AMR and health crisis

Context:  Antimicrobial resistance (AMR), a silent pandemic, is growing at an alarming rate.

Why is AMR growing at an alarming rate?

• AMR:  Globally, about 35% of common human infections have become resistant to available medicines.
• About 700,000 people die every year because available antimicrobial drugs (antibiotics, antivirals, anti-parasitic and antifungals) have become less effective at combating pathogens.
• Resistance to second- and third-line antibiotics the last lines of defence against some common diseases are projected to almost double between 2005 and 2030.
• According to a study published in The Lancet, an estimated 58,000 new-born children die annually from sepsis in India alone because antibiotics can no longer treat certain bacterial infections.
• Reasons for AMR:
• Microorganisms develop resistance to antimicrobial agents as a natural defence mechanism. Human activity has significantly accelerated the process.
• The misuse and overuse of antimicrobials for humans, livestock and agriculture is probably the biggest reason for this.
• Research points to the role of environment and pollution in AMR.
  • Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria.
• Release of effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms. Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.

What are the problems faced?

• Issues faced: In India, there is capacity to treat only about 37% of the sewage generated annually. The rest is discharged into natural water bodies without 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.
• Mode of spread: Water 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.

What are the key initiatives to tackle AMR?

• UNEP: The United Nations Environment Programme (UNEP) identified antimicrobial resistance as one of six emerging issues of environmental concern in its 2017 Frontiers Report.
• The UN Environment Assembly pressed the need to further understand the role of environmental pollution in spreading AMR.
• GAP: UN agencies are working together to develop the One Health AMR Global Action Plan (GAP) that addresses the issue in human, animal, and plant health and food and environment sectors.
• MoEF&CC: The Ministry of Environment, Forest and Climate Change (MoEF&CC) issued draft standards which set limits for residues of 121 antibiotics in treated effluents from drug production units.
• The Ministry of Health and Family Welfare and MoEF&CC constituted the inter-ministerial Steering Committee on Environment and Health, with representation from WHO and UNEP.

Way forward

• The Centre and State governments in India can strengthen the environmental dimensions of their plans to tackle antimicrobial resistance.
• It is particularly important to promote measures that address known hotspots such as hospitals and manufacturing and waste treatment facilities.