In November, the world observed Antibiotic Awareness Week. In July, in its fight against the growing problem of resistance to antibiotics in disease-causing germs, the Indian government banned the manufacture, sale and use of colistin in the poultry industry . Colistin is considered the last-resort medicine to treat a person with life-threatening infection. The government’s move is among the numerous steps that will contribute to global efforts to preserve and prolong the efficacy of antibiotics and prevent the world from moving towards a dark, post-antibiotic future.
Antibiotics have saved millions of lives till date. Unfortunately, they are now becoming ineffective as many infectious diseases have ceased to respond to antibiotics. In their quest for survival and propagation, common bugs develop a variety of mechanisms to develop antimicrobial resistance (AMR). The indiscriminate use of antibiotics is the greatest driver in selection and propagation of resistant bugs. It has the potential to make fatal even minor infections. Complex surgeries such as organ transplantation and cardiac bypass might become difficult to undertake because of untreatable infectious complications that may result post-surgery.
The pipeline for the discovery, development and dissemination of new antibiotics has virtually dried out. No new class of antibiotics has been discovered in the past three decades. The reason is simple. Availability of a new antibiotic takes 10-12 years and an investment of $1 billion. Once it comes into the market, its indiscriminate use swiftly results in resistance, rendering it useless.
The resistance to antibiotics in germs is a man-made disaster. Irresponsible use of antibiotics is rampant in human health, animal health, fisheries, and agriculture. While in humans antibiotics are primarily used for treating patients, they are used as growth promoters in animals, often because they offer economic shortcuts that can replace hygienic practices. Globally, use of antibiotics in animals is expected to increase by 67% by 2030 from 2010 levels.
AMR has been recognised worldwide as an important public health challenge with serious impact on economy and development. The Sustainable Development Goals have articulated the importance of containing AMR. Similar articulations have been made by the UN general Assembly, G7, G20, EU, ASEAN and other such economic and political platforms. Earlier, the O’Neill report on AMR warned that inaction in containing AMR is likely to result in annual mortality reaching 10 million people and a 3.5% fall in global GDP by 2050.
Inter-country development agencies (WHO, FAO, and World Organisation for Animal Health) developed a Global Action Plan on AMR. India developed its National Action Plan on AMR (NAP) in 2017. It is based on the One Health approach, which means that human health, animal health and the environment sectors have equal responsibilities and strategic actions in combating AMR.
A global movement
Implementation of India’s NAP needs to be accelerated. The health of humans and animals falls in the domain of State authorities, and this adds complexity to the nationwide response. The magnitude of the problem in India remains unknown. Surveillance networks have been established in human health and animal health. The FAO has assisted India in forging the Indian Network for Fishery and Animals Antimicrobial Resistance for the generation of reliable data on the magnitude of the problem and monitoring trends in response to control activities. It is critical to expand and sustain such surveillance networks. There is an urgent need to augment capacity for regulatory mechanisms, infection control practices and diagnostics support, availability and use of guidelines for therapy, biosecurity in animal rearing practices and understanding the role of the environment and the engagement of communities. For this, the world must launch a global movement to contain AMR.
Tomio Shichiri is FAO Country Representative/Director and Rajesh Bhatia is FAO Regional Consultant on AMR