GS-2: Issues relating to development and management of Social Sector/Services relating to Health
GS-2: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Ineffective magic bullets: Antibiotic resistance is now the leading cause of deaths across the globe
Context: The phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment is known as anti-microbial resistance. It is one of the greatest challenges of the 21st century. The term antimicrobial is used for medicines targeting living microbes.
Includes antibiotics for bacterial infections, anti-virals for viral infections, antifungals for fungal infections, and anti-parasitics for infections caused by parasites.
The term broadly defines how medicines that worked efficiently earlier are unable to destroy microbes causing the disease.
Typically, a pathogen can take two routes to antibiotic resistance:
A pathogen’s own genes can mutate spontaneously to help fight the drug. Mutations take time to spread through a bacterial population.
Horizontal gene transfer- is for the bug to borrow resistance genes from its neighbours.
Scientists believe that many human pathogens today picked up their resistance genes from the environment.
Key Numbers
Untreatable infections caused at least 1.27 million deaths per year across the globe
The toll is higher than that for HIV/AIDS or malaria
There were an estimated 4.95 million deaths associated with bacterial AMR in 2019. Out of these, 1.27 million deaths were directly attributable to AMR.
Young children were found to be particularly affected by AMR, although every population group is at risk. In 2019, one in five deaths attributable to AMR occurred in children under the age of five.
Concerns
Undoes Medical Progress: AMR represents an existential threat to modern medicine. AMR is a slow tsunami that threatens to undo a century of medical progress.
Increased Mortality: AMR is already responsible for up to 7,00,000 deaths a year. Neonatal and maternal mortality will increase due to AMR.
Economic Loss: Unless urgent measures are taken to address this threat, we could soon face an unprecedented health and economic crisis of 10 million annual deaths and costs of up to $100 trillion by 2050.
Increased Vulnerability to infections: Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections.
Disproportionate Burden on Poor Economies: The low- and middle-income countries (LMICs) of Asia and Africa are at severe risk of being overrun by untreatable infectious diseases.
The pediatric population is vulnerable to respiratory and diarrhea infections owing to a weaker immunity compared to the older population.
A majority of these infections are caused by viruses that cause fever, running nose, cough and watery diarrhea.
Viral infections are usually self-limiting and require only medicines to relieve symptoms; paracetamol, for example, brings down the fever. A saline nose drop relieves a blocked nose.
Antibiotics that are meant to treat bacterial infections have no effect on viruses. And yet, antibiotics are widely misused.
Children often receive multiple courses of antibiotics every year since viral infections are recurrent. This problem is further precipitated in children who have hypersensitive airways that make them cough whenever there is a change in climatic conditions or pollution levels. These conditions are often mistaken as bacterial pneumonia and are treated unnecessarily with antibiotics.
Reasons
Natural process catalyzed: Microorganisms develop resistance to antimicrobial agents as a natural defence mechanism. But, human activity has significantly accelerated the process.
Misuse of Antibodies: The misuse and overuse of antimicrobials for humans, livestock and agriculture is probably the biggest reason for this, but other factors also contribute. COVID-19 has increased awareness of infections and control measures such as hand washing and surveillance. But increased hospitalisations have raised fears that AMR will worsen due to increased use of antibiotics by patients.
Waste releases: Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria. Also, they are release in effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms.
Ineffective Wastewater treatment: An analysis of single wastewater discharge from a treatment facility in India catering to drug manufacturers found concentrations of antibiotics high enough to treat over 40,000 people daily. Thus, Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.
Pollution: Research points to the role of environment and pollution in AMR.
Other reasons: Water, then, may be a major mode for the spread of AMR, especially in places with inadequate water supply, sanitation and hygiene. Wildlife that comes into contact with discharge containing antimicrobials can also become colonised with drug-resistant organisms.
Way Ahead
India is severely affected by anti-microbial resistance and this has increased the burden of diseases. It is important for the government to initiate several measures from creating awareness to policies that shall be instrumental to address the same.
Comprehensive Surveillance Framework: To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
Sustained Investments: Finally, since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
Managing Pharmaceutical Waste: Given the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste, there is a need to look into measures to curb the amount of active antibiotics released in pharmaceutical waste.
Controlled Prescription & Consumer Awareness: Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand.
Multi-sectoral Coordination: AMR must no longer be the remit solely of the health sector, but needs engagement from a wide range of stakeholders, representing agriculture, trade and the environment. Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
Public awareness about the need for judicious use of antimicrobials needs to be ramped up. This would help physicians to not resort to antimicrobials just for satisfying the health seeker.
Better and rapid diagnostic facilities: The availability of rapid diagnostic tests such as rapid malarial antigen test, Dengue NS1 Antigen test, etc., has revolutionised the time taken to confirm a clinical diagnosis and give appropriate treatment.
The country needs stringent regulations to avoid irrational antibiotic combinations as well as over-the-counter availability of antibiotics. Vaccination plays an important role in preventing bacterial diseases such as pneumonia, typhoid, diphtheria, meningitis, whooping cough, etc.
Can you answer the following questions?
Elaborate on the criticality of antimicrobial resistance in India. How does it affect the socio economic set up of India?
A bigger challenge lies in checking irrational use of antimicrobials for common viral illnesses that a majority of children suffer from. Discuss.
