Addressing Antimicrobial Resistance through 'One Health' Approach

Manisha Verma

Shania Tahir

 

The escalating threat of Antimicrobial Resistance (AMR) has positioned it at the forefront of global health concerns. India that currently dons the mantle of the G20 Presidency has recognised the urgency to combat this impending crisis. The G20 India Health Track is guided by three pivotal priorities that encompass health emergency prevention, preparedness, and response, with a particularly accentuated focus on AMR within the framework of One Health.

 

The G20 countries acknowledged the urgency of addressing AMR at the 2017 summit in Hamburg, Germany. The need for international collaborations was emphasised as a part of the key actions to combat AMR. With India at the helm of G20 Presidency this year, AMR has been taken up as Priority No. 1 of the G20 Health Track. The topic was a prime focus for detailed discussions at the three meetings of the Health Working Group (HWG) of G20 at Thiruvananthapuram, Kerala, Goa and Hyderabad, Telangana and the G20 Health Ministers' Meet held from August 17-19, 2023 in Gujarat.

What is Antimicrobial Resistance (AMR)?

Antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics, are crucial for preventing and treating infections in humans, animals, and plants. However, prolonged and inappropriate usage, coupled with overuse, has led to the emergence of Antimicrobial Resistance (AMR). This phenomenon renders these medications ineffective in combatting diseases. Microorganisms like bacteria, viruses, fungi, and parasites naturally evolve over time, developing resistance to once-effective treatments. Even environmental exposure to resistant microorganisms can trigger resistance in bacteria found in water, soil, and air. This resistance complicates infection treatment, elevates disease transmission risks, and poses substantial health hazards, often resulting in prolonged, costly, and challenging-to-treat conditions, and sometimes even fatalities.

The misuse of antimicrobials in human and agricultural contexts, unregulated release of these substances into the environment, inadequate management of antimicrobial waste, and insufficient awareness among stakeholders contribute significantly to exacerbating this problem. Misconceptions, misinformation, and lack of understanding further compound the issue. Additionally, the shortage of new, effective antibiotics, combined with limited access to quality antimicrobials, worsens the situation, heightening the global threat of AMR.

Economic Sectors Impacting AMR Spread

The United Nations Environment Programme (UNEP) identifies three key economic sectors that significantly impact the development and dissemination of Antimicrobial Resistance (AMR): pharmaceuticals and chemical manufacturing, agriculture and food production (including crops and animal farming), and healthcare delivery encompassing hospitals, medical facilities, community health centers, and pharmacies where various chemicals and disinfectants are utilised.

AMR: A Looming Global Catastrophe

Antimicrobial Resistance (AMR) is swiftly evolving into a global catastrophe, acknowledged as a top 10 threat by the WHO. Startling figures tell the story: in the US alone, 3 million infections in 2019 were spawned by resistant pathogens. Disturbingly, projections predict 10 million annual deaths worldwide due to AMR by 2050. In Europe, high-income countries accounted for 25,000 AMR-related deaths in 2019. This crisis disproportionately impacts low-income nations, foreboding higher fatality rates. Swift action is non-negotiable, emphasised by both WHO's Global Action Plan and Food and Agricultural Organization's initiatives. Beyond human lives, the economic and healthcare toll is too colossal to ignore, making inaction an unthinkable risk.

One Health Approach

A "One Health" approach is being propounded as an effective framework to combat AMR's complexity. Originating during the SARS outbreak (2003-2004), the concept underscores the interdependence of human, animal, and environmental health. It urges all health-related sectors to take responsibility for curbing AMR's spread. Collaboration among government, academia, and private sectors forms the core, integrating solutions across healthcare domains. Many countries and international bodies employ this approach, focusing on infection control, surveillance, improved antimicrobial use, and regulations. Raising public awareness is vital, prompting responsible antibiotic use through educational campaigns.

 

India's AMR Initiatives

India is resolutely tackling Antimicrobial Resistance (AMR) through the 'One Health' approach. Prime Minister Shri Narendra Modi affirmed India's commitment to combat AMR as a global health menace in 2016. Union Health Minister Dr. Mansukh Mandaviya, echoing India's G20 Presidency's philosophy, voiced support for global AMR efforts at the 76th World Health Assembly.

Notably, the National Health Policy 2017 identifies AMR as a priority. Key initiatives include standardising antibiotic guidelines, curbing over-the-counter antibiotic sales, and promoting responsible antibiotic use. The National Action Plan for AMR (NAP-AMR) emphasises an integrated One Health strategy, bridging state, national, and international coordination.

India's National Action Plan 2017-21 aligns with the Global Action Plan on AMR (GAP-AMR). It focuses on surveillance, awareness, infection reduction, optimised antibiotic use, research, and leadership development. The plan leverages the National Centre for Disease Control (NCDC) and Indian Council Medical Research (ICMR) for AMR surveillance, antimicrobial stewardship, and animal sector monitoring.

Progress is evident with restricted antibiotic availability, infection control guidelines, and antimicrobial waste regulation. Noteworthy initiatives include the "Red Line Campaign on Antibiotics," national treatment guidelines, and National Guidelines for Infection Prevention and Control. AMR surveillance networks and Antimicrobial Stewardship Programs further strengthen the battle.

Inclusive private sector involvement is pivotal. Investments in research and development, responsible antibiotic promotion, and physician education are vital. Together, India is forging a comprehensive front against AMR's multifaceted threat, underscoring One Health's transformative power.

Forging Ahead Against AMR: Data-Driven Strategies        

To effectively combat AMR, building a comprehensive database is pivotal, encompassing its causes, impacts, and solutions. Surveillance stands as a key tool, aiding trend assessment, strategy monitoring, and evidence-based policy formulation. The Global Antimicrobial Resistance and Use Surveillance System (GLASS) was established by WHO in 2015, streamlining data collection and sharing.

However, GLASS needs updates to match AMR's evolving nature. Expanding data scope, enhancing quality, and employing advanced analytics while broadening participation can provide deeper insights. Updated GLASS with regional interventions can uncover key AMR drivers, empowering policymakers and researchers. Low- and middle-income countries (LMICs) need support in real-time data collection, potentially through user-friendly digital platforms.

The G20's contribution to the WHO and World Bank Pandemic Fund can bolster AMR efforts, especially in capacity building and laboratory maintenance. Utilising their economic power, G20 nations are vital in pursuing a comprehensive 'One Health' approach to tackle AMR, embracing new antimicrobial development, enhancing treatments, enforcing judicious antimicrobial use, bolstering infection control, and elevating surveillance.

(The author, Manisha Verma is Additional Director General (Media & Communication), Union Health Ministry, and Shania Tahir is an independent writer. You can send us your feedback on the article at feedback.employmentnews@gmail.com)

Views expressed are personal.