India must raise the standard of living for citizens, besides regulating antibiotic use

• The recent publication of The Lancet’s global burden of bacterial antimicrobial resistance comes at a time when the world seems to ignore the need for a robust AMR policy.
• The report makes it clear that no slacking can be allowed on this front.
• It estimated that 4.95 million deaths were associated with bacterial AMR in 2019 alone.
• It also identified the pathogens and pathogen-drug combinations that cause such resistance.

Bacterial AMR

• It occurs when the drugs used to treat infections become less effective, as a result of the pathogens becoming resistant to the drugs.
• This happens due to indiscriminate use of antibiotics, availability of antibiotics over the counter, poor hygiene and sanitation, antimicrobial use in the farming and poultry industry, lack of vaccines and newer antibiotics, and poor infection control practices in hospitals.

Various Causes of antibiotic resistance

• Microbes can become resistant to drugs for both biological and social reasons.
• Microbial behaviour: Any new antimicrobial drug, will become ineffective at some point in time. This is primarily due to changes occurring within the microbes.
• People’s behaviour: Not following recommendations for the use of some drugs can increase the risk of antimicrobial resistance.
• The way in which people use antimicrobial drugs is a significant contributing factor. Some individualistic reasons are:
• Wrong diagnosis: Doctors sometimes prescribe antimicrobials “just in case,” or they prescribe broad-spectrum antimicrobials when a specific drug would be more suitable. Using these medications in this way increases the risk of AMR.
• Inappropriate use: If a person does not complete a course of antimicrobial drugs, some microbes may survive and develop resistance to the drug. Also, antibiotics recommended by quacks or pharmacists contribute to magnify the issue.
• Agricultural use: Using antibiotics in farm animals can promote drug resistance.
• Hospital use: People who are critically ill often receive high doses of antimicrobials. This encourages the spread of AMR microbes, particularly in an environment where various diseases are present.

AMR in India

• In 2008, when the NDM1 enzyme that renders bacteria resistant to a range of antibiotics was traced back to India, it served as an urgent call for action.
• India released its own AMR action plan in 2017 and announced a task force for implementation.
• By 2019, Kerala and Madhya Pradesh had rolled out State action plans.
• Since then, little progress has ensued: 11 other States are still framing their action plans.
• The Chennai Declaration: a consortium of doctors and health-care institutions against AMR, was formed in 2012 to draw up a road map.
• The ban on Colistin in the poultry, aqua farming and animal feeds supplements sectors, which India enforced from July 2019, was considered a strong strike in countering the AMR challenge.

Conclusion

• Scientific publications have established the correlation between AMR and poor hygiene, lax administrative governance and poor ratio of public-private expenditure.
• While the scientific community looks for solutions, governments must raise the standard of living for citizens, providing them accessible and affordable quality health care, besides regulating the sale and use of antibiotics.