Time to step up the fight against AMR
This article is authored by Dr Jaideep Gogtay, global chief medical officer, Cipla Limited.
Invisible yet rampant, antimicrobial resistance (AMR) is responsible for five million deaths worldwide each year, surpassing both HIV/AIDS and malaria in terms of mortality rates. Closer to home, it is estimated that India will experience two million deaths annually resulting from AMR. The reasons are many ranging from a high infection burden to overuse of antibiotics and self-medication by patients.
Findings indicate that approximately 50% of antibiotic treatments are initiated through usage of the wrong drug and without proper diagnosis. Towards this, several efforts are run to promote the judicious use of antibiotics such as the World Health Organization (WHO) AWaRE antibiotic book which provides concise, evidence-based guidance on the appropriate use of antibiotics, its dose and treatment duration for over 30 of the most common infections in children and adults. That being said, curbing the overuse or misuse of antibiotics does not suffice in the fight against AMR. There are other integral aspects that need attention and action. The recently concluded United Nations General Assembly special session on AMR, set an ambitious target of 70% antibiotic use belonging to the WHO ‘access’ groups with low adverse effects and potential to cause AMR.
A key concern is the use of poor-quality antibiotics for treatment which results in more deaths, and in turn accelerates the spread of drug resistance. Access to affordable high-quality treatments continues to be an issue, in many low- and middle-income countries. While the pace of antibiotics development is slow due to low commercial viability, the ones that do get developed, rarely make their way to these countries. Improving access to an effective first line of antibiotics alone could be a major game changer in preventing over 50 million deaths by 2050.
Given the high risk, low reward conundrum of developing new antimicrobial drugs, the development of novel antibiotics is not optimal. Developing a new antimicrobial is a long drawn and complex process, which is rarely a profitable proposition for companies. Revenue streams from developed nations that are traditionally known to cover research and development (R&D) costs is missing, thereby lower and middle income countries (LMICs)’ markets that are in dire need of treatments against resistant bacteria do not have a solid line of defence. While WHO has noted an increase in the product pipeline, there is a dire need to pick up the pace for innovative agents against serious infections.
Investments in new drug development to fight resistant bacteria is urgently needed. Increased funding for early and mid-stage R&D often run by academia and small and medium enterprises should be seriously considered. Governments should look at incentivisation programmes that encourage large investors and pharmaceutical players to back such projects. Collaborative efforts like the Biomedical Advanced Research and Development Authority (BARDA), AMR Action Fund and more recently, Global Antibiotic Research and Development Partnership (GARDP), exemplify how joining forces between pharma companies, philanthropies, development banks and multilateral organisations is needed to accelerate antibiotic development and reduce the financial risks associated with it. The role of Indian pharmaceutical companies in this area is growing. Some of the key factors for tackling AMR include establishing a nationwide AMR surveillance system beyond the tertiary hospitals, strengthening hygiene practices within the communities, promoting rational usage of antibiotics and last but not the least, awareness campaigns to educate HCPs, policymakers, and the public about AMR.
A robust preventive care ecosystem is the first line of defence to reduce the risk of infections. Vaccines, good sanitation, and safe water must also be focused upon. Appropriate management of pharmaceutical waste and avoiding the excessive use of antibiotics in livestock is also essential. Additionally, the development of and access to rapid and accurate diagnostic tools can help with right and timely treatment. These tools can quickly identify specific pathogen causing an infection and determine its susceptibility to antibiotics. It can also identify drug-resistant pathogens in real-time and provide valuable data on infection patterns and resistance trends which can inform public health policies and monitor resistance evolution.
The Indian Council of Medical Research (ICMR) has an AMR surveillance network in place to monitor resistance patterns across the country. This network can further be widened to include a large number of testing labs and hospitals that can be tasked with generating data to inform policies and interventions. In this context, studies have highlighted patterns of certain bacterial strains showing alarming resistance. For instance, the ICMR AMR 2023 report highlighted continued increased resistance against antimicrobials used in treatment of urinary tract infections, pneumonia and bloodstream infections. Specifically, understanding the type of resistance of pathogens that are prevalent in LMICs is crucial in developing drugs and reducing our dependency on drugs being developed in the western countries.
Moreover, we need to also stop using antibiotics irrationally. Avoiding unnecessary antibiotics minimises adverse reactions and costs. For instance, many people tend to self-medicate a viral infection with antibiotics even though it is used for the treatment of bacterial infections. Awareness and education programmes focused on building community know-how about AMR and equipping them with the right tools for prevention is also essential.
Given the intensity of the threat we are faced with, AMR deserves due priority amidst the world’s attention on treating chronic diseases. The fight against AMR is not one that can be fought in silos or by addressing one of the causative factors. It needs to gather holistic steam. Collective action across the board comprising both preventive and corrective action is the essential path forward to break the chain and save millions of lives globally.
This article is authored by Dr Jaideep Gogtay, global chief medical officer, Cipla Limited.
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