2nd December 2019 -The Hindu Editorials Notes : Mains Sure Shot

Note – There is another article on Indian economy and why a boost in consumption is important. These have been already mentioned earlier in the articles of 16th September, 16th October and 18th October.

Question – What is antimicrobial resistance (AMR)? Where does India stand in this and what are the steps that can be taken?

Context – Antibiotic Awareness Week, November.

What is antimicrobial resistance?

• According to WHO, Antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.
• In simple terms, Antimicrobial resistance is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe. The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics.
• The resistance to antibiotics in germs is a man-made disaster. Irresponsible use of antibiotics is rampant in human health, animal health, fisheries, and agriculture. While in humans antibiotics are primarily used for treating patients, they are used as growth promoters in animals, often because they offer economic shortcuts that can replace hygienic practices. Globally, use of antibiotics in animals is expected to increase by 67% by 2030 from 2010 levels.

Analysis of AMR in India:

• Antimicrobial resistance (AMR) has emerged as a major threat to public health estimated to cause 10 million deaths annually by 2050. India carries one of the largest burdens of drug-resistant pathogens worldwide.
• NDM-1 reported in 2008, rapidly spread to other countries was named after India’s capital. (New Delhi metallo-beta-lactamase 1 (NDM–1) is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections.) Its first case was reported in India hence it is so it was named. From India it spread to other countries.
• India is one of the largest consumers of antibiotics worldwide, and antibiotic sale is increasing rapidly.
• AMR develops when microbes develop mechanisms to evade the action of antimicrobials. The factors that contribute to AMR include irrational and overuse of antibiotics.

Actions taken to prevent AMR in India:

• In India, various actions have been taken including setting up of a National Task Force on AMR Containment (2010), “Chennai Declaration” by a consortium of the Indian Medical Societies (2012), Setting of Indian Council of Medical Research national surveillance network of laboratories, “Redline” campaign for educating public and National Action Plan on AMR 2017.
• The Indian government banned the manufacture, sale and use of colistin in the poultry industry from July. Colistin is considered the last-resort medicine to treat a person with life-threatening infection.
• The government’s move is among the numerous steps that will contribute to global efforts to preserve and prolong the efficacy of antibiotics and prevent the world from moving towards a dark, post-antibiotic future.

The dangers of AMR:

• The indiscriminate use of antibiotics is the greatest driver in selection and propagation of resistant bugs. It has the potential to make fatal even minor infections. Complex surgeries such as organ transplantation and cardiac bypass might become difficult to undertake because of untreatable infectious complications that may result post-surgery.
• No new antibiotic is available to deal with AMR patients at present. The pipeline for the discovery, development and dissemination of new antibiotics has virtually dried out. No new class of antibiotics has been discovered in the past three decades. The reason is simple. Availability of a new antibiotic takes 10-12 years and an investment of $1 billion. Once it comes into the market, its indiscriminate use swiftly results in resistance, rendering it useless.

Global initiatives to deal with AMR:

• The Sustainable Development Goals have articulated the importance of containing AMR. 
• Similar articulations have been made by the UN general Assembly, G7, G20, EU, ASEAN and other such economic and political platforms. Earlier, the O’Neill report on AMR warned that inaction in containing AMR is likely to result in annual mortality reaching 10 million people and a 3.5% fall in global GDP by 2050.
• Inter-country development agencies (WHO, FAO, and World Organisation for Animal Health) developed a Global Action Plan on AMR. 
• India developed its National Action Plan on AMR (NAP) in 2017. It is based on the One Health approach, which means that human health, animal health and the environment sectors have equal responsibilities and strategic actions in combating AMR.

What can be done/ way ahead:

• Implementation of India’s NAP needs to be accelerated.
• The health of humans and animals falls in the domain of State authorities, and this adds complexity to the nationwide response. 
• The magnitude of the problem in India remains unknown. Intensive  surveillance needs to be done in both humans and animals so that the alertness can be channelised accordingly.
• The FAO has assisted India in forging the Indian Network for Fishery and Animals Antimicrobial Resistance for the generation of reliable data on the magnitude of the problem and monitoring trends in response to control activities. It is critical to expand and sustain such surveillance networks.
• There is an urgent need to augment capacity for regulatory mechanisms, infection control practices and diagnostics support, availability and use of guidelines for therapy, biosecurity in animal rearing practices and understanding the role of the environment and the engagement of communities. 
• Also there is a need for integrating AMR education in medical education. 
• India needs to start the subspecialty of infectious diseases and strengthen laboratory services.
• Every hospital needs to have an AMR policy including infection control, improvement in hygiene, and sanitation and antibiotic use. 
• An element of research needs to be integrated into the AMR policy and encouragement of the pharmaceutical industry to develop “superbug antibiotics.” Unless AMR is addressed effectively the gains made in health are likely to be lost.