antimicrobial agents without considering the future consequences.
• This large reservoir of antimicrobial agents forms a favourable niche for the emergence of MDR pathogens who then drift into the water bodies with rains and floods. The paucity of data on the extent of AMR, especially in animals and environment, presents hurdles to framing and implementation of policies on the control of AMR.

Steps to be taken to curb AMR in the environment:

• Promoting further research on the drivers of AMR with due importance to components other than antimicrobial use for human health alone
• Framing of antibiotic stewardship plans for healthcare settings to monitor and ensure judicious use of antimicrobials, including all tiers of healthcare-primary health centres, secondary and tertiary hospitals
• Strict vigilance and control over sale of antimicrobial agents. Prescription audit to bring down the over the counter (OTC) sale
• Disciplinary control over the functioning of hospital effluent plants with periodic assessment and reporting of antimicrobial residue in the discharge
• Regulation of waste water discharges from pharmaceutical companies with regular monitoring of antimicrobial residues in them along with provision of legislative support to punish offenders
• Framing and implementing rules and regulations for the use of antimicrobial agents in food animals including farmed seafood
• Improving agricultural practices by ensuring use of environment-friendly manure and fertilizers
• Educating the masses at the community level regarding AMR and formulating educational bodies/non-governmental organizations for continued dissipation of information.

Way Forward:

• AMR in the environment has been a neglected topic in India so far. With environment in India posing a continuously increasing threat of AMR, urgent steps are necessary to halt its progress and spread. A multispectral and multidisciplinary approach with combined efforts and supervision is required to tackle this problem

Source: The Hindu

Mains Question:

Q. According to GRAM report, India is an AMR capital of the world, in this context discuss the Antimicrobial resistance as a major threat to public health in India? Critically examine.