By Dr. Rajib Dasgupta
Antimicrobial resistance (AMR) is a silent pandemic, directly linked to the development and use of antibiotics that have been used relentlessly in the human, animal husbandry, and agricultural sectors. Its impact is manifest in terms of increased health care costs, millions of preventable deaths and long-lasting disabilities, threat to food security, severe effects on livelihood, and loss of animal lives.
The 78th session of the UN General Assembly noted that current estimates point to about five million deaths annually; left unaddressed, it could cause up to 10 million deaths per year by 2050. The WHO has flagged AMR as one of the top 10 threats to global health and development and being directly responsible for 1.3 million deaths a year, a fifth of those being children and could reduce life expectancy by almost two year if urgent actions were not initiated before 2030.
There are four key takeaways from the Centre for Global Development’s recently released report “Forecasting the Fallout from AMR: Economic Impacts of Antimicrobial Resistance in Humans”:
The current direct health care costs associated with AMR is estimated at US$ 66 billion per year (0.7% of global health expenditures) and is projected to rise to US$ 159 billion per year by 2050 (1.2% of global health expenditure) in a business-as-usual scenario, disproportionately affecting low- and lower-middle-income countries.
If resistance rates increased at the rate of the bottom 15% of countries, AMR health costs would rise to US$ 325 billion and the global economy would be US$ 1.7 trillion smaller in 2050 (compared to the business-as-usual scenario).
With high quality treatment accessible to everyone with bacterial infections and funding innovative new antibiotics health costs could be US$ 97 billion less and by 2050 the economy could be US$ 990 billion larger.
Improving innovation and access to high quality treatment can cost up to US$ 63 billion per year, offering a global return on investment of 28:1.
The current United National General Assembly session this week took some historic resolutions. The second High-Level Meeting on Antimicrobial Resistance (AMR)was held on 26 September 2024. The first high-level meeting was held on 21 September 2016 and recognized that AMR posed “a fundamental threat to human health, development, and security” and called for an all-round investment in immunization, safe water and sanitation, and good hygiene in hospitals and animal husbandry.
The Political Declaration of the High-level Meeting on Antimicrobial Resistance flagged as one of the “most urgent global threats to health and development”. It recognized that the burden was disproportionately borne by the developing countries and that effective, safe, and affordable antibiotics are a prerequisite for providing quality, accessible and timely health-care services. It is in this backdrop that the Declaration called for a set of multi-sectoral commitments. The immediate task would be to reduce the estimated 4.95 million human deaths associated with bacterial AMR annually by 10 percent by 2030. The approved declaration calls for sustainable national financing and 100 million U.S. dollars in catalytic funding, to help achieve a target of at least 60 percent of countries having funded national action plans on AMR by 2030. It has set an ambitious target: at least 70 percent of antibiotics used for human health globally should belong to the WHO Access
group antibiotics.
The WHO AWaRe (Access, Watch, Reserve) framework categorizes antibiotics into three groups; Access group comprises of antibiotics that are first- and second-line treatments and generally safe, inexpensive, with a lower risk of developing resistance. Watch antibiotics that have a higher potential of developing resistance and Reserve antibiotics are last-resort treatments for multidrug-resistant infections. The WHO’s current recommendation that 60% of all prescribed antibiotics
should be in the Access group.
To put this to context, over 55% of antibiotics used in India are from the Watch group. Usage of Access group was about 48% in 2020. Between 2011 and 2019, the share
of Access antibiotics decreased by 13.1% and the Access/Watch ratio declined from 0.59 to 0.49. This analysis found that the share of the Access group increased in Kerala (7.4%) and Gujarat (1.2%), while it decreased (i.e., worsened) in all other states and the maximal decline was in Bihar (13.4%).
The Watch group antibiotics increased in all states except Gujarat, Karnataka, Kerala, and Tamil Nadu. The use of Reserve antibiotics also increased in all states but remained around 1.0%. It has also set a target for at least 80 per cent of countries being able to test resistance in all bacterial and fungal GLASS pathogens by 2030. The WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) launched in 2015 is a standardized approach to the collection, analysis and sharing of AMR data by countries and currently includes 8 pathogens.
The leadership called for systems-wide strengthening through comprehensive primary and secondary antimicrobial resistance prevention strategies including AMR stewardship programs and environmental surveillance and management of air, water, plants, soil, food, and vectors that consider potential adverse effects of climate change on increased antimicrobial usage.
Given the multitude of interventions, the UN declaration has called for sustainable national financing and 100 million U.S. dollars in catalytic funding, to help achieve a target of at least 60 percent of countries having funded national action plans on AMR by 2030. India launched its first National Action Plan (NAP) on AMR in 2017 with action points around 6 strategic priorities; this was followed by several states drawing up state action plans. The G20 deliberations under the Indian Presidency reaffirmed commitment to addressing AMR through a One Health approach. A multi-stakeholder NAP2.0 is around the corner; it has its task cut out.
(Dr. Rajib Dasgupta is Professor (Community Health), Jawaharlal Nehru University, New Delhi and Co-Investigator of the UKRI-GCRF One Health Poultry Hub. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com)
