One of the most important advancements in modern medicine is at risk of becoming obsolete. The discovery of antibiotics almost a century ago, and which marked a new age of medicine, has helped produce cures for dozens of infections, from syphilis to pneumonia. However, health experts have always cautioned us of the risks of misusing antibiotics.
The problem lies in the natural ability of bacteria to develop resistance to external threats, including antibiotics. Over time, and under the right conditions, bacteria can develop resistance to multiple antibiotics yielding strains of ‘superbugs’ that are becoming increasingly difficult to kill. This phenomenon, known as antimicrobial resistance, can turn a simple, treatable infection into a death sentence.
Last year, an American woman died after an infection with a bacterium that was resistant to 26 different kinds of antibiotics. With the spread of highly resistant bacteria, we risk regressing to a world and time where many infections and simple surgical procedures could again become life-threatening conditions again.
A high burden
Globally, about 7 lakh people die because of drug-resistant infections each year; this figure includes more than 55,000 newborn babies in India. If current trends persist, global deaths due to antimicrobial resistance could reach 1 crore per year by 2050. In India, where the disease burden of bacterial infections is among the highest in the world, the dangers posed by antimicrobial resistance are immense. Several initiatives have worked to ensure that antibiotics are prescribed appropriately, but with limited success. But this doomsday scenario is not inevitable. Fortunately, our best hope in the fight against antimicrobial resistance and the spread of these deadly infections lies in another of medicine’s most powerful tools: vaccines.
Vaccines prevent infections from occurring in the first place, thus reducing the need for antibiotics. This reduces the spread of infectious bacteria, including resistant strains. Vaccines also protect against a range of viral infections, which cannot be treated by antibiotics. In fact, antibiotics are often incorrectly administered for viral illnesses that promote the spread of antimicrobial resistance. By protecting individuals from viral infections, vaccination can avert this misuse of antibiotics and slow down the development of resistance. Take the case of pneumonia. In India, it is one of the leading infectious causes of death in children under 5 years, having caused 1.8 lakh deaths in 2015. Although pneumonia has many causes, the most significant is bacterial which is often treated with antibiotics.
A vaccine with promise
With drug-resistant bacterial strains on the rise, vaccines could make a difference in the fight against antimicrobial resistance. One promising option is the pneumococcal conjugate vaccine (PCV). It offers protection against a bacterium called Streptococcus pneumoniae, which is one of the leading causes of severe pneumonia. The benefit is two-fold: it can protect children from strains of the bacteria that cause pneumonia, meningitis, sepsis, and other illnesses, while reducing the need for antibiotic use in children.
In 2017, the Government of India took an important step to address the twin burdens of pneumonia and antimicrobial resistance by introducing PCV into the Universal Immunisation Programme in three States. Earlier this month, the vaccine was introduced in two more States. In the next few years, the vaccine may be rolled out across the remaining States.
PCV is an example of the extraordinary potential of vaccines to reduce antibiotic use and resistance. This impact is not limited to one disease. Effective vaccines to prevent other preventable diseases such as measles and rubella keep children healthy while reducing the misuse of antibiotics when they fall ill. However, in order for these benefits to be fully realised, there is an urgent need to increase access to and uptake of these life-saving vaccines across the country.
Antimicrobial resistance is a universal problem that requires a collective solution. We all have a role to play in this fight. In doing so, we will all be working together towards ensuring a safer, healthier India.
Dr. N.K. Arora is Executive Director, The INCLEN Trust
