By Jyoti Joshi
The widespread use of antibiotics over the last 75 years has dramatically reduced illness and death due to infectious diseases. Unfortunately, their indiscriminate use has come at a grave cost, that of antimicrobial resistance (AMR)—the ability of microbes to adapt to drugs that act against them and become resistant to their effects in fighting disease, thus creating ‘superbugs’.
The alarming rate at which bacteria are becoming resistant to existing antibiotics has led the WHO to identify AMR as one of the top-10 threats to global health. As per estimates, 700,000 persons die every year worldwide due to AMR and inaction in containing this menace is likely to cause, by 2050, over 10 million deaths every year, more than those caused by cancers and road accidents combined.
AMR is fuelled by indiscriminate use of antibiotics by humans for our health as well as in agriculture for mass production of food animals. However, the silent role of the environment, especially of inadequately-treated sewage waste containing resistant bacteria, goes unnoticed.
In a globalised world, the presence of these antibiotic residues and resistant bacterial genes in medical waste from hospitals, sewage from homes, and effluents and waste water from pharmaceutical plants magnify the burden of AMR manifold, creating resistant bacteria or superbugs. The threat of AMR is stark in India that has some of the highest antibiotic resistance rates among bacteria that commonly cause infections.
India took a major step by announcing a National Action Plan (NAP) on AMR in April 2017, which, in addition to the 5 Global Action Plan priorities, included a sixth pillar for “strengthening India’s leadership on AMR” among overall strategies. This was followed with subnational (state) action plans led by Kerala. Today, two years after the launch of NAP, it is heartening to note the progress in the country, from the establishment of an AMR lab surveillance network, to laying down of national guidelines for antimicrobial use and infection prevention and control in healthcare facilities. However, much remains to be done. AMR needs to be tackled in mission mode through a multi-stakeholder approach.
The Indian pharma industry is known to supply about 20% of generic drugs (2014), and manufacturing sites in India and China account for 80% of the antibiotics sold by pharma MNCs globally. But effluents from manufacturing units continue to wreak havoc on our environment by discharging unhealthy levels of antibiotic residues, resistant bacteria and genes into lakes and rivers. The existing Good Manufacturing Practices (GMP) framework is restricted to drug safety, and current environment standards do not include AMR-specific environmental safeguards. Regulation of environmental discharges from manufacturing units is left to local governments.
In India, the CPCB established effluent standards for pharma industry waste, and all state pollution control boards follow the same. Unfortunately, these standards do not include antibiotic residues, and thus are not monitored for propagation of resistance. As a country that aspires to demonstrate leadership in AMR policy, it’s time India establishes standards for maximum residual limits for antibiotic waste. Leadership by India will provide an opportunity to mobilise global procurement agencies in the supply chain.
By sourcing responsibly-made antibiotics manufactured in environmentally-sustainable way, using green technology, they can encourage manufacturers to comply with environment-friendly standards. During audits of pharma plants for GMP practices, waste discharge policies in place need to be assessed and action taken where required.
For the industry as a whole, business needs to bear greater social responsibility. As the pharma industry draws most benefits from the sale and use of antibiotics, they must take proactive leadership to monitor production, sell their products and dispose of waste responsibly. The faceless epidemic of antimicrobial resistance wreaks havoc on us every day by making lifesaving antibiotics ineffective. It is time for all of us to work together if we want to leave a lasting legacy of antibiotics that are still effective in saving lives from infections.
(The author is Head, South Asia, Center For Disease Dynamics, Economics & Policy)