Antimicrobial resistance: the silent threat
- The COVID-19 pandemic has exposed the vulnerabilities of health systems to infectious diseases, and caused millions of deaths around the globe since last year.
- As serious as the current health and economic crisis is, there is a possibility that COVID-19 may be the harbinger of future crises.
- Antimicrobial resistance (AMR) is the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment.
- It is one of the greatest challenges of the 21st century. The World Health Organization Director-General has termed AMR as a slow tsunami that threatens to undo a century of medical progress.
- AMR represents an existential threat to modern medicine. At present it is already responsible for up to 7,00,000 deaths a year.
- Unless urgent measures are taken to address this threat, we could soon face an unprecedented health and economic crisis of 10 million annual deaths and costs of up to $100 trillion by 2050.
CHALLENGES AMR CAN IMPOSE
- Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections.
- Neonatal and maternal mortality will increase.
- All these effects will be felt globally, but the low- and middle-income countries (LMICs) of Asia and Africa will be affected more.
- LMICs have significantly driven down mortality using cheap and easily available antimicrobials. In the absence of new therapies, health systems in these countries are at severe risk of being overrun by untreatable infectious diseases.
CAUSES OF AMR
Drug resistance in microbes emerges for several reasons. These include:
- The misuse of antimicrobials in medicine,
- Inappropriate use in agriculture,
- Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.
- These reasons are compounded by the serious challenge that no new classes of antibiotics have made it to the market in the last three decades.
- This can be attributed to inadequate incentives for their development and production, as a result major pharmaceutical companies have largely abandoned innovation in this space.
WHAT NEEDS TO BE DONE?
- Tackling these diverse challenges requires action in a range of areas –
- In addition to developing new antimicrobials, infection-control measures can reduce antibiotic use. A mix of incentives and sanctions would encourage appropriate clinical use.
- At the same time, it is critical to ensure that all those who need an antimicrobial have access to it (5.7 million people worldwide die annually because they cannot access drugs for infections that are treatable).
- Further, the spread of resistance in microbes needs to be tracked. Surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
- Finally, since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need to ensure sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
- A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics,
- The U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability.
- Other initiatives include Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions, Australian regulatory reforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme.
- Beyond human use, Denmark’s reforms to prevent the use of antibiotics in livestock have led to a significant reduction in the prevalence of resistant microbes in animals, along with the improved efficiency of farming.
- Further, given the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste, there is a need to look into laws such as those recently proposed by India, one of the largest manufacturers of pharmaceuticals, to curb the amount of active antibiotics released in pharmaceutical waste.
LACUNAE IN PRESENT APPROACH
- While the range of initiatives that seek to control the emergence and spread of AMR is welcome, there is a need to recognise the limitations of a siloed approach.
- Current initiatives largely target individual issues related to AMR and consequently, narrowly defined groups of stakeholders (providers, patients and pharmaceutical companies).
- Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand.
- Standard treatment guidelines should be issued to empower providers against such demands, as well as provide point-of-care diagnostics to aid clinical decision-making.
- Policy alignment is also needed beyond the health system. Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
- Successful policies in individual countries are no guarantee of global success.
- International alignment and coordination are paramount in both policymaking and its implementation.
- In this direction, recent papers have proposed using the Paris Agreement as a blueprint for developing a similar global approach to tackling AMR.
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