3rd Global High-level Ministerial Conference on AMR

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The World Antimicrobial Awareness Week 2022 concluded recently with the Muscat Ministerial Manifesto on AMR being agreed upon at the Third Global High-level Ministerial Conference on Antimicrobial Resistance (AMR).

Key Highlights

• Background: 
  • This Conference is a follow up of two earlier high level conferences held in the Netherlands in 2014 and 2019. 
• Theme of the Conference: 
  • The AMR Pandemic: From Policy to One Health Action.
• Three Global Targets:
  • Reducing the total amount of antimicrobials used in agrifood systems by at least 30 per cent-50 per cent by 2030.
  • Preserving critically important antimicrobials for human medicine and ending the use of medically important antimicrobials for growth promotion in animals.
  • Ensuring that ‘Access’ group antibiotics (a category of antibiotics that are affordable, safe and have a low AMR risk) represent at least 60 percent of overall antibiotic consumption in humans by 2030.
• Countries endorsing the manifesto:
  • The Manifesto has been endorsed by 34 of the 45 countries that participated at the conference. 

What is Antimicrobial Resistance (AMR)?

• 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. 
• Emergence and spread of AMR:
  • AMR occurs naturally over time, usually through genetic changes.
  • Antimicrobial-resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air). 
  • They can spread from person to person or between people and animals, including from food of animal origin.
  • The main drivers of antimicrobial resistance include:
    • The misuse and overuse of antimicrobials, 
    • 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, and 
    • Lack of enforcement of legislation. 

Image Courtesy: Conservation 

Factors Causing AMR in India

• Inappropriate consumption of broad-spectrum (last resort) antibiotics is high because of changing prescription practice in the healthcare system due to the non-availability of a narrow spectrum of antibiotics.
• Inappropriate antibiotic use among the general public like Self-medication to avoid the financial burden.
• The large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.
• What are Antimicrobials?
  • Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants. 

Image Courtesy: Toi 

Challenges Posed by AMR

• Antibiotic resistance is emerging as the threat to successful treatment of infectious diseases, organ transplantation, cancer chemotherapy and major surgeries.
• The issue of AMR causes out of pocket expenditure on health care, especially on medicines. The use of high order drugs or second-line expensive antibiotics pushing treatment cost high.
• Neonates and elderly both are prone to infections and are vulnerable.

Various Initiatives Adopted In This Aspect

• Global Efforts:
  • Global Action Plan on Antimicrobial Resistance (GAP): Globally, countries committed to the framework set out in the Global Action Plan1 (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans. 
  • Tripartite Joint Secretariat on Antimicrobial Resistance: Tripartite joint secretariat (FAO, OIE and WHO) has been established and is hosted by WHO to drive multi-stakeholder engagement in AMR. 
  • Interagency Coordination Group (IACG) on AMR: It was convened by the Secretary-General of the United Nations after the UN High-Level Meeting on Antimicrobial Resistance in 2016. 
    • The IACG brought together partners across the UN, international organizations and individuals with expertise across human, animal and plant health, as well as the food, animal feed, trade to formulate a plan for the fight against antimicrobial resistance.
  • World Antimicrobial Awareness Week (WAAW): WAAW was previously called the World Antibiotic Awareness Week. From 2020, it will be called the World Antimicrobial Awareness Week. 
    • It is a global campaign that aims to raise awareness of antimicrobial resistance worldwide.
  • Global Antimicrobial Resistance and Use Surveillance System (GLASS): WHO launched it  in 2015 to continue filling knowledge gaps and to inform strategies at all levels. 
    • GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and the environment. 
  • Global Antibiotic Research and Development Partnership (GARDP): A joint initiative of WHO and the Drugs for Neglected Diseases Initiative (DNDi), GARDP encourages research and development through public-private partnerships. 
    • By 2025, the partnership aims to develop and deliver five new treatments that target drug-resistant bacteria identified by WHO as posing the greatest threat.
  • Country wise initiatives: A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics, and the U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability. 
    • 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 not only led to a significant reduction in the prevalence of resistant microbes in animals, but also improved the efficiency of farming. 
• India’s initiative:
  • To prevent the Over the counter sales of antibiotics, the central drug standard control organization(CDSO) prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription.
  • India’s Red Line campaign: Which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics– is a step forward.
  • National Health Policy, 2017, terms antimicrobial resistance as one of the key healthcare issues and prioritizes the development of guidelines regarding antibiotic use and check on restricting the growth of antibiotics.
  • The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 has assigned coordinated tasks to multiple government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance.
  • FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.

Way Ahead

• Countries should Revise and effectively implement National Action Plans (NAP) for AMR 
• Countries should Strengthen their surveillance systems. 
• The Quadripartite organisations provide guidance and technical support for implementation of the targets.
• Different stakeholders in human health, animal health, environment sectors come together to be able to implement AMR NAPs, through appropriate engagement of civil society, private sector, and public and private partnerships.
• There is a need for mobilisation of financial resources from public and private financing institutions for NAP-AMR implementation. This is to be done to:
  • Enable improved access to innovations (new antimicrobials, vaccines, diagnostics, waste management tools, alternatives to antimicrobials) and 
  • For the development and implementation of innovative and safe infection prevention and control practices.
• AMR is a silent and invisible pandemic that cannot be overshadowed by other competing public health priorities so should be made a priority.
• It is important to have political support and collaboration at the international, national and sub-national levels to tackle the challenge posed by AMR.

Source: DTE