Opinion Don’t ignore the threat of antimicrobial resistance

A 2021 report by Lancet, documenting data from 204 countries, estimated that 4.95 million deaths were associated with bacterial AMR, and 1.27 million deaths were directly attributed to bacterial AMR. The magnitude is equal to that of diseases such as HIV and malaria. Sub-Saharan Africa and South Asia had the highest death rates, signifying high susceptibility to AMR.

The rising levels of antimicrobial resistance, driven by excessive antimicrobial use threaten to compromise not only public-health gains in the field of infectious diseases but also jeopardises cancer treatment, transplants etc. G20 countries are home to over 60 per cent of the world’s population. Now, Africa, with 17.89 per cent of the global population, is also a part of the coalition. It will have profound implications for low and middle-income countries with low investments in healthcare infrastructure.

For the intent of the declaration to translate into implementable action, it will require concerted global and local effort. At the global level, some key areas can be prioritised. First would be to work with developing countries to create regional AMR action plans. Most G20 countries have well-developed NAPs. But their efficacy varies with policy, planning, performance and patient and public engagement.

Second, G20 countries should consider championing an international funding mechanism that focuses on AMR R&D.

Third, efforts should be made to promote patent reforms for fostering innovation and ensuring affordability in new antibiotics. Dialogue among developing countries to explore models like the Medicines Patent Pool will be useful.

At the local level, countries need to prioritise implementation of NAPs. India was one of the first countries to develop a comprehensive NAP on AMR (NAP-AMR) in 2017. It saw sub-optimal implementation because of the absence of leadership and resources. There has been a special focus on surveillance and research under the NAP-AMR, both for innovative affordable interventions and implementation, with emphasis on inter-sectoral connections between human, animal, plant health and the environment. We must expand the scope of existing monitoring networks, currently limited to a few tertiary care hospitals, to understand the extent of the problem.

Government initiatives like Free Diagnostic Services and Kayakalp, strict protocols under Indian Public Health Standards have the potential to strengthen AMR containment efforts. Another area that requires attention is promotion of responsible behaviour among citizens by educating people on the dangers of overusing antibiotics. Involving academia and civil society organisations (CSOs) in these efforts is essential. Academia can help understand the environmental dimensions of AMR better, develop new technologies and provide training and education to healthcare professionals. CSOs can raise awareness and advocate for policy changes. Unlike TB and HIV/AIDS programs, where CSO engagement led to major advancement in increasing coverage of the programs, little CSO engagement has been seen for AMR containment in India.

AMR may not be as palpable a pandemic as Covid-19, but with an annual death toll in the same order of magnitude, it represents a clear and present danger. The same impetus, investment and prioritisation as Covid-19 needs to be applied to AMR. Indonesia has developed national surveillance plans, Australia prioritised animal health and committed to reducing antibiotic use in livestock, Brazil has shown reduction in antibiotic use in humans and the UK and the US are investing in research to develop new diagnostics, drugs and vaccines. India has also taken steps in the right direction. By expanding the scope of existing surveillance and monitoring networks, promoting responsible behaviour among citizens and encouraging collaboration among nations, India can lead the way in reducing the burden of AMR.

The writer is senior scientist and programme officer, AMR, Indian Council of Medical Research