URGENT NEED OF A STATE ACTION PLAN ON AMR
Antimicrobial resistance (AMR) has emerged as a major threat to public health (WHO, 2014a). It is estimated that infections by antibiotic resistant pathogens cause 700,000 to several million deaths per year (WHO, 2014b; O’nell, 2016). In the United States alone, at least 2 million people become infected each year with bacteria that are resistant to antibiotics resulting in 23,000 deaths (CDC, 2017). Latest estimates have projected AMR to cause 10 million deaths each year globally by 2050. India carries one of the largest burdens of drug-resistant pathogens worldwide (Dixit et al., 2019). The frequency and level of antimicrobial resistance is increasing globally because of greater access to antibiotic drugs in the developing countries (Anon, 2018).
A World Health Organization (WHO) report released on April, 2014 stated, “This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country.” A global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the 68th World Health Assembly in May, 2015. One of the key objectives of the plan is to improve awareness and understanding of antimicrobial resistance through effective communication, education and training (WHO, 2015). In the last few years, international agencies have developed strategies and guidance that can identify and recommend evidence-based interventions to prevent emergence of AMR. Experts point out that there is an urgent need to bring global governance to the effort to preserve the effectiveness of antibiotics (Heymann and Ross, 2019). One of the first steps should be to embark on a process to identify which of the interventions proposed in the global action plans, strategies and guidance of WHO, FAO and the OIE would be priorities and feasible for all countries to implement (IACG, 2019).
Emergence of antimicrobial resistance in pathogens may be contributed by a number of factors including inappropriate use of antibiotics for treatment of infectious diseases in humans and animals, for growth promotion and disease prevention in animals, horticulture and fisheries, use of animal manure in soil, inadequate treatment of effluents from healthcare facilities and farms, etc. Therefore, to combat this global menace, a holistic approach with active participation of all the stakeholders is essential. Unlike several other developed countries, in our country, so far no legal stipulations are there to make it mandatory for every individual medico or veterinarian to keep record of usage/prescription of antibiotics. Moreover, any such medicine may be sold or purchased over the counter even without a prescription. Hence, a sincere effort backed by stringent policies and required legislations is necessary at both national and state levels. It is heartening to note that the Government of India has already come up with a National Action Plan on AMR (NAP‐AMR) in April 2017. Following this development, in December 2017, the Government of Kerala, the first among the Indian states, also adapted an action plan for the state. Madhya Pradesh has become the second state in India after Kerala to develop an action plan to manage antimicrobial resistance. Recently on July 26, 2019, the Madhya Pradesh State Action Plan for Containment of Antimicrobial Resistance (MP-SAPCAR) was released by the State Health Minister (Khullar, 2019). The MP-SAPCAR aims to holistically address AMR and talks about carrying out state-level AMR surveillance across all sectors including human health, animal husbandry, fisheries, environment, and food. Further, it aims to track antibiotic usage in humans, animals, fisheries, crops, as well as to ensure effective infection prevention and control in human and animal health, community and environment.
Adaption of similar action plans at the state level would certainly contribute to the effective and timely implementation of the National Action Plan on AMR. It is the need of the hour for other states including Assam to initiate immediate steps in the same manner so as to take a holistic approach to effectively combat the menace of antimicrobial resistance.
References:
1. Anon (2018). “Calls to rein in antibiotic use after study shows 65% increase worldwide”. The Guardian. https://www.theguardian.com/science/2018/mar/26/calls-to-rein-in-antibiotic -use-after-study-shows-65-increase-worldwide. Retrieved on 5th August, 2019.
2. CDC (2017). Antibiotic / Antimicrobial Resistance. www.cdc.gov. Retrieved on 5th August, 2019.
3. Dixit, A.; Kumar, N.; Kumar, S. and Trigun, V. (2019). Antimicrobial resistance: Progress in the decade since emergence of New Delhi metallo-β-lactamase in India. Indian Journal of Community Medicine. 44(1): 4-8.
4. Heymann, D. and Ross, E. (2019). Preserve the Effectiveness of Antibiotics with a Global Treaty. Chatham House, Royal Institute of International Affairs. https://www.chathamhouse. org/expert/comment/preserve-effectiveness-antibiotics-global-treaty?gclid=EAIaIQobChMIiYPcy7Hr4wIVWiQrCh37XwtgEAAYASAAEg KmZfD_BwE. Retrieved on 5th August, 2019.
5. IACG (2019). ‘No Time to Wait’. Inter-agency Coordination Group on Antimicrobial Reistance, Report to the Secretary-General of the United Nations, April, 2019. https://www.who.int/docs/default-source/documents/no-time-to-wait-securing-the-future-from-drug-resistant-infections-en.pdf?sfvrsn=5b424d7_6. Retrieved on 5th August, 2019.
6. Khullar, B. (2019). Madhya Pradesh second state to have plan for antimicrobial resistance. Down to Earth. https://www.downtoearth.org.in/blog/health/madhya-pradesh-second-state-to-have-plan-for-antimicrobial-resistance-65954. Retrieved on 5th August, 2019.
7. O’neill, J. (2016). “Tackling Drug-Resistant Infections Globally: Final Report and Recommendations”. amr-review.org/. Retrieved on 5th August, 2019.
8. WHO (2014a). “WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health” https://www.who.int/mediacentre/news/releases/2014/amr-report/en/ Retrieved on 5th August, 2019.
9. WHO (2014b). “Antimicrobial resistance: global report on surveillance 2014”. https://www.who.int/drugresistance/documents/surveillancereport/en/. Retrieved on 5th August, 2019.
10. WHO (2015). World Antibiotic Awareness Week. https://www.who.int/mediacentre /events/2015/world-antibiotic-awareness-week/event/en/ Retrieved on 5th August, 2019.
