AMR, a looming public health threat

Antimicrobial Resistance (AMR) poses a grave threat to global public health, ranking among the top ten challenges identified by the World Health Organisation (WHO). If corrective actions are not taken promptly, experts warn that AMR could soon escalate in to a pandemic. AMR occurs when bacteria, viruses, fungi, and other parasites evolve and become resistant to medicines, rendering infections harder to treat and increasing the risk to severe illness and death.

The Lancet’s report revealed that AMR claimed at least 1.27 million people worldwide in 2019, and if left unchecked could result in the global loss of 10 million lives annually by 2050.

The misuse and overuse of antimicrobials, lack of access to clean water and sanitation, and poor infection control in healthcare facilities and farms, lack of awareness and knowledge, and inadequate enforcement of legislation are identified as the main drivers of AMR. Alarming data from the Washington-based Centre for Disease Dynamics, Economics & Policy (CDEEP) shows a 65% increase in antibiotic consumption between 2000 and 2015, with China and India emerging as major hotspots of resistance and new ones emerging in Brazil and Kenya.

AMR’s economic impact is also significant, with projections indicating that it could push 28.3 million people into extreme poverty by 2050 due to high treatment costs and chronic infections. Additionally, the rise of drug-resistant infections jeopardises $100 trillion of economic output by 2050. India, with its high burden of communicable diseases, overburdened public health system, and unrestricted access to antibiotics, faces a unique challenge in combating AMR. Antibiotic use in India has risen sharply, with about a 30% increase in their per capita use during the past decade, according to the State of the World’s Antibiotics 2021 report. Researchers found that India consumed over 500 crore antibiotics in 2019, of which Azithromycin was the most consumed antibiotic molecule.

A worrisome trend is the excessive use of antimicrobials in the farm sector, both in India and globally. Antibiotics, once used primarily for treating sick animals, are now employed imprudently as growth promoters and feed additives, contributing to the problem. India’s antibiotic consumption has surged, with Azithromycin topping the list as the most consumed antibiotic molecule. The estimated total use of antimicrobials in animals in 2020 in India was 2,160.02 tonnes, which is expected to reach 2,236.74 tonnes by 2030.

To effectively tackle AMR, India must adopt a holistic and multidisciplinary approach. While the National Action Plan for AMR outlines priorities and strategies, its implementation remains limited. The recent Colloquium on State Action Plans on AMR aimed to revitalise efforts by facilitating inter-state discussions on action steps. However, it is matter of serious concern, as of March 2022, three states Kerala, Madhya Pradesh, and New Delhi are the only states with functional State Action Plans on AMR that are currently at its implementation phase. Nothing much changed in last one year.

To curb the over-the-counter sale and usage of antibiotics, India needs stronger regulations and monitoring systems. Public-private collaborations and political support are crucial in prioritizing AMR containment. Public awareness and community engagement are vital components of impactful strategies to combat AMR.

As AMR continues to loom as a pressing threat, concerted efforts are imperative to safeguard public health, preserve the efficacy of medicines, and secure a healthier future for humanity.

(The writer is a consumer activist, a member of Central Advisory Committee of FSSAI, and Scientific Board - Competere, Italy, Rome)