Improving access to antibiotics through innovation 
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 Antimicrobial resistance is a growing health crisis, and tackling it needs a multi-pronged approach

August 27, 2022 07:40 pm | Updated 07:40 pm IST

On a rise: India is projected to have 1.6 million multi-drug resistant infectious cases in 2040. 

On a rise: India is projected to have 1.6 million multi-drug resistant infectious cases in 2040.  | Photo Credit: Getty Images

In his Nobel lecture, Sir Alexander Fleming, who was awarded the Prize for the discovery of penicillin, had a profound warning. “The time may come when penicillin can be bought by anyone in the shops,” he said. “Then, there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Within a century of his prophecy, the time has come.  

Our reckless use of antibiotics, including penicillin, has given rise to bacteria, viruses, fungi and parasites that have become resistant to commonly used antimicrobials. What is more concerning is that these microbes are evolving faster than we can invent drugs to tackle them. Our stash of antimicrobials is drying up while more drug resistant ‘superbugs’ are evolving and taking over the world. 

Antimicrobial resistance (AMR) is a growing health crisis, and tackling it needs a multi-pronged approach. We need newer, more effective antimicrobial drugs, improved access to life-saving antimicrobials across the globe; better diagnostics to identify drug-resistant infections and treat them with drugs that work, and robust surveillance systems to monitor the spread of drug resistant infections.

While discovering new antimicrobial drugs through pharmaceutical research and development is expensive, time-consuming, and often out of reach for many low- and middle-income countries, India can rely on collaborations and innovations to build game-changing strategies in tackling the AMR crisis and catch up with the evolving superbugs.  

Scale of AMR crisis 

In 2019 alone, drug-resistant superbugs killed about 1.27 million people globally — a toll more than HIV/AIDS or malaria — and according to the United Nations’ (UN) estimates, that number could reach 10 million by 2050.

In India, the largest consumer of antimicrobials globally, AMR is gaining ground, and the use of last-resort antibiotics like cephalosporins is soaring. The country is projected to have 1.6 million multi-drug resistant infectious cases in 2040, which is significantly higher than any country. The warnings are stark, but our current approaches to reign in the spread of superbugs seem inadequate. 

Diagnostic innovations

One way to prevent the reckless overuse of antimicrobials is to diagnose what’s causing an infection early, which helps determine the right course of drugs. In India, many doctors prescribe antibiotics to treat infections that are likely caused by viruses. Rapid diagnostics, which can help identify the exact microbe and the drug to which they are susceptible to, can avoid antibiotic misuse at the point of care.

The COVID-19 pandemic demonstrated how quickly rapid diagnostic tests could be developed and made available to people. Similarly, diagnosing AMR needs research on identifying the appropriate biomarkers to detect multi-drug resistant pathogens and developing accurate and affordable detection tools. Agencies like ICMR, BIRAC could fund such development.

Antibiotic discovery

While the consumption of antibiotics like cephalosporins, quinolones, and macrolides has sharply increased in low-and middle-income countries, the pipeline of new antibiotics is dry. Lack of funding in pharmaceutical research, clinical trial and supply chain challenges, and regulatory hurdles have slowed down new antibiotics development.

Developing new antibiotics is expensive and it takes a few years for new drugs to become available in low- and middle-income countries. India needs to jumpstart in-house development of new antibiotics by leveraging public-private partnerships between pharma companies and government research labs, as it did with Covaxin.

Government agencies like ICMR and CSIR, along with DBT, DST could work with international partners like Global Antibiotic Research Development Partnership (GARDP), Wellcome Trust and others to pursue antibacterial research, develop world-class clinical trial infrastructure to accelerate drug development.

In India, where 80% urban healthcare providers are private, resource-starved hospitals struggle to procure pricey antibiotics. Innovative pricing models, bulk procurement of such antibiotics and guaranteed purchase commitments from hospitals could not only reduce cost but also imbibe confidence in pharma companies that have invested in antibiotics research. The rollout of universal health coverage in India could improve access to antibiotics for more than 100 million families by reducing out-of-pocket spending for individuals while also easing procurement for the government with bulk orders.

AMR is an emerging pandemic, and India is the AMR capital of the world — a distinction that calls for swift action from policymakers and the scientific community. With India’s demonstrated prowess in pharmaceutical knowledge, experience and infrastructure, as witnessed during the COVID-19 pandemic with vaccine development and roll-out, the country has the opportunity to tackle AMR and show the way for other low- and middle-income countries.

In this direction, fostering innovation and international partnerships are key. With millions of lives at stake with the soon-to-become AMR pandemic, the country must act now. 

(Y.K. Gupta is Principal Advisor India Strategy Development, Global Antibiotics Research and Development Partnership (GARDP). Subasree Srinivasan is Medical Director, Global Antibiotics Research and Development Partnership (GARDP), Geneva.)

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