Antimicrobial Resistance (AMR) is the ability of microorganisms to persist or grow in the presence of drugs designed to inhibit or kill them. AMR is an urgent global public health threat across human, animal, and plant health sectors, and is often referred to as a silent pandemic. It is one of the top 10 global health threats facing humanity, according to the World Health Organization (WHO).
The global use of antibiotics was estimated to be 40.2 billion DDD (defined daily doses) in 2018 and has increased by about 50 percent in the last two decades. At the same time, antibiotic consumption was 20.6 DDD in high-income countries (HIC) compared to 13.1 DDD per 1000 population per day in low and middle-income countries (LMIC). The Food and Agricultural Organization (FAO) estimates that antibiotic consumption in global agriculture is between 63,000-240,000 tonnes per year. Upto 90 percent of tested antibiotics excreted by animals are unmetabolised, pollute waste water and constitute an important reservoir of antibiotic resistance.
Research suggests that almost every major public health emergency since the past century has resulted from the crossover of pathogens from animals to humans. A Lancet review in 2019 pointed out some alarming global statistics. It studied the deaths and disability-adjusted life years (DALYs) attributable to, and associated with, bacterial AMR for 23 pathogens and 88 pathogen drug combinations covering 204 countries. An estimated 4.95 million deaths were associated with bacterial AMR, and 1.27 million deaths were directly attributed to bacterial AMR. Six bacterial pathogens were directly responsible for nearly 70 percent of the deaths. It also showed that AMR is a leading cause of death around the world whose magnitude is at least as large as major diseases such as HIV and malaria—enveloping its highest burden in low-resource settings. Sub-Saharan Africa and South Asia had the highest death rates signifying high susceptibility to AMR.
Direct and indirect Covid-19 pandemic responses were considered to be potentially inimical to the three components of AMR evolution in a population: emergence, transmission, and population-level infection burden. High rates of prescription of inappropriate antimicrobials and the overall high use of biocides, along with the interruption of treatment for other conditions, were considered negative impacts of the pandemic on health parameters. A report by the US Centre for Disease Control observed that the gains achieved in antibiotic stewardship getting reversed during Covid-19-resistant infections during hospitalisation, grew at least 15 percent in the US from 2019 to 2020.
Combating AMR will be critical towards achieving the United Nation's Sustainable Development Goals (SDGs). The G20 introduced AMR as a key issue in the 2016 Hangzhou, China summit. The 2017 Hamburg Summit resolved to “maximise the impact of existing and new antimicrobial basic and clinical research initiatives as well as product development”.
The 2022 Bali Summit committed to a multi-sectoral One Health approach and to enable global pathogen surveillance to implement the International Health Regulations (2005). Reaffirming the One Health approach, the Agriculture Ministers’ Meeting also committed to accelerating the response to AMR in the context of agriculture and food and emphasised cross-sectoral collaboration.
The need to develop policies, invest in research and build the ecosystem to strengthen the connection between environment and human and animal health has been highlighted as a top priority not just by G20 but at all global high-level for a ranging from the discussions in UNGA, G7 to G20 Presidencies.
G20 member countries have well-developed National Action Plans (NAP), however a systematic evidence synthesis of existing NAPs marked gaps and variability in the maturity of NAP development and operationalisation in terms of policy and strategic planning; medicines management and prescribing systems; operational delivery and monitoring; and, patient and public engagement and involvement.
We have seen countries like Brazil showing a reduction in antibiotic use, Indonesia developing good surveillance plans, Australia prioritising animal health and reducing antibiotic use in livestock, and the UK and the US investing in research to develop new diagnostics, drugs, and vaccines as some examples of AMR.
India has always accorded top priority to One Health and AMR, and was one of the first few countries to develop a comprehensive National Action Plan on AMR (NAP AMR) in 2017. Subsequently, the formulation of state action plans was prioritised. There has been a special focus on surveillance and research, both for innovative affordable interventions and for implementation research, with emphasis on intersectoral connections between human, animal, and plant health and the environment.
With India now taking on the Presidency of G20, it is imperative that we take this agenda forward, and there should be a renewed commitment to ensure investments flow into the national and multi-sectoral action plans. Some immediate steps to tackle AMR are to launch a Global One Health Consortium with a common vision and mission, connect health targets and policies with SDGs, and ensure One Health is centre staged. Research for new diagnostics, antibiotics, and vaccines needs to be prioritised along with a strong demand-driven market ensuring an assured supply and a well-structured supply chain.
If it is 'One Health' it has to be for 'One World'. We need global access to resources, shared infrastructure, globally accessible repositories, and a global consortium for the exchange of knowledge to meet the global target, help plan new surveillance and monitoring strategies, and develop new products. It’s time for a global call to action for AMR and One Health.
The author is a former secretary Department of Biotechnology, Ministry of Science & Technology, Government of India, and Vice Chair Board of Directors, International Centre for Antimicrobial Resistance Solutions.
(Views expressed are personal)
The thoughts and opinions shared here are of the author.
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