WAAW 2024: One Health holds the key to India’s fight against AMR

Antibiotics are life-saving drugs for humans and animals, with their therapeutic benefits well recognised in treating humans, livestock and companion animals. However, antimicrobial resistance (AMR) has emerged as one of the biggest threats to human, animal, environmental and planetary health. It has the potential to undermine and destabilise medical progress, making it a critical health issue requiring urgent attention. 

Goal 3 of the United Nations-mandated Sustainable Development Goals (SDG) highlights the threat of bloodstream infections due to antimicrobial-resistant organisms and the increased costs of treatment due to AMR. The World Health Organization (WHO) estimates that by 2050, AMR could lead to 10 million deaths annually.

India is no exception, with an exponential rise in AMR in human, animal and environmental sectors over the last decade. Following the WHO's Global Action Plan on AMR, India launched a National Action Plan (NAP) on AMR in 2017.

Some Indian states have followed suit by developing their respective state action plans. Despite these efforts, the irrational use of antibiotics remains inadequately regulated, with the COVID-19 pandemic marked by significant misuse.

There are various reasons for the irrational and high consumption of antibiotics in India, including over-the-counter medication, unprescribed usage (both over- and under-use), lack of diagnostic facilities for humans and animals, inadequate training among healthcare providers and a weak regulatory structure. 

The industrial-scale expansion of agricultural production, including fisheries, dairy and poultry, has increased susceptibility to AMR, posing a potential threat to the growth and productivity of these sectors.

It is essential to address these issues urgently by aligning them with the SDGs, not only to understand their impacts on health but also to recognise the intersectionality of issues such as poverty, hunger, food security, nutrition, agriculture, water and sanitation and economic growth. Thus, a comprehensive, multi-sectoral approach premised on equity across sectors and settings is required.

India’s One Health response to AMR

In the past decade, various efforts have been made in India, including the development of the NAP and state action plans, which emphasise a multi-sectoral approach to address the complex challenges of AMR. These policy documents represent some of the first One Health initiatives by the government of India to address AMR.

The NAP and state action plans highlight the urgency of rational antibiotic use, strengthened infection prevention and control measures and lay down a roadmap for AMR surveillance.

The Indian Council of Medical Research (ICMR) established the AMR Surveillance and Research Network (AMRSN) in 2013 to generate evidence and monitor trends and patterns of drug-resistant infections across India. This network includes 30 tertiary care hospitals, both private and public.

As part of the 12th Five-Year Plan (2012–17), the Programme for Strengthening Inter-sectoral Coordination for Prevention and Control of Zoonotic Diseases was launched, which continues as the National One Health Programme for Prevention and Control of Zoonoses, set to run until 2026.

Furthering the One Health approach, ICMR has collaborated with the Indian Council of Agriculture Research on the project Integrated One Health Surveillance Network for Antimicrobial Resistance, aimed at preparing Indian veterinary laboratories for integrated AMR surveillance. Similarly, the National Centre for Disease Control (NCDC) has developed a network of 151 laboratories to contain AMR and has also developed national treatment and infection control guidelines.

In 2022, the Prime Minister's Science, Technology and Innovation Advisory Council (PM-STIAC) approved the National One Health Mission under the leadership of the Principal Scientific Adviser’s Office of the Government of India. This mission focuses on the interconnections between human, animal and environmental health and aims to develop an integrated approach to address AMR, zoonotic diseases and environmental degradation.

Challenges yet to be addressed

The One Health approach to tackling AMR and planetary health is promising, yet several challenges require prompt attention for a healthier future. One of the biggest challenges is the lack of social and behavioural science data and existing structural disparities in healthcare access.

There is also a need to strengthen the implementation of training, guidelines and behaviour change interventions through locally tailored community engagement plans that consider contextual factors at all levels of the health system and within communities. Furthermore, timely updates to the curricula for human, animal, agricultural and environmental health professionals are necessary, focusing on integrated health programmes across sectors.

In conclusion, policymakers and practitioners must balance upstream and downstream issues; for example, regulatory changes should ensure resource availability at local levels. Finally, it is essential to gather surveillance data from tertiary to community levels to enable informed health plans that address AMR.

Rajib Dasgupta is Professor and Chairperson, Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi and a former Co-Investigator, UKRI-GCRF One Health Poultry Hub

Pallavi Mishra is a researcher in international politics and global health and former Senior Consultant, UKRI-GCRF One Health Poultry Hub

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