AMR: The Silent Pandemic

The Covid Pandemic has shown us that the delicate interconnections between animals, environment and human ecosystem will continue to be tested by climate change. SARs-CoV-2, the virus responsible for this pandemic originates from animals, while this zoonotic virus had pandemic potential, zoo noses like Severe Acute Respiratory syndrome (SARs), the Middle East Respiratory syndrome (MERs) and Ebola, among others have had a significant bearing on public health in the past. Further the degradation of the health of the three ecosystems will contribute to the spread and emergence of new pandemics. But there is another health crisis we should be aware of.
Antimicrobial Resistance (AMR) is a silent pandemic that poses a huge threat to global health and development. The World Health Organization and its partner organizations are seeking to raise awareness of the issue. Dubbed as the silent pandemic, AMR can induce up to 10 million global deaths every year by 2050 and force 28 million people into poverty. Further our health system will be overburdened because drugs will lose their efficacy due to build up AMR as per expert’s opinion.However, strategies to tackle environmental antimicrobial resistance have been limited. This is worrying because the progress in animals and human verticals of AMR can be eroded due to the interlinkage between the three ecosystems. It is critical to have regulations limiting antibiotic concentration in hospitals wastewater and effluents from pharmaceutical manufacturing units. Central wastewater treatment for hospital effluents in India is uncommon and reportedly less than 45% of hospitals have treatment facilities. Additionally poor hygiene standards and lack of access to clean drinking water and sanitation further facilitate the spread and emergence of AMR.The overuse of antimicrobial like antibiotics in human medicine and improper usage of antibiotics in agriculture, aquaculture, livestock and poultry have been addressed through multi-sectorial practices approaches.
In the absence of standards, the high concentration of antibiotics in pharmaceutical effluents discharged into water bodies poses a grave healthcare threat to animals and human. Of late several instances of pharmaceutical pollution across states have been reported, the recent one being of the Baddi Pharma hub of Himachal Pradesh and antibiotic pollution of the Sirsa River. The heavy trace of antibiotics ultimately infiltrates the animals and human ecosystems through the food chain and silently drive up AMR. Given that Indian pharmateucal industry’s spread across the corners of India and its expansionary outlook, the industry and the government must deliberate and formulate standards that limit the discharge of antibiotic residue into the environment. Untreated hospital’s wastewater is a heady cocktail of antibiotics and other drugs and if untreated, can be a hot spot for drug-resistant pathogens, known as superbugs. The blaNDM-1, superbug, more commonly known as the New-Delhi superbug was found in wastewater outfalls of hospitals and sewages drains of country’s capital. As expected, the concentration of superbug was much higher in the wastewater outfalls of clinical settings. Subsequently the superbug has spread over 70 countries including the pristine Artic Circle. Such instances call for pronounced wastewater surveillance along with Antimicrobial Stewardship Practices(AMSP) to prevent hospitals from turning into hotbeds of AMR.The ongoing SARCs-CoV-2 pandemic has highlighted the importance of the rapid development of vaccines and antivirals. However the potential for emergence of antibiotic resistances due to the increased use of antibacterial cleaning products and therapeutics present an additional underreports threat. Most antibacterial cleaners contains simple quaternary ammonium compounds (QACs), however, these compounds are steadily becoming less effective as antibacterial agents. QACs are extensively used in SARs-CoV-2 related sanitization in clinical and household settings. Similarly due to the danger of secondary infections, antibiotic therapeutics is increasingly used as a compound of Covid-19 treatment regimens, even in the absence of a bacterial infection diagnosis.
Improving WASH (Water, Sanitation and Hygiene) standards are the third area of concern for environmental AMR. Poor sanitation and hygiene coupled with unclean drinking water expedite the natural mutation process in microbes, thereby speeding AMR. A recent study by the University of Birmingham has revealed that poor WASH standards contribute to the uptick of AMR in countries like Bangladesh. While the sanitization and hygiene parameters have drastically improved due to the Swachh Bharat Mission in India, the coverage of the ambitious Har Ghar Nal Se Jal, scheme can play a pivotal role in arresting environmental AMR. InIndia, there has been an emphasis on improving antimicrobial stewardship practices (AMPSP) in hospitals, expanding the coverage of healthcare sites reporting data on AMR, bettering the capacity of health care professionals and focusing on R &D for discovery of new therapeutics. To address the misuse of antibiotics in aquaculture, livestock and poultry, stringent measures like the ban on Celestin, an antibiotic medication and regulating the maximum permissible limits of antibiotics and veterinary drugs have been taken.The mitigation of AMR is underpinned by protecting the health of animal, environment and human ecosystems. Seizing the importance of the issue, global and national action plans on AMR having been drawn out. Nestled in the one-Health approach, the action plans provide a framework to arrest AMR across ecosystems and it is pertinent that the policy framework is detached from a soiled approach and implementation of these policies is emphasized. To facilitate the convergence and implementation of Multi-sectorial policies, on AMR regulatory authority must be instituted. Further, separation of veterinary drugs from human medicine, regulation of animal food by a competent authority and discouraging the sale of over the-counter medication will ultimately protect against AMR in all three ecosystems. The increased use of antibacterial agents cleaners and therapeutic is anticipated to lead to novel resistance in the coming years. However the administrative efforts will fall short unless supported by industry, Civil Society organizations and the public.
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