Anti-Microbial Resistance

The scientific community has expressed its concerns about the potential removal of measures addressing antimicrobial resistance (AMR) in the upcoming draft pandemic treaty which is being developed

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Context: The scientific community has expressed its concerns about the potential removal of measures addressing antimicrobial resistance (AMR) in the upcoming draft “pandemic treaty”, which is being developed by the World Health Organization (WHO) to protect nations and communities from future pandemic emergencies.

Need for the treaty

To enable countries to strengthen national, regional, and global capacities and resilience to future pandemics.
For early detection and prevention of pandemics.
To Respond to any future pandemics by ensuring universal access to medical solutions.

Call for inclusion of AMR Provisions

So far, while the focus of the negotiations on the Pandemic Instrument has primarily been on preventing pandemics similar to COVID-19, there have been calls from civil society and experts to include AMR in the instrument.
- AMR refers to the ability of microorganisms to resist the effects of medications.
This is because, not all pandemics in the past have been caused by viruses and that future pandemics could be caused by bacteria or other microbes such as plague and cholera.
Work on the Pandemic Instrument began in December 2021 after the WHA agreed to a global process to draft and negotiate an international instrument in this regard.
While earlier drafts of the Pandemic Instrument drew on guidance from AMR policy, however, after the first round of negotiations, all these insertions, are now at risk for removal.
Therefore, experts have advocated for the inclusion of AMR in the Pandemic Instrument, highlighting the potential risks posed by bacterial and other microbial pandemics and have also emphasized the need for a comprehensive approach to pandemic preparedness and response.

Understanding Anti-Microbial Resistance

AMR is the ability of microorganisms to persist or grow in the presence of drugs designed to inhibit or kill them.
It is one of the major threats to global health, food security and development as it threatens the effective prevention and treatment of infections caused by bacteria, parasites, viruses and fungi.
Antimicrobial resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air).

Reasons for the spread of Antimicrobial Resistance (AMR)

Antibiotic consumption in humans: Excessive and inappropriate use of antibiotics in human healthcare can contribute to the emergence of bacterial strains resistant to multiple antibiotics. This includes the unnecessary use of antibiotic fixed dose combinations.
Social factors: Practices such as self-medication and easy access to antibiotics without prescription can contribute to the misuse and overuse of antibiotics. Lack of knowledge about when to use antibiotics appropriately also plays a role.
Cultural activities: Certain cultural practices, such as mass bathing in rivers during religious mass gatherings, can contribute to the spread of AMR by facilitating the exchange of antibiotic-resistant organisms.
Antibiotic consumption in food animals: The use of antibiotics, especially those crucial to human health, as growth promoters in food animals, such as poultry, can contribute to the development of AMR. Antibiotic residues can enter the food chain and contribute to the spread of resistance.
Pharmaceutical industry pollution: Wastewater effluents from antibiotic manufacturing units often contain significant amounts of antibiotics. When these effluents are not properly treated, they can contaminate water bodies, leading to the presence of antibiotic residues and antibiotic-resistant organisms.
Environmental sanitation: Inadequate disposal of sewage and improper treatment of wastewater can contribute to the contamination of rivers and other water bodies with antibiotic residues and antibiotic-resistant bacteria.
Infection control practices in healthcare settings: Poor adherence to infection control practices, such as hand hygiene, in healthcare facilities can facilitate the transmission of antibiotic-resistant bacteria among patients.

Scale of Antimicrobial Resistance (AMR)

Global: In 2019 alone, drug-resistant superbugs killed about 1.27 million people globally — a toll more than HIV/AIDS or malaria — and according to the UN estimates, that number could reach 10 million by 2050.
India: India has been referred to as ‘the AMR capital of the world & we are the largest consumer of antimicrobials globally. The country is projected to have 1.6 million multi-drug resistant infectious cases in 2040, which is significantly higher than any country.

Impacts of Antimicrobial Resistance

Economic impacts: A report by the World Bank Group entitled “Drug Resistant Infections: A Threat to Our Economic Future”, highlighted that, drug-resistant infections have the potential to cause a level of economic damage similar to—and likely worse than—that caused by the 2008 financial crisis.
- Annual global GDP could decrease by approximately 1% and there would be a 5–7% loss in developing countries by 2050.
Social impacts: AMR leads to higher medical costs, prolonged hospital stays, and increased mortality and morbidity, and decreased productivity.
Environmental impacts: As natural environment is an important reservoir of AMR, the release of antimicrobial compounds into the environment leads to contamination of soil and water, and gene pollution and alteration in the wildlife.

Global measures to tackle Antimicrobial Resistance:

Global Action Plan on Antimicrobial Resistance (GAP): Countries have adopted it during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans.
The Global Antimicrobial Resistance and Use Surveillance System (GLASS): WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to continue filling knowledge gaps and to inform strategies at all levels.
STI-led BRICS Innovation Cooperation Action Plan (2021-24): With one of the thematic areas being the AMR.
World Antimicrobial Awareness Week (WAAW): Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy makers to slow the development and spread of drug-resistant infections.

Measures taken to address AMR in India

National Programme on AMR containment: Launched in 2012. Under this programme, AMR Surveillance Network has been strengthened by establishing labs in State Medical College.
National Action Plan on AMR: It focuses on One Health approach and was launched in April 2017 with the aim of involving various stakeholder ministries/departments.
AMR Surveillance and Research Network (AMRSN): It was launched in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
AMR Research & International Collaboration: Indian Council of Medical Research (ICMR) has taken initiatives to develop new drugs /medicines through international collaborations to strengthen medical research in AMR.

Way Forward

The global challenge to address AMR goes beyond the production of new antibiotics and therapies.
Reducing demand for new antibiotics through public awareness, infection prevention and control, prudent and rational use of antibiotics, as well as effective diagnosis and surveillance of antibiotic-resistant infections and antibiotic use, with a One Health perspective are crucial when dealing with this problem globally.