How US, India can combat antimicrobial resistance
Who would have thought that a single moldy melon would hold the key to saving millions of lives? Penicillin — the first antibiotic — was discovered in 1928 by the British scientist Alexander Fleming. However, it was not until 1942, with the help of a cantaloupe harbouring a particularly productive Penicillium mold, that a burgeoning U.S. pharmaceutical industry could manufacture enough of the drug to save the lives of thousands of soldiers during World War II.
This miracle drug helped mankind avert a repeat of World War I, during which more soldiers died of infections than battle injuries. Death rates due to common conditions such as pneumonia and skin infections also plummeted, heralding an era in which many thought the battle against infectious diseases had been decisively won. Early indications of a decrease in penicillin’s effectiveness were countered by the discovery of new antibiotics. As late as 1985, a keynote address at the annual meeting of the Infectious Diseases Society of America questioned the need for infectious disease specialists at all.
And yet, less than 35 years later, there is a new reality in which these life-saving drugs may no longer work. The World Health Organization has named antimicrobial resistance (AMR) — when germs do not respond to the drugs designed to kill them — as one of the top 10 threats to global health, with an estimated 214,000 neonatal deaths annually due to AMR pathogens or superbugs. AMR is increasing worldwide and can affect anyone, of any age, in any part of the world. Left unaddressed, antibiotic resistance could take us back to a time in which people routinely died from basic bacterial infections.
Simply put, we have been careless stewards of the precious resource of antibiotics, using them inappropriately on ourselves and animals. Much of the problem stems from common misconceptions, such as the belief that antibiotics can be used to treat a cold or flu, despite the fact that they have no impact on viruses. These misconceptions have led to the inappropriate use and over-prescription of antibiotics. Studies estimate that up to half of all antimicrobial use in hospitals is unnecessary or improper. The inappropriate use of antibiotics has also been rampant on animals. While preserving antibiotic effectiveness is key to saving millions of human lives, many of these drugs are used in food-producing animals to promote growth rather than treat infections. This practice is particularly worrisome given that no new class of antibiotics has been developed in over 40 years.
India and the US share a common interest in the AMR threat. More than 2.8 million antibiotic-resistant infections occur each year in the US, one of the highest per capita consumers of antibiotics worldwide. India also has a high burden of AMR, and more antibiotics are used in aggregate in India than in any other country. While this is a challenging situation, it is not a lost cause. The US and India each brings unique strengths to contribute to a potential solution.
The US is one of the world’s leading innovators in pharmaceuticals and infectious disease surveillance. India has a thriving pharmaceutical sector and vibrant public health community. We are already working together to attack the problem from various angles, including strengthening hospital infection control, building surveillance systems for antimicrobial-resistant infections, supporting scientists and innovators working toward AMR solutions, and funding the development of critically needed new antimicrobials.
This commitment was reiterated last month when I joined Balram Bhargava, the director general of the Indian Council of Medical Research (ICMR), to inaugurate a new hub for research and policy on AMR in Kolkata. I pledged that the US would continue to work closely with our Indian partners — including the ministry of health and family welfare, the ICMR, and the department of biotechnology — to combat AMR.
While our governments work together to solve this problem at a systemic level, addressing the urgent issue of AMR also requires our collective action at a personal level. As healthcare users, we should consult a qualified health provider before taking antibiotics, and prevent the spread of infection with good hygiene, including cleaning hands, covering coughs, and staying home when sick. Health workers should practise infection control, follow recognised treatment guidelines, avoid prescribing antibiotics when they are not needed, and promote available vaccinations for the prevention of infectious diseases. Farmers should vaccinate animals, and only use antibiotics to control or treat infectious diseases in animals under veterinary supervision. We also need industry to develop new antibiotics, and practice responsible stewardship and disposal of antibiotics.
We must respond individually and collectively to this challenge. Our collaboration on combating AMR will represent both a symbol of US-India cooperation, and a launch pad for what we can do together — for our two countries, and for the entire world.