India has one of the highest levels of antibiotic resistance, which complicates not only the treatment of life-threatening infections but also endangers outcomes in routine hospital procedures. The benefits gained through medical advances are also put in peril when patients contract drug-resistant bacterial infections. The situation has been further complicated by the pandemic, with 3-4 per cent Covid patients acquiring secondary bacterial infections. A recent ICMR study reported a disturbingly high mortality rate of 56 per cent among Covid patients infected with resistant bacterial infections.
The silent pandemic of antimicrobial resistance does not draw the required level of attention and resources. This omission has impacted new drug development — research has stagnated with all major pharma companies exiting the arena. The reasons range from poor return on investment, the complexity of discovering novel antibiotics for multidrug-resistant pathogens, the high cost of bringing a novel antibiotic to the market, and irrational use that renders drugs ineffective and contributes to their short market-life. Worse, antibiotics, recently discovered and developed in the West, do not find their way to India in a timely manner. It took about five to six years for novel antibiotics such as daptomycin and ceftaroline to be introduced in India after their initial launch in the US. Antibiotics such as imipenem/relebactam, and meropenem/vaborbactam, available in the US and EU for more than two years now, are yet to be introduced in India.
The development of the Covid vaccine in India was made possible by the timely infusion of funds as a result of advance purchase payments to companies involved in production. The Covid vaccine story needs to be replicated to support the country’s antibiotic needs.
The bulk of initial drug development happens in small and medium-sized entities and academic institutions that are dependent on external funding and development partnerships . India needs to put together a plan for developing new antimicrobials. As a first step, the government needs to recognise the snags and deficiencies in the production pipeline. Efforts should be initiated to consolidate the country’s existing strengths in pharmaceuticals by engaging relevant actors. Independent studies demonstrating the therapeutic value of novel drugs could contribute to identifying drugs whose development can be undertaken.
Despite constraints, the antibiotic space in India has seen a few successes. The novel combination cefepime-zidebactam discovered in the country, and highly effective against multidrug-resistant pathogens in animal studies and early human studies, has come under the ambit of the US FDA’s QIDP scheme to promote development of antibacterial drugs. It is time that such valuable leads from Indian laboratories mature into ready-to-use drugs for the country’s patients. That will provide a strong impetus to making the country atmanirbhar in healthcare.
This column first appeared in the print edition on August 16, 2021 under the title ‘Vaccine example for medicines’.
Veeraraghavan is Hilda Lazarus Core Research Chair, CMCH, Vellore; Walia is Scientist, Division of Epidemiology and Communicable Diseases, Antimicrobial Resistance Surveillance and Research Network, ICMR
📣 The Indian Express is now on Telegram. Click here to join our channel (@indianexpress) and stay updated with the latest headlines
- The Indian Express website has been rated GREEN for its credibility and trustworthiness by Newsguard, a global service that rates news sources for their journalistic standards.