Collaborative Approach against the Anti-Microbial Resistance

In a recent report, WHO highlighted the need of collaborative action to reduce Anti-microbial Resistance (AMR).

• The report provides a strategic framework to advance a One Health response to AMR at the global, regional and country levels.
• It is a joint effort by the
  • World Health Organization (WHO)
  • Food and Agriculture Organisation (FAO)
  • World Organisation for Animal Health (OIE)
  • United Nations Environment Program (UNEP)

What is Anti-Microbial Resistance?

• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
• Antimicrobials - including antibiotics, antivirals, antifungals and antiparasitics - are medicines used to prevent and treat infections in humans, animals and plants.
• Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

• Uneven and unregulated antibiotic usage is one of the most important reasons behind the AMR crisis. In developed countries, doctors prescribe antibiotics even for the most basic maladies like the common cold.
• Inequalities in access to medicine, excessive use, and poor sanitation services complicate the problem.
• Farmers using antibiotics to speed the growth of chickens and other livestock, drug-resistant germs find new ways to enter the environment.

• The goal of the strategic framework is to preserve antimicrobial efficacy and ensure sustainable and equitable access to antimicrobials for responsible and prudent use in human, animal and plant health, contributing to achieving the UN-mandated Sustainable Development Goals (SDGs).
• To achieve this goal, the objectives, mentioned in the framework are:
  • Optimize the production and use of antimicrobials along the whole life cycle — from research and development to disposal — and decrease the incidence of infection in humans, animals and plants to reduce the development and spread of AMR. 
  • The overall impact to which the four organisations aim to contribute through their collaboration is for countries to have the capacity to design and sustainably implement evidence-informed One Health responses to AMR. 

• Policy and law support effective country-owned One Health AMR responses: Recognise AMR as a priority in the broader development agenda, acknowledging the need for capacity building to strengthen AMR-specific legislation, policy coherence and sector-specific research.
• Systems and structures for country-owned one-health AMR Responses: National Action Plans on AMR and guidelines to be regularly updated including monitoring and surveillance of AMR and antimicrobial use (AMU). Access to good quality antimicrobials strengthened for all sectors. 
• Increased and sustained resourcing: Priority actions from national action plans on AMR mainstreamed into national plans and budgets.
• There are several divided outcomes for the approach. The first intermediate outcome relates to the support provided at country level, while the second is focused on the tripartite (WHO, OIE and FAO) and UNEP action at global and regional levels in support of countries’ efforts.

The World Health Organisation (WHO) had released guidelines on how each class of drugs should be used to treat 21 of the most common infections.

• Governments, Medical Associations must also commit to tackling the antibiotic crisis together. India’s medical societies adopted the Chennai Declaration to promote steps to tackle issues.
• Implement the formulation by the Indian Health Ministry, control over-the-counter sales of antibiotics.
• Reduce unnecessary antibiotic use by people and in agriculture.
• Antibiotics should never be used as unnecessary growth promoters in livestock farming.
• Prevent infections from happening in the first place with better hygiene, access to clean water, infection control in healthcare facilities, and vaccination.
• Improving the surveillance of superbugs, the UK had committed $ 300 Million to support microbiology surveillance capacity in developing countries.
• Steps have been proposed to speed up the adoption of state-of-the-art diagnostics in hospitals, clinics, pharmacies, and homes so that unnecessary use of antibiotics can be reduced.
• Pharmaceutical companies and government agencies are gaining a better understanding of the role that vaccines and alternative therapies could play in reducing antimicrobial resistance.

• The “National Programme on the containment of Antimicrobial Resistance” has been launched in the ageis of National Centre for Disease Control (NCDC).
• The objectives of the programme were:
  • Establish a laboratory AMR surveillance system of 30 Network laboratories
  • Generating quality data on AMR for pathogens of public health importance
  • To strengthen infection control guidelines and practices.
  • Promote the rational use of antibiotics in both healthcare providers and the community.
  • Situation analysis regarding the manufacture, use, and misuse of antimicrobials.
  • Identify the prescription pattern and establish a monitoring system for the same.

• National Action plan on Antimicrobial Resistance- India released the AMR action plan in 2017, two years after the Global Action Plan was released by the World Health Organisation.
  • Only two states Kerala and Madhya Pradesh have State Action Plan.
  • Objectives of the plan are: (i) to define the timeline and allocate the budget to slow the emergence of AMR in India and to strengthen the coordination between various organizations.
    1. Strengthen the Surveillance and optimize the use of antibiotics in all sectors enhanced investments in AMR activities, research, and innovations.
    2. Monitor and evaluate the NAP-AMR implementations.
  • Impacts of the plan:
    1. Improve awareness and understanding of AMR through effective communication, training, and education.
    2. Strengthen knowledge and evidence through surveillance.
    3. Reduce the incidence of infection through effective infection prevention and control.
    4. Optimize the use of antimicrobial agents in health, animals, and food.
    5. Promote investments for AMR activities, research, and innovations.
    6. Strengthen India’s leadership on AMR.

There is a need to plan and strategize the framework for Antimicrobial Resistance and this initiative by the trio of world health organisation, food and agriculture organisation, world organisation for animal Health and UNEP will make the development against it faster. The implementation of such programme on regional, global and country level is the way ahead for the issue.