Antimicrobial Resistance Threat to global health security

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  Antimicrobial Resistance Threat to global health security

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1. The story: Antimicrobial resistance (AMR) is a growing global problem to which the ongoing Covid-19 pandemic may further contribute. With resources deployed away from antimicrobial stewardship, evidence of substantial preemptive antibiotic use in Covid-19 patients and indirectly, with deteriorating economic conditions fuelling poverty potentially impacting on levels of resistance, AMR threat remains significant.
2. Points to note: Antimicrobial resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections. So, standard treatments become ineffective, infections persist and may spread to others. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
3. How it builds up: Some bacteria due to the presence of resistance genes are intrinsically resistant and therefore survive on being exposed to antibiotics. Bacteria can also acquire resistance. This can happen in two ways: (i) By sharing and transferring resistance genes present in the rest of the population, or (ii) By genetic mutations that help the bacteria survive antibiotic exposure.
4. Reasons for spread: The misuse of antimicrobials in medicine and inappropriate use in agriculture is directly contributing to it. Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.
5. Serious state: AMR is already responsible for up to 7,00,000 deaths a year, and is a threat to prevention and treatment of infections - medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements). It is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals. No new classes of antibiotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production. Without urgent action, an antibiotic apocalypse is brewig slowly – a future without antibiotics, with bacteria becoming completely resistant to treatment and when common infections and minor injuries could once again kill.
6. Indian situation: India, with its combination of large population, rising incomes that facilitate purchase of antibiotics, high burden of infectious diseases and easy over-the-counter access to antibiotics, is an important locus for the generation of resistance genes. The multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region to spread globally. Africa, Europe and other parts of Asia have also been affected by multi-drug resistant typhoid originating from South Asia. India has undertaken many activities like Mission Indradhanush — to address low vaccination coverage — strengthened micro-planning and additional mechanisms to improve monitoring and accountability. India has also launched the National Action Plan on AMR resistance 2017-2021.
7. Summary: Since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis. To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.

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