Dr N K Ganguly, former director-general of the Indian Council of Medical Research (ICMR), who is among the authors of a white paper on antimicrobial resistance, tells The Indian Express that during the Covid-19 pandemic, the use of antibiotics has increased manifold with a tendency among citizens for self-medicating, leading to indiscriminate use of antibiotics which may result in issues such as increased drug resistance.
“Our white paper recommends harmonious actions across human, animal and environmental health paradigms to deal with the impending public health crisis of AMR,” he said.
How does the issue of anti-microbial resistance (AMR) contribute to the disease burden?
The WHO has recognised antimicrobial resistance (AMR) as a global threat. According to the Interagency Coordination Group on Antimicrobial Resistance, in some member countries of the Organisation for Economic Co-operation and Development (OECD), about 35 per cent of common human infections are already resistant to currently available medicines, and in some low- and middle-income countries, resistance rates are as high as 80 to 90 per cent for some antibiotic-bacterium combinations.
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More than a third of the countries providing data to the WHO in 2017 reported widespread resistance. Of this, India has one of the highest infectious disease burdens in the world and contributes to one-fourth of the global burden of multidrug-resistant tuberculosis.
What initiatives have been taken globally and by India to combat the problem of AMR?
In May 2015, the World Health Assembly had adopted a global action plan on AMR with a clear set of five strategic objectives. Similarly, the World Economic Forum has also identified AMR as a global risk. In India, the government had launched the National Programme on Antimicrobial Resistance Containment during the 12th five-year plan (2012-2017) which was being coordinated by NCDC (National Centre for Disease Control). It also had the Delhi Declaration on Antimicrobial Resistance which was endorsed at the Inter-Ministerial Consultation in April 2017, and a network of 10 state medical colleges was included under the programme as of March 2017. It has been expanded currently to 29 state medical college labs in 24 states and union territories.
Compliance with regulations, which govern antibiotic discharge by pharma manufacturing plants, has been a concern. Please comment.
The national scenario of AMR in India is worrisome. The indiscriminate usage of antibiotics is leading to increased drug resistance and can thwart our health aspirations. India contributes to one-fourth of the global burden of multidrug-resistant TB and more than 30 per cent of neonatal sepsis deaths in India are due to AMR.
The long-term sustainability of the healthcare system also depends on more stringent manufacturing practices in the pharma industry which needs to actively focus on improving processes and treatments to prevent unnecessary antibiotics from being released along with effluents. Establishing a common framework for managing antibiotic discharge, and its standardised application across manufacturing and supply chains at the earliest need to be given top priority.
For instance, India’s 2017 National Action Plan for Antimicrobial resistance talks about imposing limits on antibiotics in industrial waste, but compliance is poor. These regulations will need better implementation with cooperation from the Central Pollution Control Board. Pharma waste can also be treated before release to make it non-hazardous. In fact, management and proper disposal of this waste should form an integral part of industrial practice. It can be said that the pharma sector is also one of the drivers of antibiotic resistance
One of the reasons for the proliferation of AMR is the misuse of antibiotics in veterinary medicine and livestock industry. In terms of regulations and surveillance, what steps have been taken? What should be the way forward?
Improved capacity of drug regulatory bodies may enhance safeguard against antibiotics being sold over the counter and phasing out the use of antimicrobial growth promoters in livestock. The Food Safety and Standards Authority of India (FSSAI) has issued regulations on permissible levels of antibiotic residue in meat and meat products in 2017, effectively restricting the irrational use of these drugs in livestock.
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