• While the world is emerging from the acute phase of the COVID-19 pandemic, the very harmful but invisible pandemic of Antimicrobial Resistance (AMR) is unfortunately here to stay.
• Similar to the efforts done against COVID-19, rapidly rising AMR rates also need an accelerated, multi-sectoral, global and national response.

Antimicrobials and Anti-microbial resistance

• Antimicrobials: It includes antibiotics, antivirals, antifungals and antiparasitics medicines used to prevent and treat infections in humans, animals and plants.
• Antimicrobial Resistance (AMR): It is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs that are used to treat infections.
• It occurs when a microorganism changes over time and no longer responds to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
• The WHO has identified AMR as one of the top ten threats to global health.
• Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

Reasons for the Spread of AMR

• Antibiotic consumption in humans:
• Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics.
• Social factors:
• Self-medication.
• Access to antibiotics without prescription.
• Lack of knowledge about when to use antibiotics.
• Culture activities:
• Mass bathing in rivers as part of religious mass gathering occasions.

• Antibiotic Consumption in Food Animals:
• Antibiotics which are critical to human health are commonly used for growth promotion in poultry.
• Pharmaceutical Industry Pollution:
• The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
• Environmental Sanitation:
• Untreated disposal of sewage water bodies - leading to contamination of rivers with antibiotic residues and antibiotic-resistant organisms.
• Infection Control Practices in Healthcare Settings:
• A report on hand-washing practices of nurses and doctors found that only 31.8% of them washed hands after contact with patients.

Concerns related with the AMR

• Global public health response has been threatened due to rising misuse and overuse of antibiotics in humans and animals.
• Microbial resistance to antibiotics has made it harder to treat infections such as pneumonia, tuberculosis (TB), blood-poisoning (septicaemia) and several food-borne diseases.
• AMR also imposes a huge health cost on the patient in the form of longer hospitalisation, health complications and delayed recovery.
• It puts patients undergoing major surgeries and treatments, such as chemotherapy, at a greater risk.
• Many times, patients recover from advanced medical procedures but succumb to untreatable infections.
• It adds to the burden of communicable diseases and strains the health systems of a country.
• Recently conducted a study by Indian Council of Medical Research (ICMR) showed that the resistance level increases from 5% to 10% every year for broad-spectrum antimicrobials.
• In 2019, AMR was associated with an estimated 4.95 million human deaths.

India and the Muscat Conference

• Over 30 countries adopted Muscat Ministerial Manifesto on AMR at recently held 3^rd Global High-Level Ministerial Conference on AMR in Muscat, Oman.
• It also recognised the need to address the impact of AMR not only on humans but also on animals, and in areas of environmental health, food security and economic growth and development.
• The conference focused on three health targets:
• Reduce the total amount of antimicrobials used in the agri-food system at least by 30-50% by 2030.
• Eliminate use in animals and food production of antimicrobials that are medically important for human health.
• To ensure that by 2030 at least 60% of overall antibiotic consumption in humans is from the WHO “Access” group of antibiotics.
• Targets by Muscat Manifesto:

• It encourages countries to prioritize their national action plans for AMR keeping the One Health approach.
• The One Health approach requires all stakeholders to work together towards an integrated programme
• It linking challenges of humans, terrestrial and aquatic animals, plant health, food and feed production and the environment.
• This approach will enable the world to effectively prevent, predict and detect the health crisis induced by AMR.
• Tackling AMR requires constant monitoring of antibiotic consumption, identifying the types and quantities of antibiotics being used.
• There is an urgent need to reduce the usage of antimicrobials in the agri-food system.

Government Initiatives for AMR

• National Action Plan on Antimicrobial Resistance (2017-21) emphasized the effectiveness of the government''s initiatives for hand hygiene and sanitation programs such as Swachh Bharat Abhiyan, Kayakalp, and Swachh Swasth Sarvatra.
• The government has also attempted to raise community awareness about healthier and better food production practices, particularly in the animal food industry.
• National Health Policy, 2017:  It included specific guidelines for the use of antibiotics, such as limiting the use of antibiotics as over-the-counter medications and prohibiting or restricting the use of antibiotics for livestock growth promotion.
• Red Line campaign in India requires prescription-only antibiotics to be marked with a red line to discourage the over-the-counter sale of antibiotics.
• Food Safety and Standards Authority of India (FSSAI) has established guidelines for limiting antibiotics in food products such as fish and honey.

Global Initiatives for AMR

• Global Action Plan on Antimicrobial Resistance (GAP):
• During the 2015 World Health Assembly, countries committed to the framework outlined in the Global Action Plan1 (GAP) on AMR, as well as the development and implementation of multisectoral national action plans.
• Tripartite Joint Secretariat on Antimicrobial Resistance:
• A tripartite joint secretariat (FAO, OIE, and WHO) has been established and is hosted by WHO to drive multi-stakeholder engagement in AMR.
• World Antimicrobial Awareness Week (WAAW):
• It was previously called the World Antibiotic Awareness Week. From 2020, it will be known as World Antimicrobial Awareness Week. It is a global campaign aimed at raising global awareness of antimicrobial resistance.
• Global Antimicrobial Resistance and Use Surveillance System (GLASS):
• WHO launched it in 2015 to continue filling knowledge gaps and informing strategies at all levels.
• GLASS was designed to gradually incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain, and AMR in the environment.
• Global Antibiotic Research and Development Partnership (GARDP):
• It a joint initiative of WHO and the Drugs for Neglected Diseases Initiative (DNDi), promotes research and development through public-private partnerships.
• By 2025, the partnership hopes to have developed and delivered five new treatments that target drug-resistant bacteria identified by WHO as the greatest threat.
• Global Research and Development Priority Setting for AMR:
• WHO developed the priority pathogens list in 2017 to guide research and development of new antimicrobials, diagnostics, and vaccines.
• WHO reviews the pre-clinical and clinical antibacterial pipelines on an annual basis to see how the pipeline is progressing in relation to the WHO priority pathogens list.

Looking ahead

• The rapidly rising AMR rates need an accelerated, multi-sectoral, global and national response.
• G-20 health summits offers an opportunity for India to ensure that all aspects of AMR are addressed and countries commit to progress.
• Some key areas for action are:
• Surveillance of priority pathogens and sharing of data, including through WHO’s GLASS platform.
• Regulatory and policy action to stop use of antibiotics that are important for human health in animals.
• No use of antibiotics for growth promotion in animals.
• More government investment in research and innovation for new antibiotics.
• Explore use of vaccines to prevent certain infections due to AMR organisms in humans and animals.
• Special focus on combating TB and drug-resistant TB.
• Tackling AMR requires constant monitoring of antibiotic consumption, identifying the types and quantities of antibiotics being used.
• There is an urgent need to reduce the usage of antimicrobials in the agri-food system.
• Scientific evidence suggests that the less antimicrobials are used, it is less likely that there will be an emergence of drug resistance.
• Countries such as the Netherlands and Thailand have decreased their usage by almost 50%.
• In China, the consumption of antibiotics in the agricultural sector has fallen substantially.

AMR is a serious global health threat and could not be overshadowed by other competing public health priorities. India needs to increasing surveillance and funding research on new antibiotics. It also intends to increase private sector participation and data reporting to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other standardized systems. The various G-20 health summits scheduled through 2023 provide an opportunity for India to ensure that all aspects of AMR are addressed and countries commit to progress.