Antimicrobial resistance: Here’s what can be done to address environmental AMR in India

India is the world’s largest consumer of antibiotics in terms of total volume

By Atul Bagai, Divya Datt, Neha Dharmshaktu
Published: Thursday 01 December 2022
India has the highest infectious disease burden in the world, including infections due to multi-resistant pathogens. Photo: iStock.
India has the highest infectious disease burden in the world, including infections due to multi-resistant pathogens. Photo: iStock. India has the highest infectious disease burden in the world, including infections due to multi-resistant pathogens. Photo: iStock.

Antimicrobial resistance (AMR) has been declared one of the top global public health threats by the World Health Organization (WHO). The United Nations has also called it a global health emergency.

In 2019, antibiotic-resistant infections caused 1.27 million deaths worldwide, with an overall 4.95 million deaths from associated complications.

AMR may cause a global annual GDP loss of $3.4 trillion by 2030 and it may push 24 million people into extreme poverty.

Read more: Antimicrobial resistance: Here are some practices to ensure safe poultry

The main sources which contribute to the development, transmission and spread of AMR in the environment are — poor sanitation, sewage and waste; effluent and waste from the pharmaceutical industry; effluent and waste from healthcare facilities; use of antimicrobials and manure in crop production; and releases, effluent and waste in animal production.

In 2021, the Food and Agriculture Organization, UN Environment Programme (UNEP), WHO and World Organisation for Animal Health joined forces to constitute the One Health Quadripartite to combat health risks, including AMR, at the human, animal and plant and ecosystems interface.

Environmental Dimensions of Antimicrobial Resistance Summary for Policymakers report, released on the margins of the UN Environment Assembly 5.2 in February 2022, recommended stakeholder action in four key areas.

First, by strengthening environmental governance and regulatory frameworks by including environmental ministries and agencies while developing and implementing national action plans for AMR.

Second, by targeting priority chemical pollutants like antimicrobials, metals and biocides and biological pollutants like antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARG).

Read more: Antimicrobial resistance: Use these ethnoveterinary medicines for Lumpy Skin Disease

The third key area is enhancing reporting, surveillance and monitoring of AMR by recording data on antimicrobials, AMR microbes and their genetic material releases in the environment.

Lastly, it recommends prioritising innovative and sustainable financing to address AMR through sustainable public procurement.

In parallel, there is a need for more research to better understand the spread of AMR in environmental media.

This includes — research into the role of sewage and waste effluent from pharmaceutical manufacturing and healthcare facilities, the interaction of antimicrobial residue with other chemical and biological pollutants, the evolutionary history and possible environmental origin of ARGs and the environment’s role in the development of AMR microbes.

India has the highest infectious disease burden in the world, including infections due to multi-resistant pathogens. It is also the world’s largest consumer of antibiotics in terms of total volume.

In 2019, 2,807 million packs of anti-infectives were sold in India, of which systemic antibiotics comprised 2,165 million packs (77.1 per cent).

India’s National Action Plan on AMR (NAP-AMR) for 2017-2021 addresses six critical issues. It focuses on:

  • Creating awareness and understanding of AMR through effective communication, education and training.
  • Strengthening knowledge and evidence through surveillance.
  • Reducing the incidence of infection through effective infection prevention and control.
  • Optimising the use of antimicrobial agents in health, animals and food.
  • Promoting investments for AMR activities, research and innovations.
  • Strengthening India’s leadership on AMR. 

The country is in the process of updating its NAP-AMR for the period 2022-2026 through an extensive consultative process. The environmental dimension must receive due attention and relevant agencies and stakeholders must be engaged.

The Indian Council of Medical Research-National Institute for Cholera and Enteric Diseases, with support from UNEP, has collated scientific studies on the environmental aspects of AMR to support the process.

Some studies have reported bacteria with high levels of resistance to broad-spectrum antibiotics in specific river locations and potable water sources.

The study recommended the following short-term and long-term action points related to policy, institutional framework, research, surveillance, engagement and awareness.

With India taking over the G20 Presidency in December 2022 and One Health being one of the priority areas for discussion, the time is opportune for India to also address environmental aspects as it updates its NAP-AMR to help strengthen knowledge and capacity.

Atul Bagai is the head of the UN Environment Programme, Country Office, India.

Divya Datt is programme management officer at UNEP’s India Office.

Neha Dharmshaktu is associate programme management officer at UNEP’s India Office.

Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth

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