NEW DELHI: A landmark United Nations interagency report compares the threat from drug-resistant diseases to that from climate change and calls for urgent collaborative global action to prevent 10 million deaths annually by 2050 and economic losses as catastrophic as the 2008-2009 global financial crisis.
If countries do not scale-up financing for new drug development and regulate misuse in human, animal and plant sectors, where antimicrobials are widely used as growth promoters, antimicrobial resistance (AMR) will push at least 24 million people into extreme poverty by 2030, said report by the UN Interagency Coordination Group (IACG) on Antimicrobial Resistance on Monday.
Antimicrobial (including antibiotics, antivirals, antifungal and antiprotozoal) agents are critical to fight diseases in humans, animals and plants, but misuse and overuse is making an increasing number of them ineffective.
AMR is a threat to everyone, everywhere. The WHO Global Antimicrobial Resistance Surveillance System (GLASS) collects data from 71 countries including India, in which more than a third of countries reported widespread resistance to common pathogens. In some member countries of the Organization for Economic Cooperation and Development (OECD), about 35% of common human infections are already resistant to available medicines, and in some low- and middle-income countries (LMICs), resistance rates are as high as 80%-90% for some antibiotic-bacterium combinations. Resistance to second- and third-line antibiotics, the last lines of defence against some common diseases, are projected to almost double between 2005 and 2030,” said Dr Haileyesus Getahun, director of the IACG on Antimicrobial Resistance at the World Health Organization in Geneva, in an email interview.
Drug resistance currently causes at least 700,000 deaths each year, including 230,000 from multidrug-resistant tuberculosis. The most common drug resistant pathogens, including E. coli, K. pneumoniae, Salmonella spp., Acinetobacter spp., S aureus, S pneumoniae, N gonorrhoeae, and Shigella spp, causing a variety of blood stream infections, respiratory tract infections, sexually transmitted infections and urinary tract infections, have increasingly become untreatable, according to GLASS data collated from 3,097 hospitals and 2,358 outpatients clinics in 2017.
Concurrently, inadequate access to existing antibiotics kills nearly 6 million people annually, including a million children who die of preventable sepsis and pneumonia, said Dr Getahum. “If there isn’t collective leadership and action between governments, pharmaceutical companies, international agencies and civil society, predictions suggest there could be as many as 10 million deaths worldwide by 2050. This would mark a return to the old days of people dying from common infections and injuries,” said Dr Getahun.
Learning from climate change, the Interagency Coordination Group on Antimicrobial Resistance comprising WHO, World Food and Agriculture Organization and the World Organisation for Animal Health, has called for a “One Health” approach with agencies responsible for human, animal and environment health working together like the Intergovernmental Panel on Climate Change.
The report recommends prioritising national action plans to scale-up financing and capacity-building efforts, including putting in place stronger regulatory systems, prudent use of antimicrobials by professionals in human, animal and plant health, investing in research and development for new drugs and technologies to combat antimicrobial resistance, and urgently phasing out the use of critically important antimicrobials as growth promoters in agriculture.
Unregulated and widespread sale and misuse of antibiotics have amplified the AMR crisis in India, where poor access to clean water and sanitation, inadequate health care infrastructure and weak food safety and waste management systems are increasing infectious diseases in animals and humans and contributing to the spread of drug-resistant infections.
“There is a need for reliable and validated diagnostics for rapid and early diagnosis of drug resistance, both in India and globally, to reduce AMR-associated complications and deaths and lower hospitalization and length of hospital stay to consequently decrease cost of healthcare. The Indian Council of Medical Research (ICMR)’s AMR diagnostics taskforce is mandated to establish a mechanism for the validation of rapid AMR diagnostics and develop target product profiles for diagnostics in the country,” said Dr Kamini Walia, programme officer AMR, division of epidemiology and communicable diseases, ICMR.
India’s national programme on containment of AMR launched in 2017 is floundering because of a lack of leadership. Banning fixed drug combinations have worked, but the redline campaign (red line on medicine packages to mark sale against prescription only) needs to be strengthened. “The Indian Council of Agricultural Research has banned certain drugs for growth promotion, but better convergence is needed for ongoing initiatives, including whether AMR programmes should be run by the Centre or driven by the states,” said a scientist in the health ministry who did not want to be named.
The biggest challenge is the lack of a sustainable innovation ecosystem. “The bankruptcy of small biotech firm Achaogen, which successfully developed a new antibiotic that was effective at treating drug resistant urinary tract infections, highlights the challenge to developing new antibiotics and bringing them to market. Going forward, it’s important to find ways to incentivize investment in research and development to replenish the pipeline of antimicrobials… Unless we act today, a disaster will (be) unleash(ed) in a generation,” said Dr Getahun.