A Global Public Health Threat: Antimicrobial Resistance (AMR)BY GEORGE CHERIYAN

Antimicrobial Resistance (AMR) is one of the top ten global public health threats facing humanity, according to World Health Organisation (WHO). It has the potential of taking the form of a pandemic soon, if corrective measures are not taken immediately.

AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to AMR, continues to threaten our ability to treat common infections.

AMR is killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019, according to a report released in The Lancet. AMR could result in the global loss of 10 million lives per year by 2050.

According to the Report of Washington-based Center for Disease Dynamics, Economics & Policy (CDEEP), between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65 percentage. China and India represented the largest hotspots of resistance, with new ones emerging in Brazil and Kenya.

Cost of AMR to the economy is significant. AMR could push 28.3 million people into extreme poverty by 2050 due to high costs of treatment and chronic infections. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted. Cumulatively, $100 trillion of economic output is at risk due to the rise of drug-resistant infections by 2050.

AMR is widespread in the European Region, as per the report published jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe in January 2022.

In July 2022, the EU and the Member States, identified AMR as one of the top three priority health threats, which pose one of the greatest risk to human health, with estimates from the European Union/European Economic Area (EU/EEA) alone showing that each year more than 670,000 infections are due to bacteria resistant to antibiotics and approximately 33,000 people die as a direct consequence.

Robust investments in interventions to address AMR are urgently needed and would have a significant positive impact on population health and future healthcare expenditures in the EU region.

India has one of the highest rates of resistance to antimicrobial agents used both in humans and food animals. AMR is a particular challenge in India due to the high burden of communicable diseases, an overburdened public health system, limited laboratory capacity for etiology-based diagnosis and appropriately targeted treatment, inexpensive and widely available antibiotics without prescriptions.

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 major concern is the vast increase in the use of antimicrobials in the farm sector, both in India and globally. Traditionally it is allowed to use Antibiotics to treat and cure sick animals. However, today Antibiotics are used imprudently in the farm sector as growth promotor, feed additive and as a disease preventive drug. 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.

India needs to adopt a holistic and multidisciplinary approach towards the prevention and containment of AMR.


The writer is an India Food Safety Expert, a member of CAC of FSSAI and of scientific board of Competere

Image credits: Richard A. Chance, courtesy of the NYT >>>

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