Relevance: GS-3: Biotechnology related issues.

Key Phrases:  AMR, Antimicrobials, Research on AMR, Lancet Study on AMR, Action Plan to Control AMR, Strategies to combat AMR, Data on AMR,

Why in News ?

• Recently, a study conducted by the Lancet journal covering more than 204 countries has estimated that there were 4.95 million deaths associated with bacterial AMR in 2019, including 1.27 million deaths attributable to bacterial AMR.

Key Highlights

• This death figure is several times higher than the deaths caused by HIV/AIDS or malaria.
• The Lancet research analyzed the deaths linked to 23 pathogens and 88 pathogen-drug combinations.
• The study found that more than 12 lakh deaths would not have taken place directly if the infection had not become resistant to drugs.
• The study also showed global disparity while drawing global attention to the AMR threat in Asia and Africa.

About Antimicrobial Resistance (AMR)

• Antimicrobials:
  • Antimicrobials including antibiotics, antivirals, antifungals and anti-parasitics – are medicines used to prevent and treat infections in humans, animals and plants.
• Antimicrobial Resistance (AMR):
  • It 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.
    • As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Research on a Massive Scale

• Collecting Data
  • The study is an analysis of the burden of AMR, producing estimates for 204 countries and territories, 23 bacterial pathogens, and 88 drug-pathogen combinations in 2019.
  • They obtained data from multiple data sources — including from published studies (microbiology data, in patient data, data on multiple causes of death, and pharmaceutical sales data), and directly from the collaborators on the Global Research on Antimicrobial Resistance project etc.
• Analysis of the Data
  • They computed two counterfactual scenarios
    • One where all drug resistant infections are replaced by susceptible infections, and
    • Secondly, a scenario where all drug resistant infections are replaced with no infections.
  • The deaths and burden of AMR were estimated in these two scenarios, and served as a measure to inform the development of potential intervention strategies.
• Outcome
  • The six leading pathogens for deaths associated with resistance included E. coli, S. aureus, K. pneumoniae, S. pneumoniae, A. baumannii and Pseudomonas aeruginosa.
  • They accounted for 73.4 % of the deaths attributable to AMR, and have been identified as priority pathogens by WHO.
• Worsening Situation of AMR during Covid-19 Pandemic
  • While the study was done in 2019, it is possible that the intervening epidemic has worsened the situation in terms of pushing AMR levels further.
  • Experts explain that during the COVID-19 pandemic, the use of antibiotics went up. The tendency was also to use antibiotics for patients on a ventilator with fever.
  • Secondly, due to the large number of patients during the peaking waves, lack of appropriate infection control (as will be done in the case of patients with resistant bacteria) was rendered impossible.
  • They pointed out that antibiotics are the only batch of drugs, used in one person, that can impact the rest of the community.
  • When the gut biome is modified and excreted, it can lead to contamination of lands and water sources, thus spreading resistant bacteria further in the community.

Action Plan to Control AMR

• Principles of COVID control should be applied to AMR control.
• We should involve the public, carpet bomb them with information and announce an AMR action plan that will involve them in control.
• Another major strategy would be to ensure hygiene and sanitation in all places.
• Antibiotics are life saving but there are so many factors that impact on such use such as
  • Using the right drugs
  • Following the right quantity/schedule
  • Exposure to antibiotics used in certain sectors in farming and poultry as well as the lack of clear guidelines to follow (by the medical community)
  • Incentives by the pharma industry to write out prescriptions for antibiotics
• Along with implementing hospital based prevention programmes, community based programmes that will improve hygiene, water and sanitation is essential.
  • This is particularly important in low and middle income countries where the burden of AMR is highest and a clean water and sanitation network difficult to come by.
• Preventing infections through vaccinations will automatically reduce the need for antibiotics.
  • Currently, vaccines are available only for one of the six leading pathogens (S pneumoniae) but vaccine programmes are reportedly on for some others as well.

Government Initiatives

• National Action Plan on Antimicrobial Resistance (NAP-AMR)
  • It is focusing on One Health approach and was launched on 19th April 2017 with the aim of involving various stakeholder ministries/departments.
  • It was launched to combat Antimicrobial Resistance goes hand in hand with the World Health Organization’s Global Action Plan (GAP) for AMR.
  • This plan aims to target all the human and non-human sectors affected by AMR.
    • However only three States have initiated a state plan of action. According to official sources, 11 States are still working on a state plan of action.
• AMR Surveillance Network
  • ICMR has established AMR surveillance and research network (AMRSN) in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
  • This network comprises 30 tertiary care hospitals, both private and government.
• AMR Research & International Collaboration
  • ICMR has taken initiatives to develop new drugs /medicines through international collaborations in order to strengthen medical research in AMR.
• Initiatives to control overuse or misuse of antibiotics
  • ICMR has initiated antibiotic stewardship program (AMSP) on a pilot project basis in 20 tertiary care hospitals across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
  • On the recommendations of ICMR, DCGI has banned 40 fixed dose combinations (FDCs) which were found inappropriate.
  • ICMR worked in collaboration with Indian Council of Agriculture Research, Department of Animal Husbandry, Dairy and Fisheries and the DCGI to ban use of Colistin as growth promoter in animal feed in poultry.

Way Forward

• Reducing exposure to antibiotics that are used in the farming sector and poultry industry is also key.
• India’s move to ban colistin usage in the poultry industry will go a long way in reducing the AMR burden in the country.
• Antibiotic stewardship, or minimising the use of antibiotics unless absolutely necessary, remains at the core of the fight against AMR.
• In this aspect, the strong involvement of the community is need of the hour.

Conclusion

• Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics

Source: The Hindu

Mains Question

Q. “Antimicrobial resistance (AMR) is considered one of the most significant challenges the world faces today.” Evaluate.