Antimicrobial resistance (AMR) is a broad term for resistance in different types of microorganisms such as bacteria, viruses, fungi and parasites, to antibiotics such as antibacterial, antiviral, antiparasitic and antifungal drugs. In recent years, AMR is posing a serious threat to human health and economy globally. AMR does occur naturally, but is aggravated by the inappropriate use (overuse and misuse) of antimicrobials in humans, animals and plants. AMR accelerates the natural evolutionary processes by which microbes become resistant to antimicrobial treatments. Consequently, some infections have become untreatable by existing antimicrobials. Projections suggest that AMR is likely to exacerbate global economic inequality, with the economic costs disproportionately affecting poorer countries.
In this regard, WHO has endorsed the Global Action Plan 2015 on AMR, where all member states were urged to develop a multisectoral National Action Plan within two years of endorsement. Further, 79 countries reported that they had a plan, with another 50 having a plan under development. While the two year target is still unmet, the WHO second tripartite (Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and WHO) self-assessment survey 2018 shows that the countries are making significant steps in tackling AMR, yet serious gaps remain and require urgent action.
Tackling AMR in the country
The Ministry of Health & Family Welfare (MoHFW), Government of India, identified AMR as one of the top 10 priorities for the ministry's collaborative work with World Health Organization (WHO). The Health Ministry has introduced National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 – 2021. The strategic objectives of NAP-AMR are aligned with the Global Action Plan based on national needs and priorities, furthermore India also has its own priority of India-specific dealing with AMR which includes –international, national and sub-national collaborations between government bodies, industries and NGOs on AMR.
Regulatory steps taken under NAP-AMR:
With a purpose to achieve the unified goal of reducing AMR, ICMR has invited Expression of Interest (EOI) from reputed, eligible and experienced firms offering Project Management Consultancy (PMC) Services to set up a Project Management Unit (PMU) in accordance with the Scope of Work (SoW) mentioned in NAP-AMR for a period of two (2) years commencing from date of start.
Manufacturing, sale and distribution of Colistine and its formulation have been banned for food producing animals, poultry, aqua farming and animal feed supplements.
The Ministry of Agriculture issued a circular directing Commissioner/Directors of Animal Husbandry of all states/UTs to advice state veterinarians, feed manufacturers and other involved in the treatment of ailing food producing animals for judicious use of antibiotics and hormones.
Various notices/advisories have been issued to state & UT drug regulators to raise awareness in the public regarding adverse effects of misuse of antibiotics, and strict compliance with Drugs and Cosmetic Act, 1940 and Rule made thereunder.
Subsequent to this, Central Drugs standard Control Organization (CDSCO) on December 23, 20191 issued advisory to all the stakeholders for joining the mission against AMR and support the judicious use of antibiotics and hormones towards safety and well-being of public, wherein;
all State & UTs drug controllers were asked to sensitize their enforcement officials to keep strict vigil on sale of Schedule H and H1 drugs.
Organizations of Chemist & Druggist across India were asked to co-operate with regulatory authorities and comply with Drugs and Cosmetics Act, 1940 and Rule made thereunder. Moreover, they were also advised to raise awareness regarding appropriate use of antibiotics.
Pharma industry was advised to use their well-developed marketing network to discourage the pharmacists from selling such drugs without prescription.
Note – At present, tackling AMR is one of the top priorities of government; to comply with WHO's Global Action Plan combined and sustained efforts across all government sectors and society are required.
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