Antimicrobial resistance: A call for action against the next global threat

Villagers wait to receive medicine at a free medical camp set up to provide healthcare support to villagers, amidst the spread of the coronavirus disease COVID-19), at Debipur village in South 24 Parganas district in the eastern West Bengal state, India, May 21, 2021. Image: Rupak De Chowdhuri/ Reuters

In 1928, a chance discovery by Prof. Alexander Fleming with a series of laboratory experiments gave the world its first antibiotic—penicillin—from “mould juice”, thus kick-starting the era of antibiotics. Today, nine decades later, people are consuming antibiotics in large quantities globally, majorly unaware of the repercussions it can have on their health. This, in turn, is speeding up the pace at which bacteria is developing resistance to the antibiotics used to treat them and progressively reducing the effectiveness of the drugs.

According to the World Health Organization (WHO), resistance to antibiotics and other types of antimicrobials is the single greatest challenge to managing infectious diseases today. Antibiotics are becoming increasingly ineffective as drug resistance spreads globally, leading to more difficult-to-treat infections and deaths. Each year, an estimated 700,000 people die worldwide as a result of antimicrobial-resistant (AMR) infections.

AMR has emerged as a major threat to public health, and India carries one of the largest burdens of drug-resistant pathogens worldwide. With the growing demand and subsequent sale of antibiotics rising in India, the country is one of the largest consumers of antibiotics worldwide. As per the estimates, by 2050, two million deaths will occur in India due to AMR. Several factors contribute to AMR such as irrational and overuse of drugs, lack of training at the primary healthcare level, and inappropriate manufacturing practices.

What the country needs right now is a multi-sectoral, coordinated intervention across all levels of the ecosystem to combat the threat by:

National policy / strategy-led interventions
In India, a national policy for containment of AMR was introduced in 2011. The policy aims to understand the emergence, spread, and factors influencing AMR; to set up an antimicrobial program; to rationalise the use of antimicrobials; to encourage the innovation of newer effective antimicrobials. In addition, some major action points were identified in the national policy like—establishing an AMR surveillance system, strengthening infection prevention, and educating, training, and motivating all stakeholders on rational use of antibiotics. The plan also mentions promoting investments for AMR activities, research, innovations and strengthening India’s leadership on AMR through collaborations at international, national, and sub-national levels. However, at the national level, we need policies to implement evidence-based infection control practices to prevent the spread of resistance. The government should encourage the development of more therapies and drugs to treat infections; incentivise companies to invest in research and development of new antibiotics; use innovations and new technologies to develop next-generation tools to support human and animal health that can combat this global health threat.

Collaborative action by pharma companies
The pharma industry is at the core of fighting against this global threat as manufacturers of medicines. A robust investment into R&D by pharma companies and in-licensing of innovative medicines, vaccines to help and prevent serious infections can help combat AMR. Even repurposing old drugs and optimising their use can help in this regard. Companies should come together and create a network of stakeholders and forge public-private partnerships to combat this issue. The onus lies on pharma companies to train physicians and healthcare practitioners. Expand educational training guidelines, outreach and awareness drive to educate stakeholders such as consumers, healthcare providers, and industries, on best practices for using antibiotics responsibly. It is more important now than ever to prevent the burden from spiraling out of control.

Healthcare practitioners pivotal in the fight against AMR
Doctors play a leading part since they are the point of care for patients. Increasingly, healthcare practitioners are becoming more aware and training themselves, and educating the patients to improve prescription practices to curb the overuse of antibiotics. However, more awareness is needed at the doctor and the patient level on adherence and the protocol for use of antibiotics. Factors like educating patients on the safe, recommended methods for disposing or returning unused antibiotics, and incorporating hygiene with soap or alcohol-based hand-rub are keys to protecting patients from avoidable infections contracted in healthcare settings and preventing the spread of AMR.

Responsibility at an individual and community level
Many individuals often self-medicate without seeking professional advice to treat infections. In some cases, they probably do not know the actual course of the medication or stop it midway. In some cases, they insist doctors prescribe antibiotics to treat infections faster, thereby abusing antibiotics. Instead, the focus should be on improving the standard of living, maintaining sanitation and good hygiene practices, and seeking professional guidance to avoid the multiple side effects overdose of antibiotics can have in our body. We need to understand that it is a complex problem and a major concern, not just at an individual level but at a community level.

According to a WHO report, AMR is estimated to cause 10 million deaths annually worldwide by 2050. Therefore, it must be regarded as a global, national, and local priority for the health of an individual, a community, organisations, and government. Bringing in the concept of ‘One Health’ for human health, animal health, and the environment is key since they are linked with infection transmission and prevention. An ounce of prevention is worth a pound of cure, and the sooner we realise that the faster we can collaboratively fight this rising global health threat.

The writer is MD & Global CEO of Cipla.

The thoughts and opinions shared here are of the author.