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By 2050, antibiotic-resistant infections will kill more than 1,000 people every hour in the world: CSE

Jose Kalathil

 New Delhi, India: Antibiotic-resistant infections lead to about 700,000 deaths a year globally. If no action is taken, this could increase to 10 million deaths every year by 2050 – which would mean about 27,400 lives per day or about 1,140 lives per hour; 90 per cent of these deaths can happen in Asia and Africa.

These numbers, quoted by Centre for Science and Environment (CSE) today at a high-level webinar of experts on antimicrobial resistance, spell out how critical the problem is for the world today. The webinar – titled One-Health Action to Preserve Antibiotics – was organised by CSE to mark the ongoing Antimicrobial Awareness Week, announced by the World Health Organization (WHO) from November 18-24.

Opening the virtual meet of experts from across the world, CSE Director General SunitaNarain said: “Antimicrobial resistance, or AMR, has emerged today as a full-blown chronic pandemic. At a time when the world is fighting the COVID-19 crisis, marking a week to build awareness on AMR is a welcome step. It indicates that the world is waking up to this massive health crisis, that it is getting ready, because COVID-19 has taught us what havoc can be wrought by unprepared responses to a pandemic.”

Narain added: “The AMR pandemic is a silent killer, but as grave a threat as climate change. This explains why it does not invoke panic among people,though the damage it causes is similar in scale to what the world is witnessing these days.”

The CSE webinar brought together some of the world’s foremost experts on the subject, including Haileyesus Getahun, Director of Global Coordination & PartnershipDirector of Tripartite (FAO/OIE/WHO) Joint Secretariat on AMR, Division of Antimicrobial Resistance, WHO; Keith SumptionChief Veterinary Officer/Leader Animal Health Programme, Food and Agriculture Organization (FAO); Girish K SharmaOfficer on Special Duty (Animal Health), National Dairy Development Board, India; Otridah KaponaLab Scientist-Communicable Diseases/AMR National Focal Point and Coordinator, Laboratory Systems and Networks, Zambia National Public Health Institute, Zambia; Sekesai ZinyoweraNational AMR Focal Point, Coordinator of National Microbiology Reference Laboratory, Ministry of Health and Child Care, Zimbabwe; Sarada Devi K LProfessor and Head, Department of Microbiology, Government Medical College, Thiruvananthapuram, India; and Will GazeProfessor of Microbiology, European Center for Environment and Human Health, University of Exeter Medical School, United Kingdom.

In 2015, the WHO had launched its Global Action Plan to tackle AMR. Five years after, the momentum is faltering, points out CSE. Says Amit Khurana, Programme Director of CSE’s Food Safety and Toxins Programme: “What is required here is One-Health action – a collaborative effort by multiple disciplines working at local, national and global level to attain optimal health for humans, animals and the environment. But national AMR action plans are struggling to move as planned, because they have remained largely driven by a human healthcare agenda,controlled by healthcare ministries and sector stakeholders, with very limited involvement or support from other sectors such as animalhealth and environmental management.”

CSE researchers say that a lack of dedicated budgets allocated by country governments for addressing AMR is another obstacle: this breedsdependence on donor agencies. Says Rajeshwari Sinha, Deputy Programme Manager of CSE’s Food Safety and Toxins Programme: “This indicates that the political commitment being talked about is still largely on paper.”

Khurana points out that animal and food sector stakeholders remain apprehensive of rearing food without antibiotics: “Farmers still use growth promoters, countries continue to allow the use of antibiotics for disease prevention, use of critically important antibiotics is still a common practice, antibiotics are still available without prescription and waste from farms still not managed as it should be. The situation is the same in agriculture — antibiotic misuse in crops continues.” Awareness about how to grow food without antibiotics has not yet been created among farmers and producers, he says.

In environmental management, there is a dearth of understanding and technical expertise on issues such as how to set discharge limits of antibiotics in waste, or how to manage waste from  different point sources (such as farms, healthcare settings etc) in view of the AMR determinants – antibiotics, resistant bacteria and genetic elements that can confer resistance.

CSE, which has been working for a few years now to understand this health threat, presented a set of recommendations at today’s webinar:

  • Ban antibiotics in growth promotion
  • Regulate over-the-counter sales of antibiotics and restrict mass disease prevention strategies (group preventative use)
  • Limit the use of critically important antibiotics – preserve those with highest priority for human use
  • Reduce the need for chemicals by focusing on animal husbandry, bio-security etc
  • Reduce dependence on intensive systems of food production
  • Manage waste from farms
  • Bring in policies and guidelines on bio-security, sanitation, waste management etc
  • Initiate surveillance and monitoring of waste and effluents, litter etc
  • Introduce standards for antibiotics in waste needed – antibiotics in waste from commercial entities must be categorised as hazardous
  • Increase capacity of environmental regulators

Says Narain: “It is clear that it is the developing world which is going to be hugely impacted by this threat. The world will never be able to contain AMR unless stakeholders from all sectors such as human health, animal, environment, crops, food and drug come forward and act as one, in the spirit of a true One-Health approach.”

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