The article highlights the challenges posed by anti-microbial resistance (AMR) and suggests ways to deal with it.
What is Antimicrobial Resistance?
Anti microbial resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections.
As a result, standard treatments become ineffective, infections persist and may spread to others.
Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
Antimicrobial resistance is now regarded as a major threat to public health across the globe.
Understanding the severity of challenges posed by AMRl
Antimicrobial resistance (AMR) is the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment.
AMR represents an existential threat to modern medicine.
Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections.
Neonatal and maternal mortality will increase.
How AMR will affect low and middle-income countries
All these effects will be felt globally, but the scenario in the low- and middle-income countries (LMICs) of Asia and Africa is even more serious.
LMICs have significantly driven down mortality using cheap and easily available antimicrobials.
In the absence of new therapies, health systems in these countries are at severe risk of being overrun by untreatable infectious diseases.
Factors contributing to AMR
Drug resistance in microbes emerges for several reasons.
These include the misuse of antimicrobials in medicine, inappropriate use in agriculture, and contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.
Stagnant antibiotics discovery
The Challenge of AMR is compounded by fact that no new classes of antibiotics have made it to the market in the last three decades.
This has happened on account of inadequate incentives for their development and production.
A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies, 75% of which have no products currently in the market.
Major pharmaceutical companies have largely abandoned innovation in this space.
Measures to deal with the challenge of AMR
In addition to developing new antimicrobials, infection-control measures can reduce antibiotic use.
A mix of incentives and sanctions would encourage appropriate clinical use.
To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
Finally, since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics.
The U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability.
Other initiatives focused on the appropriate use of antibiotics include Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions.
Australian regulatory reforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme.
Denmark’s reforms to prevent the use of antibiotics in livestock have led to a significant reduction in the prevalence of resistant microbes in animals and improved the efficiency of farming.
Finally, given the critical role of manufacturing and environmental contamination in spreading AMR there is a need to curb the amount of active antibiotics released in pharmaceutical waste.
Regulating clinician prescription of antimicrobials alone would do little in settings where patient demand is high and antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs.
Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines.
Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
AMR must no longer be the remit solely of the health sector, but needs engagement from a wide range of stakeholders, representing agriculture, trade and the environment with solutions that balance their often-competing interests.
International alignment and coordination are paramount in both policymaking and its implementation.