Antimicrobial resistance, the silent threat

Context:

As serious as the current health and economic crisis is, COVID-19 may just be the harbinger of future crises – because Antimicrobial resistance (AMR) one of the greatest challenges of the 21st century seems to be ignored.

Relevance:

GS-III: Science and Technology, GS-II: Social Justice (Health related issues)

Mains Questions:

How can engaging the health, agricultural, trade and environment sectors help in tackling the problem of Antimicrobial resistance (AMR)? (10 marks)

Dimensions of the Article:

1. What is Antimicrobial Resistance (AMR)?
2. What is Multi drug resistance?
3. The seriousness exposed by Covid-19
4. Concerns regarding AMR
5. Concerns regarding AMR in India
6. Steps taken in India regarding AMR
7. What can be done to fight against AMR?

What is Antimicrobial Resistance (AMR)?

• Antimicrobial resistance (AMR) is the ability of microorganisms such as bacteria, fungi, viruses, and parasites to remain unaffected or survive antimicrobial drugs such as antibiotics, antivirals and antimalarials.
• AMR occurs when microorganisms exposed to antimicrobial drugs develop antimicrobial resistance resulting in standard treatments becoming ineffective leading to persistence of infections and spreading of infections.
• Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
• The misuse of antimicrobials in medicine and inappropriate use in agriculture is one of the major causes of spread of Antimicrobial Resistance.
• Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment also leads to spread of AMR.

What is Multi drug resistance?

• Multiple drug resistance (MDR), multidrug resistance or multi-resistance is antimicrobial resistance shown by a species of microorganism to multiple antimicrobial drugs.
• The types most threatening to public health are MDR bacteria that resist multiple antibiotics; other types include MDR viruses, parasites (resistant to multiple antifungals, antiviral, and antiparasitic drugs of a wide chemical variety).
• Recognizing different degrees of MDR, the terms extensively drug resistant (XDR) and pandrug-resistant (PDR) have been introduced.

Basis of Antimicrobial Resistance

• 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 by sharing and transferring resistance genes present in the rest of the population, or by genetic mutations that help the bacteria survive antibiotic exposure.

The seriousness exposed by Covid-19

• Since January 2020, there have been over three million deaths globally on account of COVID-19, starkly exposing the vulnerabilities of health systems to infectious diseases, even in the richest countries.
• The speed of COVID-19’s spread across international borders has underscored the need for cross-national cooperation around surveillance, monitoring and disease notification — the key activities that underpin our ability to minimise the impact of acute public health events and maintain global health security.
• Antimicrobial resistance (AMR), the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment, is one of the greatest challenges of the 21st century and it is already responsible for up to 7,00,000 deaths a year.
• Unless urgent measures are taken to address this threat, we could soon face an unprecedented health and economic crisis of 10 million annual deaths and costs of up to $100 trillion by 2050 according to WHO.

Concerns regarding AMR

• Medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very risky due to AMR.
• AMR increases the cost of healthcare with lengthier stays in hospitals, additional tests and use of more expensive drugs.
• 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, we are heading towards a future without antibiotics and with bacteria becoming completely resistant to treatment and when common infections and minor injuries could once again kill (referred to as antibiotic apocalypse).
• It is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals.

Concerns regarding AMR in India

• 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.
• In India, over 56,000 newborn deaths each year due to sepsis are caused by organisms that are resistant to first line antibiotics.

Steps taken in India regarding AMR

• India has undertaken many activities like Mission Indradhanush — to address low vaccination coverage — strengthened micro-planning and additional mechanisms to improve monitoring and accountability.
• The Ministry of Health & Family Welfare (MoHFW) identified AMR as one of the top 10 priorities for the ministry’s collaborative work with the World Health Organisation (WHO).
• India has also launched the National Action Plan on AMR resistance 2017-2021.

What can be done to fight against AMR?

1. We need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
2. Issuing standard treatment guidelines that would empower providers to stand up to inappropriate demand as well as provide point-of-care diagnostics to aid clinical decision-making will help in preventing unnecessary over-exposure to antimicrobials.
3. Efforts to control prescription of antimicrobials should be accompanied by efforts to educate consumers as well in order to prevent overexposure to antimicrobial drugs.
4. It is critical to ensure that all those who need an antimicrobial have access to it – hence, in addition to developing new antimicrobials, infection-control measures should be introduced to reduce dependence on antibiotic use.
5. Measure to track the spread of resistance in microbes – such as surveillance to identify these organisms should implemented. Their implementation also needs to be expanded to beyond hospitals and encompass livestock, wastewater and farm run-offs.

-Source: The Hindu