Superbugs and One Health Approach

Antimicrobial resistance (AMR) is a global public health issue as it increases the severity, incidence and cost of infection. Majority of antimicrobial classes can be used in both animals and humans. One health approach includes the health of humans, animals and the environment.  International agencies and several countries have developed the action plan which includes one health approach such as improvements in antimicrobial use regulation and policy, surveillance, stewardship, infection control, sanitation, animal husbandry, and alternatives to antimicrobials. Guidelines provided by WHO can be followed to address the antimicrobial resistance crisis.

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Antimicrobial resistance (AMR) is a global health and development threat. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).

WHO has declared that AMR is one of the top 10 global public health threats facing humanity.

Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.

Lack of clean water and sanitation and inadequate infection prevention and control promotes the spread of microbes, some of which can be resistant to antimicrobial treatment.

The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted.

Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk. //www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

The threat of antimicrobial resistance (AMR) is growing at an alarming rate and the situation is perhaps aggravated in developing countries due to gross abuse in the use of antimicrobials. It is well known that any use of antimicrobials however appropriate and justified, contributes to the development of resistance, but widespread unnecessary and excessive use makes the situation worse. Misuse of antimicrobials is facilitated in developing countries by their availability over the counter, without prescription, and through unregulated supply chains. Non-compliance in the use of antimicrobials has many repercussions upon resistance and poverty is a major root factor of antimicrobial misuse in developing countries. On the other hand, even among the rich, some patients miss doses either by mistake or deliberate, especially in cases where signs and symptoms begin to subside after an initial favorable therapeutic response. In other situations, such as in the event of an acute side effect, patients abandon their treatment, only to return to the hospital with a recurring infection by a more virulent and resistant strain of the microbe. These actions result in the exposure of surviving pathogens to sub-therapeutic concentrations of antimicrobials thus increasing the chances of acquiring resistance. Self-medication is a common practice in developing countries where patients often get antimicrobials without prescription and through unregulated supply chains. To make the situation even worst, some patients seek their first line of treatment from traditional healers who provide them with herbal combinations for the treatment of infections. These substances of unknown composition and potency may enhance pathogen fitness and contribute to the development of resistance. Antimicrobial resistance often occurs through the inhibition of specific antimicrobial pathways such as cell wall synthesis, nucleic acid synthesis, ribosome function, protein synthesis, folate metabolism, and cell membrane function.

The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicenter of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR.

In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative. Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health- care systems.

Antibiotics are becoming increasingly ineffective as drug resistance spreads globally leading to more difficult to treat infections and death. New antibacterials are urgently needed – for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list. However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.

The cost of AMR to national economies and their health systems is significant as it affects the productivity of patients or their caretakers through prolonged hospital stays and the need for more expensive and intensive care.  

The response to AMR has been spearheaded through the One Health Global Action Plan, developed by WHO in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE).

The 5 objectives of the Global Action Plan on AMR are to:

1. improve awareness and understanding of AMR communication, education, and training

2. strengthen the knowledge and evidence base through surveillance and research

3: reduce the incidence of infection through effective sanitation, hygiene, and infection prevention measures

4: optimize the use of antimicrobial medicines in human and animal health

5: develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines, and other interventions.

Because the many contributing factors of AMR vary greatly, WHO urged member countries to come up with their own national action plans. But WHO has found that WASH and wastewater management and improvement actions continue to be underrepresented in these plans. So, to encourage the implementation of WASH and wastewater management to reduce the spread of AMR, WHO has released a new technical brief summarizing the evidence and rationale for WASH and wastewater actions within AMR national action plans and sector-specific policy to combat AMR. 

In response, India has given due cognizance to the problem of antimicrobial resistance (AMR) and to tackle this issue, the Government of India launched a “National Programme on AMR Containment” during the 12^th five-year plan (2012-2017) which is being coordinated by NCDC. The network of labs is being expanded in a phased manner and currently includes 30 state medical college labs in 24 States/UTs.

The main objectives of this program are: 

1. Establish a laboratory-based AMR surveillance system in the country to generate quality data on antimicrobial resistance
2. Carry out surveillance of antimicrobial usage in different health care settings
3. Strengthen infection control practices and promote rational use of antimicrobials through Antimicrobial stewardship activities
4. Generate awareness amongst health care providers and the community on antimicrobial resistance and rational use of antimicrobials.