Due to wide-ranging causes, we are witnessing a continuous rise of resistance to antibiotics which is threatening the world with a catastrophic public health emergency in the years to come.
By Robin Koenig
Over the years, antibiotics have been foundational to healthcare systems and medical advancements across the world. However, due to wide-ranging causes, we are witnessing a continuous rise of resistance to antibiotics which is threatening the world with a catastrophic public health emergency in the years to come. Acknowledging this threat of Antimicrobial Resistance (AMR), it has found its place on the agenda of the G20 Summit, the United Nations General Assembly since 2016 and even the World Health Organization (WHO) has included AMR as one of the top health challenges for the next decade.
Severity of the peril of AMR
As per the AMR Review 2014, estimates show that AMR led to over 700,000 annual deaths the world over. The review also estimated that by 2050, AMR is likely to cause a devastating 10 million deaths per year. The assessments also projected $100 trillion lost from GDP and a threat to development and global prosperity.
AMR and its linkage to Covid-19
AMR is a multi-faceted problem and slowing down its impact necessitates a multi-pronged methodology. The One Health concept draws attention to the interconnection among human health, animal health, food and environment, and promotes joint effort by the stakeholders. Hence, all the factors must be dealt with equal intensity and requires stakeholders across different domains, including the pharmaceutical industry to work together to save the future generations from an unprecedented public health catastrophe.
There are multiple causes that lead to AMR and the most prevalent and commonly debated issue is that of misuse and overuse of antibiotics. The current pandemic has also seen antibiotics been used extensively, even if it was not needed as part of the diagnosis. According to the findings of a meta-analysis published in September 2020, the total number COVID-19 patients who had a bacterial infection was 6.9%. However, the worrisome finding is about 72% of the same set of patients were administered antibiotics which is clearly a case of misuse.
Environmental factors contributing to AMR
However, a less talked about but equally pertinent cause, especially for India is the contamination through the effluent discharge of antibiotic/ Active Pharmaceutical Ingredient (API) manufacturing units. According to the scoping report on antimicrobial resistance in India by the Department of Biotechnology and the CDDEP in November 2017, it is estimated that 80% of antibiotics sold by global pharmaceutical companies worldwide are manufactured in India and China.
If these effluents are not adequately treated to remove antibiotic residue, these chemicals eventually reach the environment and water bodies, through wastewater streams, creating “hotspots” for development of resistance in the bacteria in these surroundings. The environmental burden of AMR is understandably higher around pharmaceutical manufacturing hubs. While environmental regulations for the pharmaceutical industry exist, they presently do not address antibiotic residues.
India – Leading the way in Tackling AMR
India has been proactive and focused on dealing with the problem holistically with a ‘one-health’ approach and has taken several initiatives under its NAP-AMR to bring together different stakeholders from the ministries of health, environment, water, agriculture and science and technology to work on AMR. Keeping the urgent need to fight this grave public health issue, it is promising to see the progress and commitment made by India on the environmental aspect of tackling AMR. The Central Pollution Control Board and the Ministry of Environment, Forests and Climate Change have issued the Draft Environment (Protection) Amendment Rules, 2019 in January 2020 for antibiotic residues in the treated effluents of the pharmaceutical industry. Once the draft becomes a legislation India will become the first ever country which will have discharge limits for antibiotics in effluent from the pharmaceutical industry. This step will position India as a thought leader heading the discourse on AMR.
These standards are extremely important as they promote sustainable manufacturing and safeguard the country from the negative impact of AMR on India’s public health system. In all this, companies also have a huge role to play – they need to take cognizance of their responsibilities towards public health as well as sustainability, and accordingly need to adhere to environmentally friendly processes and put mechanisms to safeguard and promote sustainable manufacturing.
Antimicrobial stewardship activities need to become an integral part of India and the world’s focus area when it comes to public health management. The industry must collaboratively work with the government and other stakeholders in the ecosystem to shoulder the responsibility to avert an antibiotic crisis and ensure sustainability for both the environment and the industry as well as patients/communities.
(The columnist is Regional Business Director, South Asia Region, Centrient Pharmaceuticals. Views expressed are the author’s own.)