Antimicrobial Resistance & Air Pollution

Syllabus: GS2/ Health, Government Policies & Interventions, Issues Arising out of their Design & Implementation

In Context

• According to the Lancet Planetary Journal, Air laden with unhealthy amounts of PM2.5 can become a highway for antibiotic-resistant bacteria and genes.

Particulate Matter & Antimicrobial resistance (AMR)

• According to a new analysis published in The Lancet Planetary Journal, this particulate matter, called PM2.5, could drive the world’s next public health threat – antimicrobial resistance (AMR), when disease-causing bacteria become immune to the drugs that could once destroy them.
• The researchers wrote that this airborne spread could have resulted in premature deaths in India and China, and other population-dense countries. 
• Some 18.2 million years of life could have been lost this way in 2018 worldwide, resulting in an economic loss of $395 billion (more than Pakistan’s GDP).

Relation of PM & AMR

• The authors of the journal have found that every 10% rise in air pollution was correlated with an AMR increase of 1.1% across countries and continents. 
• PM2.5 emissions from burning firewood in homes for cooking or heating could carry bacteria and antibiotic-resistant genes, be transmitted over long distances, and eventually be inhaled by individuals. 
• PM2.5 is known to penetrate the body’s defences and enter the bloodstream and lungs – a symptom associated with chronic conditions such as cancer, heart disease, and asthma.
• The analysis found that the contribution of PM2.5 to AMR was found to be greater than that of antibiotic use or due to drinking water.

What is Antimicrobial Resistance?

• 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. 

AMR in India

• Data show that India leads the world in antibiotic use. 
  • The indiscriminate use of antibiotics among people and animals, poor hygiene and sanitation, and lack of awareness have fueled this rise. 
  • The COVID-19 pandemic only exacerbated these issues, together with a surge in the sales of antibiotics to treat bronchitis and pneumonia.
  • The higher circulation of antibiotic-resistant bacteria and antibiotic-resistance genes (ARGs) across humans, animals, and environments also creates new transmission pathways. 
  • A 2019 study found India’s rivers and lakes to be concentrated with antimicrobial-resistant bacteria. Pharmaceutical wastewater and untreated effluents from hospitals were the root causes

Major 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.

Issues

• Difficulty in treating infections: Microbial resistance to antibiotics has made it harder to treat infections such as pneumonia, tuberculosis (TB), blood-poisoning (septicaemia) and several food-borne diseases. 
• Rising health cost: AMR also imposes a huge health cost on the patient in the form of longer hospitalisation, health complications and delayed recovery. 
  • AMR adds to the burden of communicable diseases and strains the health systems of a country. 
• Other patients also at risk: It puts patients undergoing major surgeries and treatments, such as chemotherapy, at a greater risk. Many times, patients recover from advanced medical procedures but succumb to untreatable infections.
• Antimicrobials in the agri-food system: There is also an urgent need to reduce the usage of antimicrobials in the agri-food system. Scientific evidence suggests that the less antimicrobials are used, it is less likely that there will be an emergence of drug resistance. 

Measures Taken to Rising Antimicrobial Resistance in India 

• National Action Plan on Antimicrobial Resistance (NAP-AMR): It has a focus on the One Health approach & was launched with the aim of involving various stakeholders ministries/departments.
• AMR Surveillance Network: ICMR established the AMR surveillance and research network (AMRSN) 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

• Addressing Air pollution: AMR is not new. The present focus on environmental factors, however, illustrates that in the fight against antimicrobial-resistant bacteria, we need to address air pollution if we are to plug one hole, while measures to combat other drivers continue. 
  • Antibiotic use in itself is expected to rapidly increase in low- and middle-income countries like India by 2050.
• Learning from China: The analysis hailed China’s case as instructive. In the 2010s, China implemented restrictions on antibiotic sales and began to tackle air pollution on a war footing. 
  • In the next seven years, air pollution declined as much as it had in the U.S. in three decades.
  • Ultimately, the country reaped gains against the twin challenges of PM2.5 and AMR – a trend researchers predict is likely to endure.