If lack of data was an impediment to roll out action plans against antimicrobial resistance (AMR), now that excuse has been yanked off. The recent publication of The Lancet’s global burden of bacterial antimicrobial resistance — an elaborate and studied estimate validated by using counterfactual analysis for the first time — comes at a time when the world, weary with battling COVID-19, seems to have lost steam to mount a robust AMR policy. But the report makes it clear that no slacking can be allowed on this front any longer; it estimated that 4.95 million deaths were associated with bacterial AMR in 2019 alone. It also identified the pathogens and pathogen-drug combinations that cause such resistance. Bacterial AMR occurs when the drugs used to treat infections become less effective, as a result of the pathogens becoming resistant to the drugs. This happens due to indiscriminate use of antibiotics, availability of antibiotics over the counter, poor hygiene and sanitation, antimicrobial use in the farming and poultry industry, lack of vaccines and newer antibiotics, and poor infection control practices in hospitals. While data on exact number of deaths might not have been available, there was no doubt about the alarming nature of associated mortality and morbidity. And yet, few nations have a policy to counter this pernicious problem.
In 2008, when the NDM1 enzyme that renders bacteria resistant to a range of antibiotics was traced back to India, it served as an urgent call for action. India released its own AMR action plan in 2017, and announced a task force for implementation. By 2019, Kerala and Madhya Pradesh had rolled out State action plans. Since then, little progress has ensued: 11 other States are still framing their action plans. The Chennai Declaration, a consortium of doctors and health-care institutions against AMR, was also formed in 2012 to draw up a road map. The ban on Colistin in the poultry, aqua farming and animal feeds supplements sectors, which India enforced from July 2019, was considered a strong strike in countering the AMR challenge. No doubt AMR offers humanity one of the most complex challenges that it has faced; but the recognition that solutions are not only in the realm of science is necessary. Scientific publications have established the correlation between AMR and poor hygiene, lax administrative governance and poor ratio of public-private expenditure. While the scientific community looks for solutions in its ken, governments must raise the standard of living for citizens, provide them accessible and affordable quality health care, besides regulating the sale and use of antibiotics. Not doing so in studied haste will only land up eroding the significant health-care gains India has proactively, and painfully at times, secured over the years.