AMR turns a ‘silent’ pandemic

New Delhi/Nimli (Tijara): “Prevention is the best bet for low- and middle-income countries (LMICs) to control antimicrobial resistance or AMR. Otherwise, they will struggle to slow down this silent, but deadly, pandemic,” said Sunita Narain, the director general, Centre for Science and Environment (CSE), while setting the context for a two-day international workshop on the subject here.

The workshop, which is hosting over 45 globally acclaimed experts from 24 countries, has been organised by CSE to discuss priorities for LMICs to contain the crisis of antimicrobial resistance. Based on the discussions here, participating countries are hoping to put forward a set of views and recommendations at the High-Level Meeting on AMR, to be held during the UN General Assembly this year. At the High-Level Meeting, countries are expected to commit to bold and specific outcomes and targets related to reduction in antibiotic use and AMR.

“LMICs have several challenges that are different from those faced by rich countries. But they also have unique possibilities. They need to be prudent and do things differently,” added Narain, who is also a member of the Global Leaders Group on AMR. The workshop is discussing key issues like financing of national action plans on AMR and antibiotic research and development; sustainable food systems; managing antibiotic pollution from manufacturing etc.

CSE released its latest report — ‘Challenges and possibilities to prevent and contain AMR: Key takeaways from the perspective of low- and middle-income countries’ – at the workshop. AMR has emerged as a major killer. In 2019, an estimated five million deaths worldwide were associated with antibiotic resistance – about 1.3 million of these deaths were directly attributed to this silent pandemic.

Sharing the Swedish perspective during the opening session, Malin Grape, AMR Ambassador from Sweden, said: “Our presence here today holds great significance, representing our governments, or even being in a position to wield influence over their decisions. We are the ones that can ensure that the focus aligns with measures that can have an impact.”

Talking about the Kerala experience, Rajeev Sadanandan, former additional chief secretary (health), government of Kerala, said: “The key is to generate evidence, act on it and collaborate with stakeholders to handle the crisis.” Sadanandan was instrumental in developing Kerala’s state action plan on AMR.

Speaking about the dairy sector’s experience, Meenesh Shah, chairperson, National Dairy Development Board (NDDB), said: “India has a lot of ethno-veterinary medicines and for many of the common ailments, we may not need antibiotics. After a year-long observation in a district, it became apparent that 70-80 per cent of the cases, including mastitis, were treatable without antibiotics. Treating one million cases with ethno-veterinary medicines revealed a notable reduction in antibiotic usage across all treated animals.”

In a scenario where existing antibiotics are becoming ineffective in the face of increasing and more virulent infections, there is a severe dearth of new antibiotics in the market. “The antibiotic pipeline is weak and not future-ready. Most big companies no longer develop antibiotics; instead, they are drawn to the huge profits in drugs for cancer and other diseases,” says Amit Khurana, director of CSE’s sustainable food systems programme. “Access to both new and old antibiotics is a big concern in LMICs. Global funding for antibiotic development should be tied with promoting such access,” he adds.

“Access to effective antibiotics is a global public good; it should not be left to market forces,” said Jean Pierre Nyemazi, Director ai Global Coordination and Partnership & Quadripartite Joint Secretariat on AMR, World Health Organization (WHO) while referring to solutions for the antibiotic pipeline crises.

Speaking at the workshop, Anand Anandkumar, CEO and MD, Bugworks, India said: “A primary factor contributing to the failure of small- and medium-scale antibiotic developers is often not a lack of innovation, but rather, challenges in manufacturing.” Bugworks is one of the few small-medium scale antibiotic developer from India which has taken up the challenge.

Chairing a discussion on sustainable food systems, Narain said that “the food-animal systems in LMICs are largely about livelihoods, nutrition, food security and development. The biggest challenge is to produce more food while reducing antibiotic use. The need of the hour is cost-effective solutions and alternatives. ‘Prevention’ must become central to food-animal systems.”