Important to prevent emergence and spread of infections to reduce need and dependence on antimicrobials
The COVID-19 pandemic wreaked havoc across the world. But it has also made it clear that a prevention agenda will be critical to tackling current and future health pandemics, including antimicrobial resistance.
AMR is estimated to have caused about five million deaths worldwide in 2019. About 1.3 million deaths were directly attributed, in particular, to antibiotic resistance, which is the resistance of a bacteria developed against an antibiotic.
The data is just for one year, but it exceeds COVID-19 numbers, as the number of deaths caused by respiratory illness was about 6.6 million over the last three years. This means the historical impact that this silent and invisible pandemic of AMR may have had could be huge.
Without any action, this can jump to 10 million deaths annually by 2050, equivalent to three deaths every 10 seconds.
AMR is the resistance developed in bacteria, viruses, fungi and parasites against the antimicrobial drug such that they can no longer be inactivated or killed by the drug.
This occurs naturally over time but can be accelerated by the misuse and overuse of antimicrobials in human health, animal health and food production. The environment also plays a crucial role in spreading AMR through waste.
COVID- 19 pandemic reminded us of the importance of “prevention” across ‘One Health’. A virus breaking the human-animal-environment barrier wreaked havoc on the entire world and it required all sectors to get on board to conquer it.
With no treatment option in sight, prevention measures such as wearing a mask, social distancing, and washing hands helped control COVID to some extent. Even as vaccines came into the picture, the aim was to prevent the viral infection rather than treat it.
The health and economic burden of antibiotic resistance will be very high. So is the burden of containing or cleaning up the antibiotic pollution responsible for causing it.
There are very few new antibiotics in the pipeline and developing new ones also costs a lot of money and time. It is not that easy as well. Even monitoring and surveillance of resistance trends is resource intensive.
Emerging economies, which have competing priorities such as education and nutrition and are constrained by resources, would therefore struggle to optimally invest in containing antibiotic resistance through such measures.
For them, the cost of containing antibiotic resistance would be even higher, which they would not be able to afford.
What is the way out? As always and more so in this case, prevention is better than cure. This means we should think of preventing the emergence and spread of infections so that the need and dependence on antimicrobials are reduced.
Across human, animal, agriculture and environmental sectors, adopting a prevention agenda should be the key to combating AMR.
Poor sanitation is linked to the development and transmission of diarrhoeal diseases such as cholera and dysentery, apart from its linkages to the spread of AMR.
As per the World Health Organization, 1.7 billion people still did not have basic sanitation services in 2020. And at least 10 per cent of the world’s population consumed food irrigated by wastewater.
Moreover, nearly 1.7 billion cases of childhood diarrhoeal disease are reported every year. This is suggestive of the tremendous impact that investments in water, sanitation and hygiene (WaSH) systems can have in preventing infectious diseases and AMR.
The provision of clean drinking water and behavioural changes such as using toilets and washing hands can go a long way in bringing down the risk of infections and the use of antibiotics.
At the personal level, avoiding self-medication and over-the-counter antibiotics, completing an antibiotic course as prescribed and prescribing only when needed by doctors could also be some examples that could be practised.
We need to invest in systems and processes to contain antibiotic resistance from food-animal sectors that help us prevent the occurrence of diseases in farms in the first place.
One of the ways is by ensuring timely vaccinations for livestock against diseases. These play an essential role in protecting animal health, welfare, and food production.
Another way is by investing in alternatives that can help us avoid antibiotics, if the infection has occurred. This can include options like herbal preparations, probiotics, herbicides, etc.
Recently, ethnoveterinary medicines (traditional/herbal medicines) have emerged as potential alternatives to antibiotics in the Indian dairy sector and have been shown to reduce the use of antibiotics.
Implementing appropriate biosecurity measures in farms is another approach. This can include measures such as appropriate farm siting, restrictions at farm entrance (e.g., changing of clothes or shoes, showering, foot dipping, cleaning of hands), hygiene of transport vehicles and clean feed and water.
Vermin and bird control, isolating an infected animal from others and regular disinfection of farm equipment and materials (eg, bedding, feeders, drinking troughs, boots, spades, syringes and needles) are some more measures that can be practised.
Practices such as regular cleaning of farm floors using disinfectants and water sanitisers can also aid in biosecurity.
Other approaches, such as rearing local breeds of naturally disease-resilient animals as compared with breeds meant for productivity, reducing stocking density in farms to limit the zoonotic spread of infection-causing organisms and maximising the use of integrated pest management in crops, can also help.
Waste management from major point sources, such as farms and factories (eg, pharmaceutical manufacturing), holds the key to preventing the spread of AMR in the environment. This means we have to prevent antibiotic pollution and the generation of waste that can cause antibiotic resistance.
In the case of farms, waste is a resource and must be made AMR-safe before reuse. For example, waste from poultry and dairy farms, which is useful as a fertiliser for crops, must be treated well before it is applied to agriculture.
India’s growing organic and natural farming movement needs manure from animal waste. But not before it is made safe. The correct disposal of dead animals and birds, farm and hatchery waste and disinfecting wastewater before disposal can also help reduce pollution by AMR determinants.
Minimising antibiotic pollution from factories can be achieved by employing appropriate process control measures, waste management technologies as well as periodic monitoring of the hotspots. If generated, we have to manage it well through low-cost waste management technologies.
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