Context: 

The rapidly rising Antimicrobial Resistance (AMR) rates need an accelerated, multi-sectoral, global and national response.

About AMR:

• It is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs that are used to treat infections.

Reasons for the occurrence of multidrug resistance:

• Unnecessary and injudicious use of antibiotic fixed dose combinations.
• Include self-medication.
• Lack of knowledge about when to use antibiotics.
• Antibiotics which are critical to human health are commonly used for growth promotion in livestock and poultry.
• The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics.
• Mass bathing in rivers, etc.

• • The death due to AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria.
  • Most of the deaths from AMR were caused by lower respiratory infections, such as pneumonia, and bloodstream infections, which can lead to sepsis.

Concerning Issues:

• Global public health response has been threatened due to rising misuse and overuse of antibiotics in humans and animals.
• Microbial resistance to antibiotics has made it harder to treat infections such as pneumonia, tuberculosis (TB), blood-poisoning (septicaemia) and several food-borne diseases. 
• AMR also imposes a huge health cost on the patient in the form of longer hospitalisation, health complications and delayed recovery. 
• Many times, patients recover from advanced medical procedures but succumb to untreatable infections.

Concerning Facts:

• In 2019, AMR was associated with an estimated 4.95 million human deaths. 
• A 2018 report by the Organisation for Economic Co-operation and Development (OECD) warned of a phenomenal increase, by 2030, of resistance to back-up antibiotics (second and third-line).
• An Indian Council of Medical Research (ICMR) study in 2022 showed that the resistance level increases from 5% to 10% every year for broad-spectrum antimicrobials. 
• An Indian Network for Surveillance of Antimicrobial Resistance (INSAR) study indicated a high rate of resistance to commonly used drugs.

India and the Muscat conference:

• India’s commitment to the cause was evident at the Third Global High-Level Ministerial Conference on Antimicrobial Resistance .
• The Muscat Manifesto recognised the need to accelerate political commitments in the implementation of One Health action for controlling the spread 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.

• Focus areas of Conference:

The conference focused on three health targets:

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

• India has committed to strengthening surveillance and promoting research on newer drugs. 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 standardized systems.
• The manifesto encourages countries to prioritise their national action plans for AMR keeping the One Health approach.

The One Health Approach:

• It requires all stakeholders to work together towards an integrated programme linking challenges of humans, terrestrial and aquatic animal, plant health, food and feed production and the environment. 
• This approach will enable the world to effectively prevent, predict and detect the health crisis induced by AMR. 
• Tackling AMR requires constant monitoring of antibiotic consumption, identifying the types and quantities of antibiotics being used.

Need to reduce the Antimicrobial Usage:

• There is an urgent need to reduce the usage of antimicrobials in the agri-food system. 
• Scientific evidence suggests that the less antimicrobials are used, it is less likely that there will be an emergence of drug resistance. 
• Countries such as the Netherlands and Thailand have decreased their usage by almost 50%. 
• In China, the consumption of antibiotics in the agricultural sector has fallen substantially. 
• The use of antibiotics in healthy animals to boost growth has also been reduced in the last decade in many countries.

From policy to the ground level:

• The National Action Plan on Antimicrobial Resistance (2017-21) emphasised the effectiveness of the government’s initiatives for hand hygiene and sanitation programmes such as Swachh Bharat Abhiyan, Kayakalp and Swachh Swasth Sarvatra. 
• 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. 
• It also called for scrutiny of prescriptions to assess antibiotic usage in hospitals and among doctors.

Conclusion: 

• 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.

                                                                                                                                                                 News Source: The Hindu