A group of researchers led by Professor Nirmal Kumar Ganguly, Former Director-General, Indian Council of Medical Research (ICMR), have come out with a white paper on AMR, as it threatens to become the next big public health crisis in India and globally, according to a statement.

The statement said that the World Health Organization (WHO) has identified AMR as one of the significant threats to global health. It is already estimated that by 2050, 10 million deaths can be attributed to AMR.

AMR occurs when disease-causing microbes like parasites, fungi, bacteria and viruses develop resistance against the drugs that once effectively neutralised them. This increased resistance is because the structure of the microbes is altered by prolonged exposure to various drugs, including antibiotics, it added.

The statement mentioned that while some degree of mutation in microbes occurs naturally, the issue of AMR has been expedited as a result of human actions. In many countries, due to the ease of availability of drugs, patients resort to improper self-medication leading to increased drug resistance. Especially relevant against the backdrop of the pandemic, AMR is also accelerated due to the indiscriminate usage of antibiotics. While antibiotics were introduced in the animal husbandry and livestock industry to protect human health, today, most antibiotics are used to boost production. This allows for the spread of AMR as drug-resistant bacteria find their way into the food chain.

One other often ignored reason for the spread of AMR is the discharge of untreated effluents by pharmaceutical manufacturing units and hospital wastewater. When untreated effluents containing a high concentration of antibiotics from hospitals and pharmaceutical manufacturing units flow unchecked into the water bodies, these degrade the environment and affect animal and human health by increasing AMR, said the statement.

As per the statement, the white paper is divided into four sections. The first section explains the issue and provides WHO’s assessment of the problem, while the second section delves into the global scenario. The third section encapsulates the Indian context of AMR, also presenting a case study that documents the linkage between pharmaceutical production and the rise of AMR. The last section stresses on the need for newer diagnostics to detect drug-resistant infections at an earlier stage, the need for robust regulations that deter the release of untreated hospital and pharmaceutical waste, and emphasises investment in research and development of new antibiotics.

The inter-connectedness of the human, animal and environmental ecosystems plays a crucial role in AMR mitigation as the spurt in AMR in one ecosystem affects another. While many countries, including India, have adopted National Action Plans on AMR premised on the interconnected nature of the three ecosystems, these need to be backed by a synergised on-ground implementation, the statement added.

Speaking about the whitepaper, Ganguly, said, “AMR is a bigger threat than COVID-19, we need harmonised on-ground action on human, animal and environmental fronts to prevent its escalation into a public health emergency. India and many low and middle-income countries are already seeing a surge in drug resistance, even in common infections. I worry that due to COVID-19, the AMR situation has worsened. We need collective and immediate actions to curtail the aftermath.”

Monitoring and surveillance networks need to be appended for enhanced granular understanding. At present, most of the surveillance data is sourced from European and American surveillance networks, the statement further highlighted.

Professor V Samuel Raj, the second author of the paper, said, “To understand the emergence and mitigation of drug-resistant hotspots, we need better surveillance. Surveillance data in India is very limited as we are dependent on ICMR’s AMR surveillance network only. The effective anti-microbial agents are rapidly diminishing from the quiver of the available standard of care treatment options. This is a major concern.”