Opinion How to fight back against the toughest diseases
The initial response to anti-microbial resistance was hampered by a lack of quality data. Now, we can address it better
The data generated by the national networks has helped us understand the trends of AMR in the country and where we should be directing our interventions. These efforts are now being expanded to secondary-level hospitals. India also has a hospital-acquired infections surveillance network. 
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Modern medicine is under threat because of the growing burden of antimicrobial resistance (AMR). AMR happens when microbes stop responding to the drugs used against them. The drug-resistant infections are almost impossible to treat and claim many more lives. The initial response to AMR was hampered by a lack of quality data due to absent surveillance systems across the globe, especially in low- and middle-income countries where the burden is the highest. Early projections published by British economist Jim O’Neill in 2014, estimating 10 million annual deaths from AMR by 2050, drew the attention of policymakers and led to some strong actions like consolidation of the Global Action Plan in 2015 and the UN Resolution on AMR in 2016.
In the last decade, there has been notable progress in our understanding of AMR and surveillance of drug-resistant infections. In 2015, WHO launched the first global surveillance initiative — the Global Antimicrobial Resistance and Use Surveillance System (GLASS). It provides a standardised process for countries to share country-level AMR data. As of February this year, 137 countries participated in GLASS. A recent report in The Lancet documented that 1.14 million deaths in 2021 were directly attributable to AMR, with the highest burden in South Asia and Africa. AMR also poses the biggest threat to older adults, as deaths in adults aged 70 and above increased by more than 80 per cent between 1990 and 2021, thus putting countries with rapidly ageing populations at higher AMR risk.
Since the disease burden data from India does not look very different from the estimates published in the reports, this should bring a sense of urgency for greater action towards AMR containment. The data generated by the national networks has helped us understand the trends of AMR in the country and where we should be directing our interventions.
These efforts are now being expanded to secondary-level hospitals. India also has a hospital-acquired infections surveillance network. These initiatives, however, lack a national footprint. The National Essential Diagnostics List mandates that all district hospitals must have a microbiology lab, which is now being implemented in many states. In a few years, we will have AMR data from district hospitals too. India also has a surveillance network for livestock, poultry and fisheries. Efforts have been initiated to monitor antimicrobial consumption. All these need to be sustained and expanded to improve the quality of evidence that can contribute to disease-burden estimations for the country, which will, in turn, guide policies and investments.
This year will be remembered as critical in the fight against AMR. Global leaders in the political declaration at the 79th United Nations General Assembly (UNGA) High-Level Meeting on AMR, including India, committed to reducing human deaths associated with bacterial AMR annually by 10 per cent by 2030. The declaration also called for sustainable national financing and US$100 million in catalytic funding, to help achieve a target of at least 60 per cent of countries having funded national action plans on AMR by 2030.
So far, India has shown tremendous commitment to containing AMR. Too many players, missing governance mechanisms and absence of funding have been recognised as key impediments to an effective rollout of National Action Plans (NAPs) in most countries. But India was among the first few countries to launch a NAP on AMR in 2017.
Going forward, India can do the following to escalate its commitment towards AMR containment. First, as we draft the second NAP on AMR, we should commit to improved governance and accountability at the highest level to achieve the national targets. There is now enough evidence that interventions like infection control in communities and hospitals, improving vaccine uptake, and strengthening diagnostic and antimicrobial stewardship are effective in the containment of AMR by reducing transmission. Investments in healthcare systems will therefore be crucial in our fight against AMR. Third, investments to translate research into the development of new drugs, diagnostics and vaccines will enable us to respond better to crises. While sustaining the ongoing efforts, India needs to commit to ambitious action on AMR to better respond to the crisis and protect people’s health.
The writer is senior scientist and programme officer, AMR, Indian Council of Medical Research
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