Central Idea

• 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. Most countries understood in 2020 the clear and present danger of COVID-19, forcing governments, including India’s, to respond with speed and accuracy. The rapidly rising AMR rates also need an accelerated, multi-sectoral, global and national response.

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What is Antimicrobial Resistance (AMR)?

• Antimicrobial resistance (AMR) is a natural phenomenon that occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve to become resistant to antimicrobial drugs such as antibiotics, antivirals, antifungals, and antiparasitics that were previously effective in treating infections caused by those microorganisms.

The Threat of Antimicrobial Resistance

• Human deaths: In 2019, AMR caused approximately 4.95 million human deaths worldwide, highlighting the urgency of addressing this issue.
• Report by OECD: A 2018 report by the Organisation for Economic Co-operation and Development warned that the world could experience a significant rise in resistance to second and third-line antibiotics by 2030.
• Resistance increases by 5% to 10% every year: A 2022 study by the Indian Council of Medical Research (ICMR) revealed that resistance to broad-spectrum antimicrobials increases by 5% to 10% every year.
• High rate of resistance found in commonly used drugs: The Indian Network for Surveillance of Antimicrobial Resistance (INSAR) also found a high rate of resistance to commonly used drugs such as ciprofloxacin, gentamicin, co-trimoxazole, erythromycin, and clindamycin, underscoring the importance of taking steps to combat AMR.
• High levels of resistance: WHO has increasingly expressed concern about the dangerously high levels of antibiotic resistance among patients across countries.
• For example: Ciprofloxacin, an antibiotic commonly used to treat urinary tract infections. According to WHO, resistance to ciprofloxacin varied from 8.4% to 92.9% for Escherichia coli (E. coli) and from 4.1% to 79.4% for Klebsiella pneumoniae (a bacteria that can cause life-threatening infections such as pneumonia and intensive care unit- related infections). The global epidemic of TB has been severely impacted by multidrug resistance patients have less than a 60% chance of recovery.
• Adds burden to communicable disease: AMR adds to the burden of communicable diseases and strains the health systems of a country, making it even more challenging to address health crises.

What is Muscat conference is about?

• Ministerial Conference on AMR: Third Global High-Level Ministerial Conference on Antimicrobial Resistance (November 24-25, 2022) held in Muscat where over 30 countries adopted the Muscat Ministerial Manifesto on AMR.
• The conference focused on three health targets:

1. Reduce the total amount of antimicrobials used in the agri-food system at least by 30-50% by 2030;
2. Eliminate use in animals and food production of antimicrobials that are medically important for human health;
3. Ensure that by 2030 at least 60% of overall antibiotic consumption in humans is from the WHO Access group of antibiotics.

• Muscat Manifesto:

1. Need to accelerate One Health action: The manifesto recognised the need to accelerate political commitments in the implementation of One Health action for controlling the spread of AMR.
2. Need to address the overall impact of AMR: 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.

Government efforts so far

• The National Action Plan on Antimicrobial Resistance (2017-21): The National Action Plan on AMR emphasised the effectiveness of the government’s initiatives for hand hygiene and sanitation programmes such as Swachh Bharat Abhiyan, Kayakalp and Swachh Swasth Sarvatra.
• Increasing community awareness: The government has also attempted to increase community awareness about healthier and better food production practices, especially in the animal food industry.
• Specific guidelines regarding use and limiting use of antibiotics: The National Health Policy 2017 also offered specific guidelines regarding use of antibiotics, limiting the use of antibiotics as over-the-counter medications and banning or restricting the use of antibiotics for growth promotion in livestock.
• Called for scrutiny of antibiotic prescriptions: It also called for scrutiny of prescriptions to assess antibiotic usage in hospitals and among doctors.

Examples of Limiting AMR worldwide

• Less use of Antimicrobials less likely resistance: Scientific evidence suggests that the less antimicrobials are used, it is less likely that there will be an emergence of drug resistance.
• Netherlands and Thailand: Countries such as the Netherlands and Thailand have decreased their usage by almost 50%.
• China: In China, the consumption of antibiotics in the agricultural sector has fallen substantially.

Way ahead: India’s role

• India committed to strengthen surveillance: India has committed to strengthening surveillance and promoting research on newer drugs.
• GLASS: It also plans to strengthen private sector engagement and the reporting of data to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other standardised systems.

Conclusion

• The various G-20 health summits spread through 2023 offer an opportunity for India to ensure that all aspects of AMR are addressed and countries commit to progress. As the current G-20 president, and as a country vulnerable to this silent pandemic, India’s role is critical in ensuring that AMR remains high on the global public health agenda.

Mains question

Q. In the backdrop of recently held Muscat Conference on AMR highlight the threats posed by AMR and Discuss India’s efforts in combating the silent pandemic.

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