Time to act now Antimicrobial Resistance (AMR) is now global health emergency. India G20 presidency plan has taken up it as priority agenda. What does it mean? Dr Chhavi Gupta, Senior Consultant-Infectious diseases, Sanative Healthcare shares her point of view on this
Antimicrobials are medicines used to prevent and treat infections in humans, animals, and plants, these include antibiotics, antivirals, antifungals, antiparasitic etc. AMR occurs when disease causing microbes or germs change their genetic make-up in such a way that antimicrobials medicines that were originally effective in treating them become ineffective and infections become increasingly difficult or impossible to treat due to superbugs. In 1928, discovery of first antimicrobial penicillin by Sir Alexander Fleming is considered as milestone in the field of medicine and ever since invention of multiple antimicrobials had revolutionised the management of infections. However; microbes being smarter have evolved resistance mechanism to these antimicrobials quickly, under selection pressure not only acquired new mechanisms of AMR but also disseminated it to other microbes via horizontal gene transfer.
Experts have been ringing alarm bell of rising AMR for long, Sir Alexander Fleming anticipated emerging antimicrobial resistance by irrational use of penicillin early in 1945. Unfortunately, the discovery of new antimicrobials could not keep up pace with rising AMR, there has been 3 decades of discovery void where no new antimicrobials were developed. The World Health Organization (WHO) has identified AMR as one of the top 10 global health threats, every year 700000 people die of AMR. The world is now witnessing silent pandemic of AMR if not tackled is projected to cause 10 million deaths a year by 2050 and catastrophic damage to economy by forcing millions of people into extreme poverty. The estimated prevalence of AMR is just a tip of iceberg, the threat is much higher and eminent than anticipated.
The key drivers of AMR include misuse, abuse and overuse of antimicrobials by prescribers; poor infection control practices in clinical settings; over the counter sale and self-medication; unethical promotion; antimicrobial misuse and abuse in animal livestock including poultry and excessive use as pesticides. Further high burden of infectious disease, poor public health infrastructure, lack of appropriate diagnostic support and lack of universal access to water, sanitation and hygiene (WASH) have amplified the crisis in developing world. The environmental pollution and poor sanitation lead to contamination of antimicrobials in soil and water ecosystem and provide an important resistome enabling the mixing and dissemination of resistance AMR genes.
The planetary crisis of climate change and air pollution are accelerating the global threat of AMR. Global warming provides new breeding ground of resistant bacteria and also hasten the process of horizontal spread of AMR genes. Recent global analysis published in Lancet planetary health presents strong evidence that increasing air pollution is increasing the risk of AMR by means of Particulate matter (PM)2·5 air pollution carrying antibiotic resistant bacteria that could spread across the environment and humans via inhalation. The connection between two has strengthened over decades across the globe. Natural calamities like flood, droughts, tsunami restrict the access to clean safe water, sanitation, food, increases in zoonoses and food, water- and vector-borne diseases indirectly contributing to AMR. Thus, there is a close nexus between climate change, air pollution and accelerating AMR.
The multi-faceted approach is required to tackle AMR. Antimicrobial stewardship programme (AMSP) and Infection control Policy (IPC) are two key strategic interventions in healthcare settings; making AMR, AMSP and IPC core components of medical education and training may help to create awareness among prescribers; capacity building for improving diagnostics to identify infections and detect resistance; strengthening surveillance and tracking systems to respond rapidly to outbreaks, identify emerging pathogens; regulatory control over drug promotion, public awareness campaigns education and behaviour change of masses are other strategies. Harnessing alternative strategies for treatment of infections like phage therapy, antimicrobial peptides, immunomodulators, monoclonal antibodies, probiotics may help to reduce the use of antimicrobials. Involvement of academia to take up research in all dimensions of AMR to provide better insight. Lastly as Prevention is better than cure, universal access to clean water sanitation and hygiene and vaccination of humans and animal livestock are critical elements of preventing infections and reducing AMR.
Most importantly, multisectoral coordination, communication and collaboration under integrated One Health approach that incorporates human, animal and environmental ecosystem can play a vital role. In the past global eradication of small pox is the example of multisectoral coordination and political will. World have to leverage the lessons from fast-track development of COVID 19 therapeutics and vaccine including regulatory approvals and scale up the research and manufacturing of newer antimicrobials and vaccines.
Containment action plan to tackle AMR at international, national and local level is the need of hour. The efforts made in this direction are commendable be it National Action plan including AMR surveillance network for monitoring, strengthening diagnostic capabilities, pandemic preparedness, environmental policies, still it is a long journey. Health emergencies prevention, preparedness, and response, focusing on One Health and AMR is the priority health agenda at current G20 summit, but still, it is a long difficult journey to go. AMR is fast moving train fuelled by recent pandemic, climate change, air and environmental pollution, will soon speed out of control to became leading cause of death globally. Time to act fast before it is too late.