Eight years ago, Professor Timothy Walsh of the Cardiff University, United Kingdom, reported an enzyme called New Delhi metallo beta lactamase (NDM), which made bugs resistant to high-grade antibiotics such as carbapenems. This triggered outrage from the Health Ministry because of the name “New Delhi,” and concerns that it would hamper medical tourism. In an exclusive interview on the sidelines of the Falling Walls Conference, Prof. Walsh said India has made it “harder” for foreign researchers to access biological samples for research. However, he doesn’t regret naming it and would do it again, he said.
At a talk here, you said you were “banned” from India for research?
It was a lot worse than that…stories that some (of my research associates) were in jail, emails hacked into. It was quite crazy at that time. Then there was a ban on the second paper that reported evidence of NDM-1 in sewage and seepage. The Indian government was upset because that coincided with the Commonwealth Games at that time. We’d hoped that the government would then set in place a surveillance system for tracking anti-microbial resistance genes. However, regrettably, India banned export of samples. Legally, I can’t take a bowl of water out. China’s not so bad…we can get samples out of there. We have a programme on neonatal sepsis (bacterial disease in newborns) in Kolkata. We’ve set up exactly the same study in Pakistan — Islamabad, Lahore, Peshawar — and it took 3.5 weeks to set it up there and 11.5 weeks in Kolkata. This is largely due to the bureaucracy and paper work.
How much has the problem of resistance worsened? Are there only certain resistance genes to be worried about or is the problem more widespread?
It would be incredibly hard to find all the sources of resistance genes. This can include bird samples, flies, environmental samples, people. What we do is essentially cheat and look for a few markers, like NDM. Unfortunately, we look for no more than 4 markers, but when we do genome sequencing we get to know a lot many more (components) that may be driving resistance. The problem with NDM-1 was that it was on a plasmid that went into all kinds of bugs…Klebisella, Pseudomonae and into bugs I never heard of in my life….we even found it in yeast. However mcr (mobilised colistin resistance) that we found in China, is almost exclusively found in Escherichia coli.
If resistance genes are all around, how worried should we be?
You and I are chock-full of resistance genes. However, very few people are sick. NDM, for instance, is found often in non-pathogenic bugs. That is strange but true. As long as one is young, healthy, maintains hygiene and has a good lifestyle these genes rarely matter. But there are several reports of young women in rural India with constant cystitis and tested to have NDM because of faecal contamination and lack of access to clean water.
One aspect about the antimicrobial resistance debate in India is about the consumption of antibiotics. Wanton prescription, it is said, accelerates resistance but on the other hand the per capita consumption of antibiotics is much higher in the West than India. So who’s to blame?
I don’t think India’s problem is antibiotic consumption. Some believe that but I don’t. We’ve done studies in Karachi and found that carriers of key resistance markers didn’t have a history of antibiotic consumption but stood out in the type of toilet, water supply and sanitation. You can easily extrapolate what goes in Karachi to Mumbai, Kolkata and Delhi. It’s mostly environmental conditions. There is also contamination from quinolines that’s let out in the water from pharmaceutical companies. In that way the West is being negligent…we want your (Indian) cheap antibiotics but we haven’t been tough enough on companies such as Ranbaxy to make sure that the effluents from these factories are clean enough.
The Lancet journal, which published your NDM study, eventually apologised for the New Delhi name. Were they right?
No. I was asked many a time if I would have changed the name and — rightly or wrongly — we set in motion a process that brought the threat of AMR into unprecedented focus. The world became interested in carbapenems…same with NDM as it made everybody wake up. There was the Chennai declaration and the government’s National Action Plan. We stirred the proverbial hornet’s nest.
If you found a new resistance gene from Hyderabad… would you call it so?
I would, because if I didn’t, I’d be changing my behaviour for all the wrong reasons. When we found morc in China — a different gene and behaviour — we clarified to the government that ‘c’ didn’t stand for China. We learnt from the fallout with India. We didn’t behave entirely properly but so didn’t several other people in India. However, I’ve given up finding and naming genes. It’s for younger people.
( The reporter was an invitee of the Falling Walls Foundation in Berlin )