Problem underpinned by complex drivers and behaviours; multisectoral and multidimensional efforts required
Photo: iStock Antimicrobial resistance (AMR) is among the top 10 global threats to human health, according to the World Health Organization (WHO). AMR could push over four million people into poverty and cause up to 10 million deaths per year by 2050, a United Nations Environment Programme (UNEP) study estimated.
Studies in the journal The Lancet and by the WHO on AMR and its burden have referred to it as a slow pandemic. The containment of AMR is critical for achieving UN-mandate Sustainable Development Goals (SDG). It requires multisectoral efforts and multidimensional approaches that include organisational, behavioural and environmental aspects, particularly in low-and middle-income countries.
The AMR problem is underpinned by complex drivers and behaviours, including environmental factors. From an environmental perspective, the main contributors to AMR include pollution from agriculture, pharmaceutical health and other sectors. Action is necessary to reduce the emergency transmission and spread of bacteria strains and instances of AMR.
The impact of pollution on AMR was also pointed out by UNEP Executive Director Inger Andersen, who said:
Pollution of air, soil and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environment degradation are worsening the AMR problem. The impacts of AMR could destroy our health and food systems
The concept of One Health focuses on health, agriculture and environmental protection. One method of containing it is to manage the entire chain of antibacterial agents and AMR.
Environmental pollution is mainly caused by a lack of strict control over the disposal of health, agriculture and pharmaceutical waste, particularly in low- and middle-income countries. Controlling pollution sources like poor sanitation, sewage and community and municipal waste is key.
One Health framework suggested improved water management, governance, planning and regulatory and legal frameworks at the national level. It also suggested international standards for microbiological indicators, investments in AMR containment and funding for sustainable development.
For example, Delhi-National Capital Region (NCR) is suffering from severe air pollution, which is causing health issues and affecting economic development. Governments are taking precautions like banning the entry of old vehicles into cities like Delhi, banning the burning of agriculture residues in neighbouring regions / states, etc.
India proposed a national action plan for controlling AMR in 2017 in line with the One Health framework and an additional aspect on socioeconomic conditions like education and awareness among the public. The national action plan focused on both human and non-human sectors and included the following:
China also responded to AMR containment by following WHO recommendations. The country’s action plan included the development of new drugs and technologies, the sale of antibiotics with prescriptions, the optimisation of surveillance, the rational use of antibiotics in both the human and animal sectors and professional education and public awareness about AMR.
The organisational dimension requires a focus on understanding the true picture across the country rather than a few selected locations/centres. It requires improvements to laboratory and training infrastructure and adequate and trained manpower. Quality standards are also required at all locations that cater to the growing needs of sectors such as health, agriculture, and pharma, all of which contribute to the growth of the AMR problem.
The involvement of government, private, and non-profit organisations in the fight against AMR is critical and urgent. Setting up adequate research and development and supply chains for optimal supply and use of antimicrobial drugs is critical from an organisational standpoint.
Current advancements in information and digital platforms can serve as cost-effective mechanisms for addressing AMR containment. Tamil Nadu and Kerala in southern India are the best examples of establishing health infrastructure and ensuring an adequate supply of essential drugs in public health facilities. WHO has recommended such efficient models for other countries to address health care delivery.
One of the most difficult aspects of not only AMR containment but also other aspects of society is behavioural change. Health-related behavioural changes have become critical in both policymaking and large-scale, sustainable implementation.
It is critical to develop and implement appropriate strategies for behavioural changes aimed at individuals and organisations. Doctors and other healthcare professionals, for example, can educate individuals on good health behaviours such as sanitation, food, and other habits, as well as the effects of antimicrobial drug overuse and misuse.
It has also been observed that using children as change agents for good health behaviours has worked effectively in a number of countries; therefore, it is strongly recommended that these strategies be used at the national level for countries such as India and China, among others.
Conducting awareness programmes alone will not be sufficient to achieve the end goal of containing AMR. Designing and implementing appropriate / contextual behavioural change strategies based on cultural, socioeconomic, and environmental factors is critical.
India can learn from successful programmes like polio eradication / vaccination programme and Swachh Bharat Abhiyan wherein the Prime Minister of India appealed to citizens and led the initiative himself along with all the key stakeholders of the country. Community engagement is vital for the success of any such large-scale programme and a similar approach can help India contain AMR effectively.
An integrated approach is required from an environmental standpoint to control contamination from various sectors such as pharma, agriculture, health, food, and others. Strict regulatory controls and coordinated interventions at all levels are required. Innovations such as public-private partnerships for national environmental management are a tried and true method.
Appropriate policy changes, the establishment of standard operating procedures for monitoring and controlling various AMR measurables, and the large-scale, long-term engagement of various stakeholders and communities can all help in the fight to contain AMR.
Venkataramanaiah Saddikuti is a professor of operations and supply chain management at IIM Lucknow and Fulbright scholar to USA in healthcare management; Ranga Reddy Burri is President – Infection Control Academy of India and Honorary Professor – School of Medical Sciences, University of Hyderabad
Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth
We are a voice to you; you have been a support to us. Together we build journalism that is independent, credible and fearless. You can further help us by making a donation. This will mean a lot for our ability to bring you news, perspectives and analysis from the ground so that we can make change together.
.png)
Comments are moderated and will be published only after the site moderator’s approval. Please use a genuine email ID and provide your name. Selected comments may also be used in the ‘Letters’ section of the Down To Earth print edition.