Antibiotic resistance: the looming pandemic

"Educate. Advocate. Act now"-this was the theme of this year's World Antimicrobial Resistance (AMR) Week, celebrated from 18th to 24 November. AMR week is a staple in the World Health Organization's initiatives to combat this global public health issue. Suppose the antibiotics are rendered ineffective, which is already confirmed for many. In that case, humankind will no longer be able to deal with common infections, which will turn fatal. With the pipeline of new antibiotics not looking promising, we must double down on prevention.

But what exactly is AMR? It is the ability of microbial agents, such as bacteria, viruses, etc., to avoid getting killed by drugs they were previously susceptible to. Antibiotics are integral to modern treatment and crucial for many critical surgeries. Infections become very difficult to treat without them, and surgeries will be very dangerous.

AMR is already here, so it is not a looming pandemic but an existing one. It affects every country across all the continents and does not spare any age, sex or income level. One of the primary reasons for AMR is the unnecessary use and abuse of these drugs.

AMR affects countries in all regions and at all income levels. The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications and a lack of new drug development by the pharmaceutical industry. Even Sir Alexander Fleming, the discoverer of the first effective antibiotic, saw that back in 1945. He commented that people would clamour for more when they saw what antibiotics could do, leading to an era of abuse.

AMR occurs naturally in microorganisms, but it is a very slow process. Overuse or misuse of antibiotics speeds it up, causing what we currently see as widespread resistance. Centres for Disease Control and Prevention data shows that almost one-third of antibiotic use is inappropriate.

Even with proper prescriptions, many people do not take drugs as advised. Many patients stop taking them as soon as they feel well, which is completely inadvisable. Treatment should be completed, and if it needs to be stopped prematurely, it is crucial to let the physician decide. Otherwise, we are contributing to the resistance.

AMR is a serious threat to our lives. In the September 2024 issue of the Lancet, the Global Research on Antimicrobial Resistance Project (GRAM) published a summary of its study, which analysed the deaths from resistance. It showed that since 1990, AMR has caused over 36 million deaths, and by the next 26 years, another 39 million are expected to perish if we fail to address it immediately.

The economy is also significantly affected by AMR in terms of health expenditure. World Bank estimates additional costs of US$ 1 trillion by 2050. The GDP loss by 2030 due to AMR is projected to be between US$ 1-3 trillion.

WHO is working hard to tackle AMR. During the 2015 World Health Assembly, countries pledged to adopt a Global Action Plan (GAP) on AMR. The plan focused, among other things, on the One Health approach, which calls for multi-sectoral collaboration and an integrated strategy to deal with the threat.

Other agencies are involved too- namely the UN Environment Programme (UNEP), the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (WOAH), together with WHO, they are called quadripartite. The quadripartite launched several international initiates, such as the Global Leaders Group on AMR, to unite the stakeholders. Several technical committees were also formed to support countries in fine-tuning their strategies.

Another important cause of AMR is the lack of development of new antibiotics. WHO data revealed that only twenty-seven drugs are in the pipeline, and a meagre six are new or innovative. This is hampering efforts to fight AMR. There is only enough money for pharmaceutical companies to invest in new antibiotics if governments incentivise them.

For now, we must rely on our existing arsenal of antibiotics, which means judicious use of these drugs is paramount. Antibiotic stewardship refers to the rational use of antibiotics, and this entails taking them as prescribed, without altering the amount or duration, and not sharing drugs with anyone. It is also important not to pressure doctors for antibiotics and not to buy them without prescriptions.

Although AMR is not new, we have only noticed its impact during the last two decades. Steps are still being taken to combat it. Still, Dr Timothy Jinks, Head of the Wellcome Trust's Infectious Disease team, a global charity focusing on innovation against infectious diseases, correctly surmises that it is far from enough. He acknowledged the progress but argued that we must do more and work fast.

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