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Insights into Editorial: Weaker germs, stronger cures

antibiotic

 

Introduction: Antibiotics:

The advent of antibiotics ignited the hope of elimination of infectious diseases in humans and animals.

However, this did not happen because of two reasons: the ingenuity and survival instinct of germs and the irrational use of antibiotics in humans and animals.

Most of the germs have acquired the capacity to resist the action of affordable antibiotics. This phenomenon is known as antimicrobial resistance (AMR). The inability of antibiotics to treat patients and animals is wreaking havoc on human health, nutrition safety and economies.

 

What is Antimicrobial Resistance?

  1. Anti-microbial resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections.
  2. As a result, standard treatments become ineffective, infections persist and may spread to others.
  3. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
  4. Antimicrobial resistance is now regarded as a major threat to public health across the globe.
  5. The long-term impact of AMR is almost comparable to that of the COVID-19 pandemic.
  6. AMR is estimated to cause 10 million deaths annually by 2050, unless concerted actions are initiated now.
  7. It will result in 7.5 % reduction in livestock production and negatively impact the global GDP by 3.5%.

 

Tackling the AMR challenge:

There are two major possible solutions to combat the AMR menace:

  1. Discovery of new drugs, before the emergence of resistance in germs; and
  2. Prudent use of available antibiotics.

The first is an expensive and unpredictable process. Since 1984, no new class of antibiotics has been developed.

The estimated cost for developing a new antibiotic exceeds $1 billion. With rapid development of resistance, the life of new antibiotics becomes limited and the return on investment on new molecules gets diminished.

This discourages the pharmaceutical industry to invest in these initiatives. The world is left with only one option: to use the available antibiotics carefully to ensure their efficacy for as long as possible.

 

Road map for tackling the AMR in global level:

  1. The World Health Organization Global Action Plan on AMR (2015) provides a road map for tackling this challenge.
  2. This plan has been endorsed by the UN General Assembly. Almost 80 countries have developed their respective national action plans in alignment with this Plan.
  3. The rational use of antibiotics in humans, animals, and agriculture warrants coordinated action in all sectors.
  4. These multi-sectoral, multidisciplinary and multi-institutional actions constitute the ‘One Health’ approach.
  5. This has gained currency across the world as an efficient and cost-effective response to AMR and several other challenges, especially endemic zoonoses (diseases transmitted between animals and humans) and pandemics.
  6. It is reinforced by the fact that all the epidemics in the current millennium (SARS, MERS, bird flu and COVID-19) have originated from animals because of unwanted excursion of humans into animal domains.
  7. The COVID-19 pandemic has emphasised the urgency of implementing One Health.

 

One platform for experts: One Health Approach:

  1. One Health should not be construed as a standalone or new programme that has to be built de novo.
  2. This endeavour utilises existing expertise and infrastructure in various sectors with a focus on inter-sectoral coordination, collaboration, and communication.
  3. The purpose of One Health is to provide a formal platform for experts to plan and work together towards shared objectives.
  4. Implementation of One Health warrants a strong and continuous national narrative on zoonoses.
  5. It advocates a multi-sectoral response to public health problems, particularly pandemics, as also to address issues related to AMR.
  6. The approach supports focussed actions on the human-animal-environment interface for the prevention, detection and response to the public health events that influence global health and food security.

 

One Health Approach advantages:

  1. One Health is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes.
  2. The areas of work in which a One Health approach is particularly relevant include food safety, the control of zoonotic diseases (diseases that can spread between animals and humans, such as flu, rabies and Rift Valley Fever), and combating antibiotic resistance (when bacteria change after being exposed to antibiotics and become more difficult to treat).
  3. India needs to leap-frog over the systemic and institutional barriers that prevent an integrated One Health framework from being operationalised.
  4. The One Health framework will help government and private institutions, across a range of disciplines, in collaborating to understand how zoonotic diseases can emerge, the threats they can pose, and the mechanisms by which the emergence or spread can be controlled.
  5. India’s National Action Plan on AMR is an excellent example of the One Health approach and can be used as a guiding document to develop a workable road map for the country to respond to other similar public health challenges.

 

Conclusion:

AMR is one of the biggest challenges to human and animal health. There is a need to optimally utilise emerging technologies to improve human health and development.

AMR has the potential to return the world to a pre-antibiotic era when medicines could not treat even simple infections.

Therefore, to contain AMR, there is need for a One Health Approach through coherent, integrated, multi sectoral cooperation and actions, as human, animal and environmental health are integrated.

Development of antibiotic resistance breakers (ARBs) to restore effectiveness of older classes of antibiotics.

One Health has been acknowledged as the optimum approach to counter the impact of AMR and future pandemics and must be adopted expeditiously.