29 Apr 2021: UPSC Exam Comprehensive News Analysis

E. Editorials

Category: HEALTH

1. Antimicrobial resistance: the silent threat

Context:

• The health crisis brought out by the COVID-19 pandemic has starkly exposed the vulnerabilities of health systems to infectious diseases, both in the developing as well as in the richest countries.

Antimicrobial resistance:

• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. Read more on antimicrobial resistance in the linked article.

Factors aiding AMR:

• Though the mutations are common in micro-organisms, human activities seem to be augmenting the process of mutation in these micro-organisms, which seem to be driving the evolution of resistance in microbes.
• Drug resistance in microbes emerges for several reasons, some of which are as follows:
  • Misuse of antimicrobials in medicine
  • Inappropriate use in agriculture
  • Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.

Concerns:

• AMR represents an existential threat to modern medicine. Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections.
• AMR is already responsible for up to 7,00,000 deaths a year. Unless urgent measures are taken to address this threat, the global community could witness an unprecedented health and economic crisis of 10 million annual deaths and costs of up to $100 trillion by 2050.
• Though the AMR would be a global challenge, the low- and middle-income countries (LMICs) of Asia and Africa are more likely to be more impacted. The LMICs have significantly driven down mortality using cheap and easily available antimicrobials. AMR which would render these antimicrobials ineffective would overrun the already deficient and overburdened health systems in these countries.
• Notably, no new classes of antibiotics have made it to the market in the last three decades. This is mainly due to the inadequate incentives for the development and production of antibiotics.
  • A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies, 75% of which have no products currently in the market. Major pharmaceutical companies have largely abandoned innovation in the antibiotics segment.
• The World Health Organization Director-General has termed AMR a slow tsunami that threatens to undo a century of medical progress.

Recommendations:

• Tackling the diverse challenges posed by AMR requires action in a range of areas.

Developing new antimicrobials:

• The medicine sector should focus on developing new generation antimicrobials.
• The government should design and devise appropriate policies to incentivize pharmaceutical companies to engage in the research and development of antibiotics.
  • A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics.
  • The U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability. This will involve the governments paying upfront for these new antimicrobials, thereby delinking the life-saving value of the drugs from the volume of sales and providing an incentive for their production.

Infection control measures:

• The infection-control measures can help reduce antibiotic use on one hand and also aid in limiting the spread of AMR diseases.

Surveillance:

• To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
• There is a need for sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.

Ensuring appropriate clinical use of antibiotics:

• Regulating clinician prescription of antimicrobials alone would do little in settings where patient demand is high and antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs. Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines that would empower providers to stand up to such demands, as well as provide point-of-care diagnostics to aid clinical decision-making.
• A mix of incentives and sanctions should encourage appropriate clinical use.
  • Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions will help ensure the appropriate use of antibiotics.
  • Australia has undertaken extensive regulatory reforms to help influence prescriber behaviour when it comes to antibiotics.
  • The EU supported VALUE-Dx programme aims to increase the use of point-of-care diagnostics. This would aid clinical decision-making and help avoid unnecessary antibiotic usage.

Looking beyond the health sector:

• The integrated approach to dealing with AMR will require the administration to look beyond the health system. Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
• AMR needs engagement from a wide range of stakeholders apart from the health sector, representing agriculture, trade and the environment with solutions that balance their often-competing interests.
  • Denmark’s reforms to prevent the use of antibiotics in livestock have not only led to a significant reduction in the prevalence of resistant microbes in animals but also improved the efficiency of farming.
  • India’s recently proposed law to curb the amount of active antibiotics released in pharmaceutical waste is a welcome initiative in helping address the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste.

Global collaborative effort:

• The high potential for the spread of infectious diseases across international borders necessitates the need for cross-national cooperation around surveillance, monitoring and disease notification. These key activities will help minimise the impact of acute public health events such as COVID-19 and will help maintain global health security.
• Given the fact that successful policies in individual countries are no guarantee of global success, international alignment and coordination are paramount in both policymaking and its implementation.
  • The Paris Agreement should act as a blueprint for developing a similar global approach to tackling AMR.

Conclusion:

• Antimicrobial resistance (AMR) is one of the greatest challenges of the 21st century.
• Given the threat posed by AMR, which the author of the article refers to as a “silent pandemic”, there is the need for urgent action to tackle the challenge.