The other 'pandemic'

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The other 'pandemic'

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• The other pandemic: The world is totally focused on the Covid-19 pandemic, but there's another public threat building up on the horizon. While 2010-2020 saw global coordination in battling it, the same may slow down now, and AMR may rise sharply.
• AMR menace: Antimicrobial Resistance (AMR) is a natural process that is speeded up by more antibiotic use, thereby shortening the time microbes need to develop resistance to new drugs. So existing treatments become weaker and useless, and infections may spread fast. 
• Prevalence: AMR is prevalent worldwide, but in different intensities. It depends on antibiotic consumption levels, vaccination coverage, access to clean water, sanitation and quality healthcare. WHO's latest 66-country report shows a higher level of AMR building, among common antimicrobials.
• Multi-dimensional challenge: Battling AMR needs a multi-sectoral work across human, animal and health domains. Although 100 nations have their NAPs (National Action Plans), action is sporadic. 

1. Resistant genes to antimicrobial compounds are known to science, but to track AMR across humans and animals, across the world, is tough
2. Unlike humans, drug-resistant pathogens simply pass from country to country! (Proof - remote poultry farms reporting resistance, with no history of agricultural antimicrobial use)
3. Present trends show that antibiotic consumption in animals will be up 11.5% by 2030, and 200% in humans (compared to 2015)
4. The initiative "One Health" needs stricter implementation now, if we want to preserve our antibiotics for future generations

• Reduce the need itself: The goal must be to reduce the need to use antibiotics in animals and humans, by better vaccination, infection control, clean water and sanitation. 
• Global report: A new report "State of World's Antibiotics in 2021" showed national dashboards on AMR status across 40 countries. There are four categories of indicators, and a DRI score also (Drug Resistance Index). 

1. Lower- and middle-income countries (LMICs) have the highest DRI scores due to high AMR burden as well as lower ability to treat infections (poor access to best antibiotics)
2. Global rise in animal protein demand has affected human and environmental health hugely. Antimicrobial consumption in animals is triple what of humans (rapid growth needs).
3. Many people in LMICs die due to lack of access to antimicrobials, rather than due to resistant infections.

• Indian story: India announced its NAP-AMR in 2017, and has established a tracking system for AMR. By universalising certain types of vaccines in the UIP (Universal Immunisation Programme), India is trying to reduce disease prevalence, to reduce antibiotic usage itself. AMR will slow down. Hygiene improvement works wonders. Biggest problem is animal sector, in both China and India, where tackling AMR is a long road.
• Summary: The risks that AMR poses to global health are here and now. Tackle it fast and hard.

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