India in the firing line of antimicrobial resistance

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November 21, 2018 5:02 AM

World Antibiotic Awareness Week (WAAW) was observed across the globe during November 12-18 2018.

antibiotics, union budget, budget 2018, AMRAntibiotic may may kill dangerous skin cancer cells, says study (Representative image)

World Antibiotic Awareness Week (WAAW) was observed across the globe during November 12-18 2018. It is an annual event that aims to increase awareness among doctors, veterinarians, pharmacists and other health workers so that they administer antibiotics with caution and only when needed. It is directed towards policymakers so that they bring appropriate policy, educational and financial tools to tackle antibiotic resistance (ABR). Most importantly, it aims to spread awareness among the general public so that they understand the menace posed by ABR and use antibiotics responsibly. The theme of WAAW this year is ‘handle antibiotics with care’. The key message is to use antibiotics wisely, regulate their distribution and ensure that they are given to humans and animals only when really required.

Considering the fact that India is the largest consumer of antibiotics in the world and its misuse and overuse is rampant, one would have expected the government to go hammer and tongs to spread the message of ABR during WAAW. But that wasn’t the case. Barring a few low-key functions and sporadic social media messages, there were barely any public awareness programmes in the country during the week—neither were there any newspaper ads or public interest ads on television and movie theatres or social media campaigns. So, why is India muted on ABR? Do we think that ABR is a minor issue for us?

As antibiotics are becoming increasingly ineffective, ABR has become a public-health threat of an unprecedented scale. Common infections and those that were previously treatable are becoming difficult to treat. The situation is so grim that the United Nations (UN) now considers ABR to be at par with diseases such as Ebola and HIV. In a recent press release, the UN referred to ABR as a ‘global health emergency’ and projected that deaths due to ABR could surpass those due to cancer.

ABR is already a health emergency in India. Every year an estimated 58,000 newborn children die due to sepsis as antibiotics fail to treat this bacterial infection. A recent study published by Sumanth Gandra and his colleagues in the peer-reviewed medical journal, Clinical Infectious Diseases, found that multi-drug resistant bacteria causes significant mortality in hospital patients in India.

India is in the firing line. We have a huge burden of infectious diseases, poor sanitation and inadequate healthcare systems. Added to this is the overuse and misuse of antibiotics in humans and animals. Put all of them together and we have a full-blown health crisis in our hands. It is not that this issue is not recognised within the government. In fact, India came up with its National Action Plan on Antimicrobial Resistance (2017-21) in April 2017.

This was released along with the Delhi Declaration on Antimicrobial Resistance, a joint declaration endorsed by 12 ministries to adopt a collaborative approach on prevention and containment of antibiotic resistance in the country. The National Action Plan (NAP) calls for all concerned ministries, departments and other stakeholders to come together and implement activities outlined in the plan. But it is clear that the progress on the implementation of NAP has been very slow over the past 18 months.

My colleagues at the Centre for Science and Environment (CSE) recently released an assessment of the state of implementation of NAP and found that in certain critical areas almost no progress has been made. But before we discuss what has not been done, let’s point out a few accomplishments.

A big development is that the Food Safety Standards Authority of India (FSSAI) has recently notified the much-awaited tolerance limits for antibiotic residues in meat, milk, egg and fish. This means that regulators can now prosecute companies for having higher residues of antibiotics in their products. The Central Pollution Control Board (CPCB) has also developed draft standards for antibiotic residues in pharmaceutical industrial effluent and common effluent treatment plants. The draft is currently under review of the ministry of environment, forest and climate change (MoEFCC). Both these standards will help contain ABR.

But, aside from the two aforementioned standards, several initiatives planned by various ministries and departments are lagging far behind. Overall, the biggest disappointments have been the ministry of health and family welfare (MoHFW) and the ministry of agriculture, especially the department of animal husbandry, dairying and fisheries (DADF).

Currently, antibiotics are widely misused in livestock, poultry and aquaculture. For instance, antibiotics are routinely given as growth promoters to chicken to fatten them. Though exact data is not available, estimates show that India uses more antibiotics in animals than in humans. Yet, DADF has failed to bring a law to control use of antibiotics as growth promoters. Similarly, it has failed to set up a system to track the use of antibiotics in animals. It has also failed to develop a plan to phase out use in animals of antibiotics that are critically important for humans.

MoHFW is the nodal agency for implementing NAP. But it seems to have abdicated its responsibilities; most of the responsibilities that were assigned to it are lagging. It was made responsible for rolling out national programmes on research, awareness, education, training and surveillance, all of which are delayed.

Similarly, it was to develop an investment plan on ABR. But, instead of dedicated investments, the ministry has removed the separate budget head for ABR; in 2017-18, there was at least a separate head. The little money that was allocated in 2018–19 for ABR is now part of a common pool allocated for different public health programmes.

Because of MoHFW inaction, the progress at the state level is even tardier. So far, Kerala is the only state that has released its state action plan. It is critical that other states quickly develop their action plans as without the active participation of states, ABR cannot be controlled.

A lot of ground will have to be covered quickly to strengthen laboratories, develop capacity, establish mechanisms to control misuse of antibiotics, and set up modalities for ABR surveillance in food, animals and environment.

These are the essential building blocks to fight ABR. We cannot delay their implementation because of bureaucratic apathy. People are already dying because of ABR. If we don’t act quickly, we risk jeopardising the lives of millions in the near future.

The author is Deputy director general of Centre of Science and Environment. Twitter: Bh_Chandra

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