Context:

A recent multi-country study published in The Lancet Infectious Diseases journal has shed light on the alarming gap in access to appropriate antibiotics for treating drug-resistant infections in low- and middle-income countries (LMICs), including India.

Scope and Methodology

The research specifically focused on carbapenem-resistant Gram-negative (CRGN) infections—one of the most dangerous classes of antibiotic-resistant bacteria. The study assessed nearly 1.5 million CRGN infection cases across eight LMICs: Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan, and South Africa.

Data was derived from The Lancet’s Global Burden of Antimicrobial Resistance (GRAM) study and pharmaceutical data from IQVIA for the year 2019.

The researchers estimated two primary parameters:

1.       The total need for treatment, i.e., the number of drug-resistant bacterial infections.

2.      The number of individuals who were potentially initiated on appropriate treatment, with an emphasis on CRGN infections.

Key highlights of the study:

·        The study, conducted by the Global Antibiotic Research and Development Partnership (GARDP), highlights that only 7.8% of patients with drug-resistant infections in India received appropriate antibiotic treatment.

·        This is marginally higher than the 6.9% average observed across the eight studied countries, but remains a deeply concerning statistic given the severity of such infections.

·        India’s case stands out in terms of both the scale of infection and the mismatch between need and access. According to the study:

·         In 2019, India recorded nearly 10 lakh (1 million) CRGN infections.

·         Of these, less than 1 lakh (approximately 78,000) patients received appropriate antibiotic treatment.

·         This represents a 7.8% access rate, indicating a wide treatment gap.

·         The modelling suggests that approximately 3.5 lakh (350,000) deaths occurred in India due to these infections in 2019 alone.

Way forward:

·        The Global Access Gap and Actionable Steps: The UN political declaration on AMR highlights that more people die from the lack of access to effective antibiotics than from AMR itself. The magnitude of this access gap remains poorly understood due to limited monitoring capacities. To address this, the SECURE Antibiotic Facility has been established to support global and regional access initiatives.

·        India’s Role in Addressing the Access Gap: India’s commitment to ensuring timely and equitable access to medical tools, including antibiotics, must now translate into concrete action. The National Programme on AMR Containment, ICMR, and CDSCO must prioritize regulations that address both timely access and the responsible use of new antibiotics.

·        Expanding Access and Controlling Resistance: India faces the growing threat of drug-resistant infections, requiring a focus on expanding access to life-saving antibiotics for critically ill patients, particularly those with MDR infections. At the same time, the country must control irrational use to prevent further resistance.

·         Collaboration and the Role of SECURE: India should draw lessons from the TB programme model and collaborate with international organizations. Implementing initiatives like SECURE and establishing a pooled procurement system will ensure controlled, nationwide access to new antibiotics, safeguarding their long-term effectiveness.