Why is Antimicrobial Resistance the biggest threat to humanity?

In 1928, at St Mary’s Hospital, London, Alexander Fleming discovered penicillin. This led to the introduction of antibiotics, which has since shaped human history.

However, like many times in our human history, our boons have been exhausted to the point where they turn into banes. The growing issue of antimicrobial resistance (AMR) is one such classic example where unsustainable practices are leading to a human-induced disaster.

AMR happens when microorganisms such as bacteria, fungi, viruses and parasites change when they are exposed to antimicrobial drugs such as antibiotics, antifungals, antivirals, antimalarials and anthelmintics.

Growing AMR basically means that humanity’s defences against infection are wearing thinner and the microbes responsible are getting stronger.

This has reached an alarming level. From what the world knows so far, globally, 700,000 deaths every year are estimated due to AMR. If AMR is not contained, about 10 million lives a year are estimated to be at risk by 2050. About 90 per cent of these will be in Asia and Africa.

This puts direct pressure on economic development. By 2050, the cumulative cost of AMR on the global economic output is estimated to be $100 trillion and the expected loss in annual gross domestic product globally in a high AMR-impact scenario is 3.8 per cent.

By 2050, the global increases in healthcare costs are expected to reach up to $1.2trillion per year in a high AMR impact scenario. Livestock production in low-income countries is estimated to decline the most by 2050 in this scenario.

This means that AMR can also significantly impact food and agriculture production, nutrition security and livelihoods. AMR will also negatively impact Universal Health Coverage and attainment of several Sustainable Development Goals.

The WHO-FAO-OIE Tripartite is leading the global momentum to fight AMR. The United Nations Environmental Programme has been recently roped in along with the Tripartite.

Global governance structures such as the Global Leaders Group on AMR is also in place. At the country level, comprehensive, multi-sectoral and ambitious National Action Plans on AMR have been developed. So far, about 144 countries have such plans in place including India.

India is especially in danger of an explosion of AMR and developing countries like India, thus, need a whole-of society and whole-of-government approach.

They need a One-Health response in its true sense. Human, animal and environmental stakeholders need to work together and manage the production of food and handling of waste. They cannot first use a lot of chemicals and then spend more to clean it up.

So, we need to re-think the AMR agenda. 

The development agenda: Rethink the way we grow our food to reduce dependence on chemicals / antibiotics and yet ensure that we can continue to increase food production.

The conversation agenda: Reduce the misuse and overuse of antibiotics in livestock, aquaculture and crops, specifically those which are of critical importance to humans need to be conserved.

The environmental agenda: Ensure that waste from food systems, pharmaceutical manufacturing and human health systems is effectively managed to contain AMR.

The prevention agenda: There should be greater focus on preventive approaches such as WASH, biosecurity, good animal husbandry and use of alternatives so that disease is reduced and so is the need for antibiotics.

AMR is a complex issue. Its rise is due to unsustainable practices in overlapping ecosystems of animal, environmental and human health. Therefore, it requires a harmonised approach spread across sectors that contribute to drug resistance.

Health India