One Health Approach: EU’s action to combat antimicrobial resistance

In Context

• Recently, the Council of the European Union (EU) adopted a set of recommendations to strengthen action against antimicrobial resistance (AMR).

About Antimicrobial resistance (AMR)

• About:
  • Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. 
  • Resistant microbes can pass between animals, plants and food and in the environment.
• Challenge of AMR:
  • This phenomenon has many health and economic implications, with an estimated 4.95 million deaths associated with bacterial AMR in 2019.
  • It is estimated that more than 35,000 people die each year in the EU / European Economic Area as a direct consequence of an infection due to bacteria resistant to antibiotics.
  • Experts predict that if the problem remains unsolved, 10 million people could die as a result by 2050.
• Causes:
  • Antibiotic resistance occurs when bacteria evolve to evade antibiotics. Overuse and misuse of antibiotics are the biggest drivers of resistance. 
  • That means that the more we use antibiotics, the worse the problem of antibiotic resistance becomes.
  • Other drivers of antimicrobial resistance include:
    • The lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, 
    • Poor infection and disease prevention and control in healthcare facilities and farms, 
    • Poor access to quality, affordable medicines, vaccines and diagnostics, 
    • Lack of awareness and knowledge.
• How does it work?
  • Antibiotics work by binding to a specific target protein on a bacteria, then entering to kill it from the inside. 
    • Penicillin, for example, weakens the bacterial cell wall, causing the cell to disintegrate.
  • The most common ways bacteria evade antibiotics come from mutations that allow them to stop drugs from binding to bacteria. 
    • It’s like the bacteria changed the locks so the antibiotic key no longer opens the cell door.
  • Bacteria can also achieve resistance by producing proteins that inactivate or modify the antibiotic, so it no longer binds to the bacteria. Or the target protein is mutated so the antibiotic can no longer bind to it.
  • But worst of all is when bacteria evolve many of these mechanisms in backup, so even if you overcome one, other resistances might fill the gap.

EU’s action to combat antimicrobial resistance

• Combating AMR in a One Health approach:
  • The commission submitted the proposal for a recommendation on stepping up EU actions to combat AMR in a One Health approach.
  • These recommendations were part of a proposal submitted by the European Commission to the European Council.
• Focussing on the health of humans, animals and the environment:
  • It recommended the prudent use of antimicrobials such as antibiotics in human and animal health for reducing the risk of microorganisms becoming resistant to medical intervention.
  • The approach was adopted because the health of humans, animals and the environment is intrinsically linked. 
    • AMR can only be overcome through joint efforts across all three areas.
• The proposal included a series of actions to:
  • Strengthen national action plans against antimicrobial resistance.
  • Reinforce surveillance and monitoring of AMR and antimicrobial consumption (AMC).
  • Strengthen infection prevention and control as well as antimicrobial stewardship and prudent use of antimicrobials.
  • Recommend targets for AMC and AMR in human health.
  • Improve awareness, education and training.
  • Foster research and development, incentives for innovation and access to antimicrobials and other AMR medical countermeasures.
  • Increase cooperation.
  • Enhance global actions.
• The target:
  • Surveillance and monitoring:
    • The targets called for closing existing surveillance and monitoring gaps and ensuring the completeness of data, including real-time information. 
      • It also includes timely access to data on both AMR and AMC at all levels, like the community, hospitals and long-term care facilities. 
  • Reducing the consumption of antibiotics:
    • Reducing the total consumption of antibiotics in humans by 20 percent in the Union compared with the baseline year of 2019 is also another target.
      • This would be applicable for the community and hospital sectors combined, including in long-term care facilities and in home-care settings. 
  • AWaRe classification of WHO:
    • The member states must also ensure that at least 65 percent of the total consumption of antibiotics in humans belongs to the access group of antibiotics as defined in the AWaRe classification of the World Health Organization.
• Farm to Fork strategy:
  • The members must also put in place appropriate measures to contribute to the farm-to-fork strategy and zero pollution action plan target of a 50 percent reduction of the overall EU sales of antimicrobials used for farmed animals and aquaculture, the targets further said.
  • The farm-to-fork strategy by the EU is aimed at redesigning our food systems to reduce the environmental and climate impact of primary production whilst ensuring fair economic returns for farmers. 

Measures Taken to Rising Anti-Microbial Resistance in India 

• National programme on AMR containment:
  • It was launched during the 12th FYP in 2012-17
• National Action Plan on Antimicrobial Resistance (NAP-AMR): 
  • It has a focus on the One Health approach & was launched on 19th April 2017 with the aim of involving various stakeholders ministries/departments.
• AMR Surveillance Network:  
  • ICMR has established the AMR surveillance and research network (AMRSN) in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
• AMR Research & International Collaboration: 
  • ICMR has taken initiatives to develop new drugs /medicines through international collaborations in order to strengthen medical research in AMR.
• India’s National Action Plan for containment of AMR:
  • It  focuses on an integrated One Health approach and involves coordination at the state, national and international levels.
• Key priority of National Health Policy 2017:
  • In its National Health Policy 2017, India has identified managing AMR as a key priority and since then the health ministry has taken several initiatives to nip the epidemic that is growing fast globally.

Suggestions & way ahead

• Modifying existing antibiotics:
  • Scientists have been working on the issue from many different angles. One approach is to modify old antibiotics so they overcome resistance.
• Developing new antibiotics:
  • Another strategy is to make brand-new drugs, but this approach hasn’t been very successful in recent decades.
  • But there are some signs of progress. For one, scientists are now armed with much more sophisticated drug discovery technologies, not least artificial intelligence (AI).
  • But central to the issue is that antibiotic resistance develops quickly whereas antimicrobials — the basis of antibiotic drugs — are developed slowly.
• Global efforts:
  • Overcoming antibiotic resistance will require tremendous international effort dedicated to the problem.