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Antimicrobial Resistance: the silent threat

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April 29, 2021

What is the issue?

  • Antimicrobial resistance (AMR) is one of the greatest challenges of the 21st century.
  • Tackling the problem calls for engaging the health, agricultural, trade and environment sectors; here is a look at the various aspects of it.

What is AMR and how serious it is?

  • Antimicrobial resistance is the phenomenon by which bacteria and fungi evolve and become resistant (drug resistance) to presently available medical treatment.
  • AMR is said to be a slow tsunami that threatens to undo a century of medical progress.
  • It is already responsible for up to 7,00,000 deaths a year.
  • Unless urgent measures are taken to address this threat, the world could soon face an unprecedented health and economic crisis.
  • It could lead to 10 million annual deaths and cost up to $100 trillion by 2050.

How does drug resistance develop?

  • Drug resistance in microbes emerges for several reasons including -
    1. the misuse of antimicrobials in medicine
    2. inappropriate use in agriculture
    3. contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment
  • All of these drive the evolution of resistance in microbes.
  • This is compounded by the serious challenge that no new classes of antibiotics have made it to the market in the last three decades.
    • This is due to inadequate incentives for their development and production.
  • A recent study found that over 95% of antibiotics in development today are from small companies.
  • And 75% of this have no products currently in the market.
  • Major pharmaceutical companies have largely abandoned innovation in this space.

What are the implications?

  • AMR represents an existential threat to modern medicine.
  • It could lead to a condition without functional antimicrobials to treat bacterial and fungal infections.
  • So, 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 scenario in the low- and middle-income countries (LMICs) of Asia and Africa is even more serious.
  • 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.

What does this call for?

  • Tackling these diverse challenges requires action in a range of area.
  • 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, to track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals.
  • It should encompass livestock, wastewater and farm run-offs.
  • Also, microbes will inevitably continue to evolve and become resistant even to new antimicrobials.
  • So, there is a need for sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
  • There is the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste.
  • So, there is a need to look into laws such as those recently proposed by India, one of the largest manufacturers of pharmaceuticals.
    • The law aims to curb the amount of active antibiotics released in pharmaceutical waste.

What is the need for caution?

  • Various countries are taking measures at individual an coordinated level.
  • The range of initiatives that seek to control the emergence and spread of AMR is welcome.
  • But, there is a need to recognise the limitations of a siloed approach.
  • Current initiatives largely target individual issues related to AMR (such as the absence of new antibiotics, inappropriate prescription and environmental contamination).
  • Thus they focus narrowly defined groups of stakeholders (providers, patients and pharmaceutical companies).
  • Regulating clinician prescription of antimicrobials alone would do little in settings where -
    • patient demand is high
    • antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs

What should the approach be?

  • Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers.
  • This will help -
    • reduce inappropriate demand
    • issue standard treatment guidelines that would empower providers to stand up to such demands
    • provide point-of-care diagnostics to aid clinical decision-making
  • Policy alignment is also needed much beyond the health system.
  • Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
  • In all, successful policies in individual countries are no guarantee of global success.
  • International alignment and coordination are paramount in both policymaking and its implementation.
  • Indeed, recent papers have proposed using the Paris Agreement as a blueprint for developing a similar global approach to tackling AMR.

 

Source: The Hindu

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