Covid-19 placed enormous stress on health systems worldwide. As we emerge from the pandemic, greater emphasis must be placed on creating not only equitable but also more resilient healthcare systems, especially against the background of the impending climate crisis and the increased occurrence of zoonotic diseases. Rising antimicrobial resistance (AMR) is one such public health hazard that can debilitate health infrastructure if multi-sectoral and synchronised policies are not implemented in time.
Recently, the Indian Council of Medical Research raised concerns about the resistance of Indian patients to carbapenem — an extremely potent antibiotic used to cure pneumonia. Further, it also underscored that AMR has pandemic potential unless urgent actions are taken.
In 2019 alone, over one million lives were lost due to AMR. It has been estimated that low-income countries like India could lose more than 5 per cent of their GDP by 2050 due to an unhealthy workforce paying increased out-of-pocket expenses.
AMR management presents a complex public policy problem. As the drivers of AMR are spread across the human, animal, and agro-environmental ecosystems, siloed solutions to AMR mitigation will not work. The spread and emergence of AMR can be due to over-consumption of antibiotics, incorrect prescriptions by physicians, improper disposal of unused or expired antibiotics, and overuse of antibiotics for growth stimulation in the agriculture, poultry, and aquaculture industries.
Another equally important but often ignored driver of AMR is the release of untreated effluents from factories, healthcare institutions, and pharmaceutical manufacturing units into water bodies. The antibiotic residue in these untreated effluents ultimately finds its way into the food chain, eventually affecting both humans and animals. An integrated approach is thus imperative.
In 2015, an action plan for the prevention and mitigation of AMR was launched by the World Health Assembly. Envisaged to encourage simultaneous and multi-sectoral activities, the global action plan was subsequently weaved into national AMR containment programmes. In India, the National Programme on AMR containment, launched during the Twelfth Plan, was further improved to reflect the global understanding of AMR mitigation and India’s National Action Plan on AMR (NAP-AMR).
During the first five years of the NAP-AMR, appreciative measures including the ban on the usage of Colistin in the poultry industry and the ban on the usage of Streptomycin and Tetracycline in the agriculture sector were implemented. However, there are a few significant gaps that must still be addressed urgently.
The over-consumption of antibiotics must be curbed through regulatory reforms and by conducting patient and overall citizen awareness programmes. Despite the Red Line Campaign by the government, over-the-counter antibiotics are available easily without prescription. Further, a lack of a formal system of antibiotic use surveillance coupled with the power of State Drug Regulatory Authorities to grant drug approvals without the CDSCO’s nod enable overuse of antibiotics.
There is a pressing need to understand the environmental dimensions of AMR and develop policy to mitigate environmental AMR. In January 2020, a visionary amendment to the Environment Protection Rules was promulgated to govern the maximum concentration of antibiotic residues in discharges from bulk drug and pharmaceutical manufacturing units. However, it was never finalised.
In the absence of such rules, antibiotic pollution in India’s rivers continues to rise; the most prominent case being the antibiotic pollution of the Sirsa river in the Baddi pharmaceutical hub in Himachal Pradesh. Given the expansionary outlook of the Indian pharmaceutical sector, standards governing antibiotic residue limits must be immediately implemented. The government must support small and medium enterprises to overcome any cost and compliance challenges when they transition to responsible manufacturing of pharmaceuticals.
The writer is Member of Parliament, Rajya Sabha