Silent pandemic needs agenda for change

We are living in unprecedented times. An rna — not even dna — has brought the world economies to a halt. Amid these disruptions, we must focus on another pandemic — one that is not so obvious today but threatens our health systems in ways that we cannot even imagine. This silent pandemic is the rise of antimicrobial resistance (AMR).

It is as catastrophic as the novel coronavirus disease (COVID-19) or climate change. Just imagine the scale of human tragedy if we lose the ability to get well — if medicines stop working, and if diseases cannot be treated. This is what AMR inflicts upon us.

It is a fact that the current health crisis, the pandemic, has taught us some lessons and thereby, it provides us an opportunity to set our house in order before it burns down.

First, it has put health at the centre of the global agenda. Today, equitable and universal access to vaccines has gained prominence; we are realising interdependence and, most importantly, the cost of inaction in public health. We know today that the rich cannot be protected from the virus unless the poor have protection — inclusive and equitable health care is essential.

Second, we understand more than ever the role and the value of prevention. COVID-19 has brought out the role of clean water in the preventive agenda.

The Indian government has included access to clean water and sanitation as part of the health sector’s spending. Clearly, we know that prevention will be key in current and future health pandemics.

We also know that countries of the South — I would argue, also the already rich countries of the North — must realise that the approach of first chemicalising and toxifying the environment and then investing in its repair is unaffordable and unsustainable. Our world, in particular, has many competing priorities — from providing universal healthcare to delivering education to all.

It is, therefore, even more critical that we learn to do things differently; we have to walk the paths that others have not taken yet — leapfrog and reinvent pathways for growth without pollution. This is where the environmental challenge of amr needs to be understood.

Third, we know now that COVID-19 and AMR are the results of our dystopian relationship with nature; it is about the way we grow our food and manage our environment. There is a massive use of antimicrobials and antibiotics in growing food — from crops to livestock and fish farming. The problem is that this practice of using antibiotics to promote growth and control diseases has been widely abused in the “modern” food manufacturing system.

It has become part of the toolkit for enhancing productivity and is justified — as was the use of pesticides and other chemicals for many years — as being critical for the livelihood security of farmers. What this assertion ignores is the fact that antimicrobials are used indiscriminately in the case of what can be called “intensive” livestock farming.

The use or misuse of antibiotics is then about the very system of food — how animals are reared; if they have access to the outdoors; how many are stocked (housed) in the facility; and how more resilient breeds are disappearing (biodiversity in the food world). It boils down to our diets. It is, therefore, wrong to pose this as a simple issue of productivity versus sustainability.

Clearly, this food and environment pathway, which adds to AMR, needs to be addressed. It needs strategies that are preventive and affordable. This is when the emerging world has many critical and competing challenges — all of which need to be managed simultaneously.

We have to increase health access to our people. We need access to life-saving medicines. We have to increase food productivity and ensure that farmers get livelihood security. But conversely, we cannot afford the high cost of clean-up after contamination.

Therefore, it is imperative to discuss the next agenda for change: One, to ensure that antimicrobials critically important for human health are not used for livestock or for crops. You may call this the ‘conservation agenda’. The next is ‘development agenda’, which must ensure that we continue to increase food production without indiscriminate use of antimicrobials. And then the ‘environmental agenda’, which is to ensure that the waste from the pharma industry and other sources like fish or poultry farms is tracked and contained.

Given that in our world farm waste is never a waste but a resource for the land, we need to prevent the use of antimicrobials so that reuse and recycling of manure is possible. So, we must conserve the critical list of antimicrobials; we must minimise their use and we must invest in prevention so that we do not have to use these medicines for maintaining our health. This is another make-or-break agenda for our world.

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