AMR: An Escalating Global Health Threat
- Definition: AMR (Antimicrobial Resistance) occurs when microorganisms resist effects of antimicrobial drugs.
- Global Impact: Contributed to 1.27 million deaths in 2019; projected to directly cause 1.91 million deaths by 2050.
- India’s Burden: 2.97 lakh deaths due to AMR in 2019; India has one of the highest bacterial infection rates globally.
Relevance : GS 2(Health ,Governance)
Key Causes of AMR
- Misuse/Overuse of Antibiotics:
- Only ~30% of antibiotics are used for humans; majority in livestock, aquaculture, and agriculture.
- Widespread over-the-counter (OTC) sales without prescriptions.
- Use of antibiotics like colistin as growth promoters in poultry (recently banned).
- Self-medication and lack of public awareness.
- Inadequate diagnostics: Delays in antibiogram reports lead to delayed/inappropriate treatments.
- Hospital-related challenges:
- Equipment quality issues, high patient load, understaffing, poor infection control.
- Lack of accountability and stewardship in healthcare systems.
Scientific Breakthrough: Nafithromycin
- Developed by: Wockhardt (India) with support from BIRAC.
- Significance: First antibiotic developed globally in 30 years.
- Features: 3-day once-a-day oral treatment for Community-Acquired Bacterial Pneumonia (CABP); 97% success rate.
- India’s Milestone: First indigenously developed antibiotic in its class.
Innovation Gaps and Market Challenges
- Antibiotic Innovation Gap:
- Post-1960s “golden era” saw decline in new antibiotics.
- Big pharma exited due to low ROI; chronic diseases more profitable.
- Drug Development Barriers:
- High cost, long timelines, stringent regulatory hurdles.
- Small companies like Wockhardt, Bugworks, Orchid Pharma taking the lead.
- Affordability Strategy: Tiered pricing based on country income level (e.g., India price 80% lower than US).
Challenges in Stewardship and Regulation
- Emerging Resistance to New Drugs:
- E.g., Ceftazidime-avibactam losing efficacy due to irrational use.
- Regulatory Gaps:
- Despite being prescription-only, antibiotics are freely available OTC in India.
- Weak enforcement and lack of pharmacy-level control.
- Public Awareness Deficit:
- Antibiotics taken for viral infections.
- Patient pressure on doctors contributes to overprescription.
Government and Institutional Action
- National Action Plan (2017): Aligns India with global AMR strategy.
- Surveillance Networks & Public Campaigns: Still in nascent stages.
- Need for Holistic Reforms:
- Better diagnostics and equipment quality.
- Healthcare professional training on AMR stewardship.
- Stronger policy and enforcement framework.
Way Forward: Multifaceted, Shared Responsibility
- 3-Pronged Approach:
- Education: For public and practitioners on responsible antibiotic use.
- Innovation: Continued R&D investment in novel antibiotics.
- Regulation: Strict control on antibiotic sales, improved hospital protocols.
- Expert Consensus: Without immediate, cross-sectoral action, AMR will spiral into a larger public health crisis.
