Mains Paper 3: Science and Tech
Prelims level: Antimicrobial resistance
Mains level: Pharma Sector and Health Science

Highlights

### Context:

• As serious as the current health and economic crisis is, COVID-19 may just be the harbinger of future crises.

• Antimicrobial resistance (AMR), the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment, is one of the greatest challenges of the 21st century.

• World Health Organization Director-General Tedros Adhanom Ghebreyesus said in July 2020, “AMR is a slow tsunami that threatens to undo a century of medical progress”.

• AMR is already responsible for up to 7,00,000 deaths a year.

• 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. ### Diverse challenges: • AMR represents an existential threat to modern medicine. • 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. • Neonatal and maternal mortality will increase. • All these effects will be felt globally, but the scenario in the low- and middle-income countries (LMICs) of Asia and Africa is even more serious. LMICs have significantly driven down mortality using cheap and easily available antimicrobials. • Drug resistance in microbes emerges for several reasons. These include 1. The misuse of antimicrobials in medicine, 2. Inappropriate use in agriculture, and 3. Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment. • This is compounded by the serious challenge that no new classes of antibiotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production. • A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies, 75% of which have no products currently in the market. • Tackling these diverse challenges requires action in a range of areas – in addition to developing new anti-microbials, infection-control measures can reduce antibiotic use. • Further, 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. • 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. ### Way forward: • A multi-sectoral$1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics, and the U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability.

• Other initiatives focused on the appropriate use of antibiotics include Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions.

• Australian regulatory reforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme.

• Beyond human use, Denmark’s reforms to prevent the use of antibiotics in livestock have not only led to a significant reduction in the prevalence of resistant microbes in animals, but also improved the efficiency of farming.

• Finally, given the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste, there is a need to look into laws such as those recently proposed by India, one of the largest manufacturers of pharmaceuticals, to curb the amount of active antibiotics released in pharmaceutical waste.
• While the range of initiatives that seek to control the emergence and spread of AMR is welcome, there is a need to recognise the limitations of a siloed approach.

• Current initiatives largely target individual issues related to AMR (such as the absence of new antibiotics, inappropriate prescription and environmental contamination) and consequently, narrowly defined groups of stakeholders (providers, patients and pharmaceutical companies).

• Regulating clinician prescription of antimicrobials alone would do little in settings where patient demand is high and antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs.
• Efforts to control prescription through provider incentives should be accompanied
1. By efforts to educate consumers to reduce inappropriate demand,
2. Issue standard treatment guidelines that would empower providers to stand up to such demands,
3. As well as provide point-of-care diagnostics to aid clinical decision-making.
• Policy alignment is also needed much beyond the health system.

• Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.

• International alignment and coordination are paramount in both policymaking and its implementation.

• Indeed, recent papers have proposed using the Paris Agreement as a blueprint for developing a similar global approach to tackling AMR.