The cost of resistance

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The cost of resistance

India must brace for the economic shocks from uncontrolled antimicrobial resistance.


Why in news?

• Even though antimicrobial resistance is acknowledged by policymakers as a major health crisis, few have considered its economic impact.

• Now, a report from the Interagency Coordination Group on Antimicrobial Resistance (IACG) puts the financial fall-out in perspective.

UN Report

• Titled “No Time to Wait: Securing The Future From Drug Resistant Infections”, it says in about three decades from now uncontrolled antimicrobial resistance will cause global economic shocks on the scale of the 2008-09 financial crisis.

• The economic impact of uncontrolled antimicrobial resistance would also be catastrophic. As drug-resistant pathogens spread, health care expenditures would increase dramatically, and sustainable food and feed production – including global trade in food, feed and livestock – will increasingly be at risk.

• With nearly 10 million people estimated to die annually from resistant infections by 2050, health-care costs and the cost of food production will spike, while income inequality will widen.

o In the worst-case scenario, the world will lose 3.8% of its annual GDP by 2050, while 24 million people will be pushed into extreme poverty by 2030. Nations must acknowledge this eventuality, the IACG says, and act to fight it.

o For high- and mid-income nations, the price of prevention, at $2 per head a year, is extremely affordable. For poorer countries, the price is higher but still modest compared to the costs of an antibiotic apocalypse.

Antimicrobial resistance

• In recent years, drug resistance has manifested itself in the emergence of superbugs that have enzymes such as the New Delhi metallo beta lactamase-I that makes them resistant to a large number of broad range antibiotics.

• And the aggressive and tenacious fungus Candida auris that required special cleaning of a room in Mount Sinai Hospital, where a person infected with the fungus had been admitted for 90 days.

o Mount Sinai, it was reported, had to rip out ceiling tiles in a bid to get rid of the Candida infestation in the room.

• The most glaring red flag in India came some years ago when doctors in Mumbai claimed to have encountered some tuberculosis cases that were totally drug-resistant (TDR).

o Though that claim did not get official sanction from health agencies such as the WHO, it did lead to a new classification of XDR (extreme drug-resistant) TB.


• The latest AMR report estimates that currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people who die from multidrug-resistant tuberculosis. India had the second highest total number of estimated MDR TB cases (99,000) in 2008, after China.

• Although antimicrobial resistance can develop naturally, misuse and overuse of antimicrobial agents in humans, terrestrial and aquatic animals, plants and crops are greatly accelerating its development and spread. In human health, poor medical prescribing practices and patient adherence to therapies, weak regulation and oversight including over-the-counter sales, and the proliferation of substandard and falsified antimicrobials are all contributing to the problem.

• The use of antimicrobials to promote growth and routinely prevent disease in healthy animals and crops without appropriate indication and in the absence of good agricultural practices to prevent infectious diseases on farms are further contributing to the development and spread of antimicrobial resistance.”

• The UN warned that more and more common diseases, including respiratory tract infections, sexually transmitted infections and urinary tract infections are becoming untreatable and lifesaving medical procedures are becoming much riskier.

Way forward

• India first published almost nine years ago the broad contours of a plan to fight antimicrobial resistance. The difficulty has been in implementing it, given the twin challenges of antibiotic overuse and underuse.

o On the one hand, many Indians still die of diseases like sepsis and pneumonia because they don’t get the right drug at the right time.

o On the other hand, a poorly regulated pharmaceutical industry means that antibiotics are freely available to those who can afford them.

• It has now recommended that countries prioritise national action plans to scale-up financing and capacity-building efforts, put in place stronger regulatory systems and support awareness programs for responsible and prudent use of antimicrobials by professionals in human, animal and plant health and invest in ambitious research and development for new technologies to combat antimicrobial resistance.

• The IACG report acknowledges these obstacles, and calls for efforts to overcome them. Some steps can be initiated right away, it says, such as phasing out critical human-use antibiotics in the animal husbandry sector, such as quinolones.

• But these steps cannot be driven by regulation alone.

o A multi-stakeholder approach, involving private industry, philanthropic groups and citizen activists is needed.

 Private pharmaceutical industries must take it upon themselves to distribute drugs in a responsible manner.

 Philanthropic charities must fund the development of new antibiotics, while citizen activists must drive awareness.

o These stakeholders must appreciate that the only way to postpone resistance is through improved hygiene and vaccinations. It is a formidable task as India still struggles with low immunisation rates and drinking water contamination. But it must consider the consequences of a failure.

• While the 2008-09 financial crisis caused global hardships, its effects began to wear off by 2011. Once crucial antibiotics are lost to humankind, they may be lost for decades.

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