Antimicrobial Resistance: A challenges to public health : Daily Current Affairs

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.

Antimicrobial resistance (AMR) is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections. Antibiotic resistance is a subset of AMR, which applies specifically to bacteria that become resistant to antibiotics.

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.

Government effort to curb AMR

  • National Programme on AMR Containment: India has given due cognizance to the problem of Antimicrobial resistance (AMR) and to tackle this issue, Government of India launched a “National Programme on AMR Containment” during the 12th five-year plan (2012-2017) which is being coordinated by NCDC. The network of labs is being expanded in a phased manner and currently includes 35 state medical college labs in 26 States/UTs.
  • The National Health Policy 2017 highlights the problem of antimicrobial resistance and calls for effective action to address it.
  • The Food Safety and Standards Authority of India (FSSAI) in 2019 banned the use of antibiotics and several pharmacologically active substances in fisheries and food items.

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

International efforts to curb AMR

  • AMR was recognized as a serious public health threat by WHO in 2013. The South East Asian Regional Office (SEARO) conducted several meetings to plan and adopt means of tackling AMR in the Region.
  • The "Global Action Plan" to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed by the World Health Assembly in May 2015 in resolution WHA67.25. The goal of the plan is to ensure 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 World Health Organization has promoted the first World Antibiotic Awareness Week running from 16 to 22 November 2015. The aim of the week is to increase global awareness of antibiotic resistance. It also wants to promote the correct usage of antibiotics across all fields in order to prevent further instances of antibiotic resistance. World Antibiotic Awareness Week has been held every November since 2015.

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.