The invisible pandemic of drug resistance

(Written by K Madan Gopal)

Pandemics are a play of geopolitical power – wealthier nations have once again shown us that consequences suffered across the world are not comparable. It is no coincidence that the first 40 countries that rolled out vaccination programmes all fell within the high income/upper middle-income bracket. India is an outlier, having managed to roll out its vaccination programme buttressed by its indigenous capacities. For the country to continue standing its ground within this inequitable global order, it has to sustain its “Atmanirbhar spirit” and start strengthening systems for future pandemic resilience.

A recent white paper released by NITI Aayog, “Vision 2035 Public Health Surveillance in India” comprehensively lays down the public health challenges that the country faces as well as the opportunities that can be harnessed. India should double down and escalate surveillance measures against the next big pandemic that could cause suffering at an even larger scale. If WHO’s list of 10 global health issues to track in 2021 is any indication, drug/antimicrobial resistance (AMR) could trigger morbidity and mortality at an even larger scale. NITI Aayog’s white paper reaffirms this threat for India.

This is the phenomenon where disease-causing pathogens develop resistance to the drugs deployed against them due to indiscriminate exposure. The COVID-19 pandemic has demonstrated the fragility of our health systems to infectious diseases and the lasting consequences when the necessary drugs/vaccines are unavailable. Even though there is talk of AMR in medical circles, the visibility of the crisis is limited as cases do not appear in “outbreaks”. Indeed, AMR claims 7,00,000 lives each year – a number which could grow to be 10 million by 2050. Data has shown that if action is not taken, antimicrobial resistance (AMR) could be responsible for as many as 10 million deaths per year by 2050. Since India (along with China) produces almost 90 per cent of the world’s active pharma ingredients (APIs) as well as antibiotics, the AMR issue needs to be tackled as a priority to safeguard public health

Already, the growth of AMR has proved to be a major challenge in the treatment of sepsis, which is a life-threatening condition and, unfortunately, the failure of antibiotics is leading to deaths which are preventable. AMR is also undermining and undoing medical advances made over decades, especially for high-burden diseases like tuberculosis and various cancers, and taking us back to a time when a scrape of a knee could potentially cut our lives short.

Taking action to address AMR is not just a prudent measure but a necessity at this point and needs accelerated momentum from stakeholders across sectors. Fortunately, India identified the threat of AMR and came out with a National Action Plan for Containment of AMR (NAP) in 2017. The state governments of Kerala, MP, Delhi supplemented the Centre’s efforts with state action plans of their own.

The NAP espouses the One Health approach and outlines measures to scale down the use of antibiotics in humans, animals in poultry farms and in agricultural settings. Of these, the action that demonstrates the government’s deep understanding of local contexts and its unwavering commitment is the step to exercise environmental stewardship through regulation of pharmaceutical effluents. India prides itself on being the “pharmacy of the world” and manufactures about 80 per cent of the global antibiotic stock jointly with China. Such guidelines are, therefore, crucial for positive health outcomes of the population.

In January 2020, the government released draft standards prescribing permissible concentration of antibiotics in effluents from the pharmaceutical industry. Once implemented, this will be a leap towards mitigating the risks of AMR. India can also wear a badge of honour in being first in the world and the chief architect of a decisive and scientific initiative.

But this is a race against time and delaying multisectoral action in administering control over widespread use of antibiotics can vividly aggravate the health risks that we face. And so, we need to adopt strategies for optimising use of antibiotics across disciplines and exercise prudence across the board including in pharmaceutical effluent discharge. Promoting research to address the data deficiency around AMR for evidence-based assessment and intervention will further arm us in this fight where we are at a clear disadvantage. With clearly set out strategies, we can navigate our way through a prospective catastrophe and meet the moment.

The writer is senior consultant, health, NITI Aayog. View expressed are personal

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