Operation AMRITH (Antimicrobial Resistance Intervention for Total Health)

General Studies Paper -2

Context: The Kerala Drug Control Department launched Operation AMRITH to prevent the overuse of antibiotics in the state.

Background

• In 2011, the Indian government introduced the H1 rule to prohibit the over-the-counter (OTC) sales of antibiotics without a prescription, responding to the growing concern over antimicrobial resistance (AMR).
• In 2013, the rule to limit the OTC restriction was limited to second- and third-line antibiotics, allowing the sale of first-line antibiotics without a prescription.
• Step was taken to ensure that life-saving antibiotics remained accessible to the public, especially in remote areas
• Operation AMRITH enforces the original H1 rule, mandating a doctor’s prescription for acquiring any class of antibiotics.

What is Antimicrobial Resistance?

• 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.
• Nearly 700,000 people die of AMR every year. The toll can rise to as many as 10 million by 2050 and eat up 8 per cent of annual global gross domestic product (GDP).

Causes for Antimicrobial Resistance

• Overuse and Misuse of Antibiotics:The excessive and inappropriate use of antibiotics in humans and animals is a major driver of antimicrobial resistance. This includes using antibiotics without a prescription, not completing the full course of prescribed antibiotics, and using antibiotics for non-bacterial infections.
• Inadequate Dosage and Duration: When antibiotics are not taken in the correct dosage and for the recommended duration, it can lead to incomplete eradication of the targeted microorganisms, allowing the surviving bacteria to develop resistance.
• Self-Medication: Self-prescription without proper medical guidance contributes to the misuse of antibiotics.
• Antibiotics Consumption in Food-Animals:Use of antibiotics as growth promoters in food animals and poultry is a common practice and later it evolves in the food chain.
• Unavailability of laboratory facilities:Over 50-70% of doctor-prescribed antibiotics are unnecessary due to lack of accurate infection diagnosis. Limited access to affordable rapid diagnostic tests contributes to this issue.

Challenges Posed by AMR

• Antibiotic resistance is emerging as the threat to successful treatment of infectious diseases, organ transplantation, cancer chemotherapy and major surgeries.
• The issue of AMR causes out of pocket expenditure on health care, especially on medicines. The use of high order drugs or second-line expensive antibiotics pushing treatment costs high.
• Poor Sanitation:The large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.

Global Efforts against Antimicrobial Resistance 

• Global Action Plan on Antimicrobial Resistance (GAP): Globally, countries committed to the framework set out in the Global Action Plan (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans.
• World Antimicrobial Awareness Week (WAAW): It is a global campaign that aims to raise awareness of antimicrobial resistance worldwide.
• Global Antimicrobial Resistance and Use Surveillance System (GLASS): WHO launched it in 2015 to continue filling knowledge gaps and to inform strategies at all levels.
• GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and the environment.
• Global Antibiotic Research and Development Partnership (GARDP): A joint initiative of WHO and the Drugs for Neglected Diseases Initiative (DNDi), GARDP encourages research and development through public-private partnerships.
• By 2025, the partnership aims to develop and deliver five new treatments that target drug-resistant bacteria identified by WHO as posing the greatest threat.
• Country wise initiatives:A multi-sectoral $1 billion AMR Action Fundwas launched in 2020 to support the development of new antibiotics, and the U.K. is trialing a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability.
• Peru’s effortson patient education to reduce unnecessary antibiotic prescriptions.
• Australian regulatoryreforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme.
• Denmark’s reformsto prevent the use of antibiotics in livestock have not only led to a significant reduction in the prevalence of resistant microbes in animals, but also improved the efficiency of farming.

Measures Taken against 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:Indian Council of Medical Research (ICMR) established the AMR surveillance and research network (AMRSN) to generate evidence and capture trends and patterns of drug resistant infections in the country.
• India’s Red Line campaign:Which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics– is a step forward.
• FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.
• National Health Policy,2017: It terms antimicrobial resistance as one of the key healthcare issues and prioritizes the development of guidelines regarding antibiotic use and checks on restricting the growth of antibiotics.
• National Antibiotic Consumption Network (NAC-NET): The network sites compile data on antibiotic consumption in their respective health facilities and send it to National Centre for Disease Control (NCDC).

Way Ahead

• Antimicrobial resistance is a socioeconomic problem, and combating it requires measures to improve public health infrastructure, sanitation facilities, and governance.
• While enforcing the OTC regulation is a welcome step, curbing antimicrobial resistance requires a multipronged approach, including reformations to physicians’ prescribing practices and mandating that hospitals report healthcare-associated infection rates.