Antimicrobial resistance — the new pandemic around the corner?
The COVID-19 pandemic has changed the world as we knew it. It locked us in our houses, restricted our physical interactions, and forced us to wear masks pretty much all day, every day. It led us — as governments, institutions, and the public — to think, discuss, and deliberate pandemics, public health, and healthcare systems, no matter how badly we wanted to avoid them.
For a few decades now, another public health crisis has been looming large right under our noses without receiving as much attention as it should have from the public. It’s the antimicrobial resistance (AMR) crisis. Perhaps the gradual nature of this phenomenon, unlike the sudden surge of COVID-19, has kept many in slumber.
But the danger of AMR is no less than a pandemic, and many governments and intergovernmental forums have begun to devise measures to tackle AMR.
According to the World Health Organization (WHO), AMR is one of the top ten global public health threats facing humanity [1]. Each year, about 7 lakh people [2] die worldwide because of infections that antimicrobial-resistant microbes cause. Studies estimate that this number could rise to 10 million by 2050 [3].
Microbes resist antimicrobial drugs using various strategies. They develop AMR mainly through genetic changes that culminate in one of the following outcomes, rendering antibiotics ineffective:
· producing enzymes that inactivate antibiotics,
· changing the structure of the proteins that the antibiotics target,
· making pumps that flush antibiotics out.
Antimicrobial-resistant microbes found in the environment, food, plants, animals, and people can spread in different ways: from plants and animals to people through food or from one person to another. They can spread from plants and animals to people through food or from one person to another. Antimicrobial-resistant bacteria in the animal gut can contaminate meat, causing AMR in humans who consume it. Similarly, antimicrobial-resistant bacteria in the soil and environment can contaminate fruits and vegetables, ultimately reaching humans. In some ways, you can compare this to the spread of some viruses from animals to humans, e.g., swine flu virus or bird flu virus. Therefore, tackling AMR warrants approaches to monitor and maintain environmental and animal health. Such an approach that recognizes the inextricable connection between human, animal, plant, and environmental health and aims to achieve optimal health outcomes for all of them with this consideration is called one health.
In addition to the mode of AMR spread through the environment, one health is a necessary strategy to tackle AMR for another critical reason.
Unlike in the case of the COVID-19 pandemic, it is not one agent that can cause AMR. One must deal with a host of bacteria, fungi, or viruses resistant to antimicrobials. For this reason, surveillance also takes center stage in tackling AMR.
Besides, the pandemic has taught us the importance of early preparedness and good healthcare systems. The recent situation when patients struggled in over-stretched medical facilities as they awaited oxygen cylinders and concentrators still haunts us. This underscores the importance of surveillance in preventing a similar catastrophe.
One important means of achieving good AMR surveillance is consolidating data available on AMR from different parts of the world.
In this direction, WHO has made efforts to consolidate the surveillance data at a regional level. In February 2018, government officials and other stakeholders from the existing IT platforms for AMR surveillance, like WHONET and the Japan Nosocomial Infections Surveillance (JANIS), gathered in New Delhi, India. The consultation aimed to check if member states would be interested in centralizing data, and discuss issues related to data security, confidentiality, support IT infrastructure, human resource, and capacity/training needs.
One of the ways to improve surveillance and preparedness against the spread of AMR is to nurture public-private partnerships in AMR response.
The existing partnerships for COVID-19 response could be realigned to address AMR. During the pandemic, such collaborations benefited different dimensions of the COVID-19 response, from testing to hospitalizations and vaccinations. Healthcare systems could use a similar strategy to improve AMR surveillance, diagnostics, and treatment. This could also be useful in establishing better healthcare systems. If there is one take-home message that the pandemic has given us through the way it swept through low-to-middle-income countries is how quickly burdened, resource-starved healthcare systems can crash.
Government and intergovernmental agencies have launched AMR surveillance programs to check the spread of AMR. For example, the WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) [4] in October 2015. GLASS helps collect, analyze, and interpret epidemiological, clinical, and population-level data of AMR in different countries. In India, the Indian Council of Medical Research (ICMR) launched Antimicrobial Resistance Surveillance and Research Network (AMRSN) in 2013. The network aims to monitor AMR, specifically at tertiary care institutes and hospitals in India. Recently, Kerala initiated an AMR surveillance program called Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP). Although government medical colleges and general hospitals are now tracking infectious pathogens, the program aims to extend this to tertiary care private hospitals through public-private partnerships.
Although the gradual spread of AMR has been consistent but it has still not caught public attention. There is an opportunity to draft and implement pandemic preparedness response policies to prevent further spread while also engaging other stakeholders. Seizing this opportunity, government, intergovernmental, and private entities must collaborate to strengthen AMR surveillance systems like GLASS, AMRSN, and KARSAP. According to India’s economic survey of 2020–2021 [5], private hospitals provide about 74% of outpatient and 65% of inpatient care in urban India. With such large proportions of the population relying on the private sector for healthcare, there must be ways to integrate data on the use of antimicrobials from the private and public sectors. This data could help formulate policies to promote antimicrobial stewardship. Further, collaborating with technology companies could help build software applications for better data management and create public awareness. One example is the Western Pacific Regional Antimicrobial Consumption Surveillance System (WPRACSS)-AMR [6], a software application built by Dure Technologies [7], a company based in India, which helps consolidate AMR data from different organizations in the Western Pacific region. Their application aims “to increase multi-stakeholder accountability and strengthen stewardship of antimicrobials to combat AMR and promote Universal Health Coverage and Sustainable Development Goals.” More such applications can be built from where data can be integrated across individuals, health centres, hospitals, etc. Many other individuals, groups, and institutions have also developed applications to educate the masses about AMR, and promote antimicrobial stewardship among clinicians, thereby checking the spread of AMR. Some examples include Antibiotic App [8], Antimicrobial Resistance [9] by GADVASU [10], Antimicrobial stewardship [11], and Antimicrobial Resistance App [12]. These actions could help shape timely public health policies that can guide AMR response based on one health philosophy and help us circumvent a grave danger.
Disclaimer: The blog is a compilation of information on a given topic that is drawn from credible sources; however, this does not claim to be an exhaustive document on the subject. The mention of entities, networks, consortiums, or partnerships is merely to highlight the stakeholders working in the field and does not reflect attestations, validations or promotion of their work. It is not intended to be prescriptive, nor does it represent the opinion of C-CAMP or its partners. The blog is intended to encourage discussion on an important topic that may be of interest to the larger community and stakeholders in associated domains.
Sources:
1.https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
3.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext
4.https://www.who.int/initiatives/glass#:~:text=Surveillance%20is%20an%20essential%20tool,local%2C%20national%20and%20global%20strategies.
5.https://www.indiabudget.gov.in/budget202122/economicsurvey/doc/vol1chapter/echap05_vol1.pdf
6.https://play.google.com/store/apps/details?id=com.duretechnologies.apps.amr&hl=en_IN&gl=US&pli=1
7. https://duretechnologies.com
8. https://play.google.com/store/apps/details?id=com.limon.screamingbrothers.atm
9. https://play.google.com/store/apps/details?id=org.gadvasu.aamr
11. https://play.google.com/store/apps/details?id=com.mssinfotech.antimicrobialstewardships
12. https://play.google.com/store/apps/details?id=com.icar.ivri.iasri.amrapp
