Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat. WHO has declared that AMR is one of the top 10 global public health threats facing humanity.

How it affects public health and economy

To Public Health

• Medical treatments such as organ transplantation, cancer chemotherapy, diabetes care, and major surgery (for example, caesarean sections or hip replacements) become extremely unsafe as a result of this threat to infection prevention and treatment.
• Without immediate action, we are on the verge of an antibiotic apocalypse — a future without antibiotics in which bacteria become entirely resistant to treatment and simple diseases and mild injuries are once again capable of killing people.
• Failure to treat infections caused by resistant bacteria puts people in danger of dying.
• The gains of modern medicine are jeopardised without effective antibiotics for infection prevention and treatment.
• Antimicrobial resistance jeopardises the Millennium Development Goals and jeopardises the Sustainable Development Goals’ achievement.

To economy

• Antimicrobial resistance raises health-care costs by requiring longer hospital stays, more tests, and the use of more expensive medications.
• As a result, health-care expenditures will rise.
• In the worst-case scenario, the world’s annual GDP will drop by 3.8 percent by 2050 as a result of this.
• In addition, by 2030, 24 million people will be living in extreme poverty.
• On the other side, the gap between rich and poor would expand.

Reasons for Spread of AMR

• Excessive and indiscriminate use of antibiotic fixed dosage combinations could result in the establishment of microorganisms resistant to numerous antibiotics.
• Access to Antibiotics without a prescription.
• A lack of understanding of when antibiotics should be used.
• Religious mass gatherings that include mass bathing in rivers.
• Antibiotics, which are essential for human health, are widely used in chickens to promote growth.
• Untreated sewage disposal in aquatic bodies, resulting in drug residues and antibiotic-resistant organisms contaminating rivers.
• According to a study of nurses’ and doctors’ hand-washing habits, only 31.8 percent of them cleansed their hands after interaction with patients.
• Self-medication
• Antibiotic-contaminated wastewater effluents from antibiotic manufacturing plants contain a significant amount of antibiotics, contaminating rivers and lakes.

Initiatives

• National Action Plan on AMR: It was launched in April 2017 with the goal of involving multiple stakeholder ministries/departments and focuses on a One Health approach.
• Antibiotic Stewardship Program: The Indian Council of Medical Research (ICMR) has launched an antibiotic stewardship programme (AMSP) as a pilot initiative across India to prevent antibiotic abuse and overuse in hospital wards and intensive care units.
• Integrated One Health Surveillance Network for AMR: To assess Indian Veterinary Laboratories’ readiness to join an integrated AMR surveillance network.
• Launched in 2012, the National Programme on AMR containment. The AMR Surveillance Network has been strengthened through the establishment of labs at State Medical College as part of this programme.
• AMR Surveillance and Research Network (AMRSN): The AMR Surveillance and Research Network (AMRSN) was established in 2013 with the goal of generating evidence and capturing trends and patterns of drug-resistant illnesses across the country.
• AMR Research and International Collaboration: In order to strengthen medical research in AMR, the Indian Council of Medical Research (ICMR) has made steps to produce novel drugs/medicines through international cooperation.
• Antibiotics, which are marked with a red vertical line, are not to be used without a doctor’s prescription, according to the Union health ministry’s Anti-Microbial Resistance awareness campaign.

What is to be done?

• Combating AMR calls for a multi-sectoral strategy nestled in the One Health Approach.
• Apart from the collaboration between governments and multi-lateral agencies, the pharmaceutical sector is a key player for the One Health Approach to have the desired impact.
• The functioning of our healthcare systems depend on sustained access to medicines. Disruptions like a pandemic or geopolitical crisis can lead to critical drug shortages and escalate adverse patient outcomes.
• While stabilising the supply chain to absorb future shocks is important, the industry must pivot towards environmentally responsible ways of manufacturing APIs and drugs in finished dosage forms. This is imperative to mitigate AMR resulting from drug manufacturing.
• It’s a difficult effort because India still has low immunisation rates and contaminated drinking water. So, in addition to regulators, private industry, charity organisations, and citizen activists must be involved.
• Private pharmaceutical companies must take responsibility for drug distribution; philanthropic foundations must fund the discovery of new antibiotics; and citizen activists must raise awareness.
• Some urgent steps could include phasing out key human-use antibiotics, such as quinolones, in the animal husbandry sector. Improved cleanliness and immunizations are the only ways to delay resistance, and this requires a multi-stakeholder approach. The rising problem is critical, since once essential antibiotics are lost to humanity, they could be lost for decades.

AMR has the potential to send the globe back to a time before antibiotics, when even minor infections were untreatable. As a result, a One Health Approach is required to restrict AMR through coherence, integration, and multi-sectoral collaboration and activities, as human, animal, and environmental health are all intertwined. Antibiotic resistance breakers (ARBs) are being developed to restore the efficiency of older antibiotic classes.

How to structure:

• Define what AMR means
• Explain how it affects public health and economy
• Now, mention the factors of the reason of AMR
• Suggest mitigation strategies
• Conclude

Reference:

1. https://www.thehindubusinessline.com/opinion/amr-mitigation-must-top-pharma-industrys-agenda/article37041222.ece