October 24, 2021

Is the World Prepared for the Next Silent Pandemic- Antimicrobial Resistance?

Anti microbial resistance (AMR) is a real, ever increasing, undetected, undiagnosed, and untreatable threat, potentially the next pandemic knocking at the door.
Keywords: Health Emergency, Global Crisis, Global Health, Antimicrobial resistance (AMR), Drug Resistance, Superbugs
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Two year of COVID-19 what have we learnt? Are we prepared for the next silent pandemic caused by antimicrobial resistance? This article raises a red flag about antibiotics becoming ineffective in treating infectious diseases and suggests strengthening and scaling up a global and national preparedness response network for countering the emerging global health emergency anti microbial resistance (AMR).

Antibiotics are the medicines used to prevent and treat bacterial infections and antibiotic resistance is when bacteria change the response to the use of antibiotics (medicines). The resistant bacteria, when they infect plants, animals or humans, are harder to treat with increased mortality, prolonged treatments and higher medical costs.

With growing population, loss of biodiversity and natural habitats, dis-balanced interactions between microbes-animals and humans, we have created conditions for diseases to jump from one species to another. The interconnected health and wellbeing systems need to be better prepared for the next public health emergency. Anti microbial resistance (AMR) is a real, ever increasing, undetected, undiagnosed, and untreatable threat, potentially the next pandemic knocking at the door. AMR could cause ten million deaths each year by 2050 and damage to the economy as catastrophic as the 2008-2009 global financial crises forcing up to 24 million people into extreme poverty by 2030. Antibiotics by themselves do not treat or prevent certain viral infections like COVID-19, still the antibiotic use increased throughout the pandemic along with cases. AMR was already a challenge to global health and now with the increasing use of antibiotics in response to COVID-19, it is proportionally exacerbating the potentiality of an even bigger global crisis. A recent study published in Nature Communications, by Indian health ministry experts, scientists from Indian research institutes in collaboration with Cambridge University have reported Global and Indian genomes showing resistances to commonly used antibiotics. Alarmingly, bacteria causing diseases like diphtheria are reported to develop resistance to several commonly used antibiotics, which indicated that diphtheria vaccines may become less effective over time. ICMR’s 2020 report on antimicrobial resistance research and surveillance across India highlights the same big worry, the decades of abuse and misuse of antibiotics, antifungals and antivirals have triggered mutations in pathogens making drugs and treatments useless when the patients need them. E Coli’s susceptibility to Imipenem has dropped from 86% in 2016 to 63% in 2019 with slight improvement to 72% in 2020. Klebsiella pneumoniae’s susceptibility has dropped from 65% in 2016 to 46% in 2019 to 45% in 2020. Acinetobacter baumannii, which used to be a relatively simple infection to treat, has emerged as a remarkable worry in 2020. The medics are running out of options to treat patients. Evidently, AMR in India can be the next national public health crisis.

So, are we prepared to stop the superbugs? Unfortunately, not fully prepared, but fortunately the world has realized and is now devising better preparedness strategies. It’s time for health leaderships to rethink, recall and remember what AMR calls for.

To combat the emerging AMR challenge, we need to focus on-

  1. Enhancing laboratory capacity and innovation in diagnostics: rapid point-of-care (POCs) diagnostics to detect, diagnose and treat with specificity, sensitivity and affordably.
  2. Strengthening national infection prevention and control policies and strategies to better understand the resistance pattern and respond more effectively.
  3. Establishing an indigenous national surveillance and tracking systems to identify the emerging trends in pathogens and respond quickly to outbreaks.
  4. Expanding the existing health (animal, human and environmental ecosystems) global and national institutional capacities to defeat AMR with simultaneous efforts for infection prevention, control and surveillance. Limiting the overuse of antibiotics in humans, agriculture, livestock industries and standardized protocol for the treatment and disposal of pharmaceutical effluents.
  5. Building an Indian Modeling Infectious Disease System in the Healthcare Network to investigate multiple factors and explore the potential of technologies like data sciences, artificial intelligence, and machine learning to simulate and estimate benefits of multiple prevention strategies in a timely and cost-effective manner.
  6. Facilitating medical innovation with a transforming approach. Collaborating with global institutions and markets for inclusive and equitable access. Handholding indigenous start-ups with validated and promising technologies and product developers to be competitive across the globe.
  7. Building Smart and fast regulatory agencies and frameworks for healthcare products: learning from COVID-19 response the review and regulatory process should expedite the approval timelines of potential studies, researches for diagnostics, vaccine and drugs etc.
  8. Bridging antibiotic guardians: developing a platform to bring diverse stakeholders to share the expertise, experience, or obstacles they face while navigating through current global and national AMR regulatory frameworks. The expert committee members can report their observations for healthcare decision makers.
  9. Giving wider hearing to the voices for change, bridging and amplifying patients, clinicians, researcher’s voice and concerns.

Conclusion:

AMR is a silent ticking time bomb and a bigger evolving threat than COVID-19. India and many LMICs (Low- and Middle-income countries), the hot spots of emerging infectious disease are already facing the surge in drug resistance in the commonest of treatable infections. The health leaderships need to acknowledge, strengthen, scale up the global and national preparedness response networks for countering the global health emergency threatened by anti microbial resistance.

References:

O’Neill J. Antimicrobial Resistance: tackling a crisis for the health and wealth of nations. The review on antimicrobial resistance.

The Interagency Coordination Group on Antimicrobial Resistance (IACG). No time to wait: securing the future from drug-resistant infections.

Boucher HW. Bad bugs, no drugs 2002–2020: progress, challenges, and call to action. Trans Am Clin Climatol Assoc. 2020; 131: 65-71

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Aakansha Bhawsar

Dr Aakansha Bhawsar is a Scientist at the Division of Basic
Medical Sciences, Indian Council of Medical Research (ICMR), Headquarters in New Delhi.

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