Check the rapidly emerging pandemic of antibiotic drug resistance
The piece has been authored by Konda Chavva, assistant representative in India for Food and Agriculture Organization ( United Nations) and Rajesh Bhatia, consultant, FAO
Of the numerous lessons we learn during the ongoing Covid19 pandemic, the one with the most far-reaching consequences is that of the inability of any medicine to act effectively and specifically against coronavirus. An affordable, efficacious antiviral drug would have saved most of the lives that were lost to Covid-19 across the world. This facet of the pandemic has been frequently articulated and highlighted. Unfortunately, a similar dimension of most, if not all widely prevalent human and animal bacterial diseases has been begging recognition of all stakeholders but has been able to attract an inadequate response.
An antibiotic is administered to cure a bacterial disease in humans and animals. The absence of a favorable response to medication is primarily because bacteria have developed resistance or unresponsiveness to the action of antibiotics. This resistance, demonstrated in common bacterial infections to almost all affordable antibiotics, is assuming menacing proportions. It will not be wrong to emphasise that the cost of inaction shall be catastrophic, pushing the world into the post-antibiotic era.
This unseen pandemic of drug resistance leads to a longer duration of illness and corresponding treatment, higher mortality, additional treatment with expensive and potentially toxic drugs, greater use of diagnostics, increased burden on the health system, and a huge impact on the economy and global human development. The resistant pathogens become dominating flora in health facilities and carry the potential to negate the technological advances, especially complex surgeries, transplantation, and other interventions for serious diseases. From a public health perspective, the patient acts as a reservoir of resistant organisms to the community and health care workers that too for a longer period.
The public health aspect of drug resistance, in technical parlance called antimicrobial resistance (AMR), is being appreciated because of the obvious mortality of humans, economic loss, deleterious impact on modern technological health solutions, and overall human development.
The drug-resistant pathogens significantly compromise food and nutrition security. Global studies have estimated a reduction in 7.5% of animal products during the next two decades because of infection in animals with drug-resistant germs. With the increasing demand for proteins of animal origin, this reduced production will have a cascading effect on the economy and access to nutrition.
The contribution of the animal health sector in the emergence and spread of drug resistance between animals, and to human beings through the food chain must be recognised and addressed in right earnest. Though exact figures are not known, there is sufficient evidence to suggest that theuse of antibiotics in the animal health sector is far more than what is consumed for human health. In some countries, it is estimated that around 80% of national consumption of antibiotics takes place for protecting animals from unfavorable environments and the impact of poor sanitation. The deployment of antibiotics – especially their irrational, indiscriminate, and excessive use is well established to be the biggest driver for the selection of resistant germs. The greater use of antibiotics in animal health as facilitators for the selection of resistant germs calls upon stronger and focused comprehensive action in mitigating the emergence and spread of drug resistance in animal environments.
In response to a call by the United Nations General Assembly, the World Health Organization, the Food and Agriculture Organization of the UN, the World Organization for Animal Health (OIE), India developed a National Action Plan to combat drug resistance in 2017. This National Plan was effective till December 31, 2021. The time is now to review and revise the Plan by incorporating best global practices and lessons learned during the past four years to make it more effective and result-oriented. The fundamentals of the existing Plan are indeed rooted in the ‘One Health’ approach. It has been felt that the approach needs to be implemented with concerted collaboration, communication, and coordination between all stakeholders, mainly human health, animal health, and environment sectors – each with its own strong capacity to respond to the challenge of drug resistance. It has become mandatory to harness national expertise and competence to fight the menace of drug resistance.
In the animal health sector, the focus should be on strengthening biosecurity in rural areas and enhancing awareness about the consequences of irrational use of antibiotics by farmers and animal farm owners. The network of veterinary professionals, para-veterinarians, and pashu mitra should be galvanised to work in a mission mode to bring about a significant reduction in unnecessary use of antibiotics. Community awareness may be entrusted to local NGOs with support from various farmer-cooperatives and the private sector.
The international agencies and development partners have been and are committed to assisting national efforts in preserving the efficacy and utility of precious antibiotics and more importantly contributing to preventing the world from sliding into a post-antibiotic era. Collective multisectoral, multi-institutional, multi-disciplinary actions are needed to combat the unseen pandemic of drug-resistant infections.
(The piece has been authored by Konda Chavva, assistant representative in India for Food and Agriculture Organization ( United Nations) and Rajesh Bhatia, consultant, FAO)