The alert sounded by FAO (Food & Agriculture Organisation) of the United Nations that the rising antimicrobial resistance (AMR) threatens to turn into the next pandemic when the world is grappling with the COVID-19 pandemic, calls for immediate action by the world community. Decoding the problem for the masses is essential to mitigate the risks in a prompt manner. The death of seven lakh people annually due to drug-resistance related diseases speaks volume about the impending doom. The 'World Antimicrobial Awareness Week' -- observed globally from November 19 to 24 -- highlights this problem and the need for a resolute action by national, state, local governments, and communities before it is too late. According to WHO (World Health Organisation), antimicrobials are medicines including antibiotic, antifungal, antivirals and antiparasitic used to treat infections in human beings, animals, and plants and the resistance occurs when bacteria, fungus, and parasites change over time and no longer respond to these medicines. This makes the treatment difficult and increases the risk for the spread of the disease, severity, and death. The 'FAO Action Plan on Antimicrobial Resistance 2021-2025' has the set goal of building resilience in the Food and also Agriculture sectors by limiting the emergence and spread of AMR. The 'Action Plan' has listed five key objectives which include increasing stakeholders' awareness and engagement, strengthening surveillance and research, enabling good practices, promoting the responsible use of antimicrobials, and strengthening governance and allocating resources sustainably. The FAO estimates that within the next ten years, the use of antimicrobials in livestock alone is projected to nearly double to cater to the food demand of the rapidly growing human population. The 'Action Plan' has set two key goals of reducing AMR prevalence and slowing the emergence and spread of resistance across the food chain and for all Food and Agriculture sectors and preserving the ability to treat infections with effective and safe antimicrobials for sustaining food and agriculture production.
Drawing up national and state plans will be critical to achieving these two goals on a global scale. In 2019, the Union Ministry of Health & Family Welfare imposed a ban on the manufacture, sale and distribution of colistin -- an antibiotic -- and its formulations, for food-producing animals, poultry, aqua farming and animal feed supplements. The ban came following investigative reports that colistin is rampantly used in the poultry industry across India as a growth promoter and for protecting the birds from diseases, posing risk of colistin-resistance in humans. The colistin is a life-saving medicine as it is the last line of antibiotic for the treatment of bacterial infections in critically-ill people resistant to almost all other antibiotics. India's 'National Action Plan on Antimicrobial Resistance' states that the burden of bacterial infection in the country is the highest among all nations. It calls for prioritising the state action plan to deal with this challenge. The national action plan acknowledged AMR as a major public health concern in the country. It highlighted that the data indicates the rising rates of AMR across multiple pathogens of clinical importance. In 2008, about 29% of isolates of Staphylococcus aureus which is a leading cause of skin and soft tissue infection were methicillin resistant, which rose to 47% by 2014. The emergence of resistance is not only limited to the older and more frequently used classes of drugs. But, there has also been a rapid increase in the resistance to the newer and more expensive drugs. And, the action plan has set off the public health alarm bell. Apart from the strong legal framework that curbs the unscientific use of antibiotics in food production, massive awareness drive among livestock farmers on the ramification of the use of animal premixed feed added with antibiotics has become an urgent necessity. Another key strategy to prevent AMR is by reducing the use of antibiotic by preventing infections in humans, animals and agriculture through effective infective prevention and control programme such good hand hygiene practice, maintenance of hospital hygiene, availability of adequate safe and pure drinking water, and improving biomedical waste management. Hygiene maintenance at each stage of food production and processing are essential components of such infection-prevention intervention. Self-medication and sale of over-the-counter antibiotics by pharmacies have added to the AMR problem. Even though law prohibits te sale of medicines without prescriptions in the country, the enforcement is poor in most states. Surveillance by the drug control authorities against the dispensing of antibiotics by pharmacies need to be intensified. Apart from punitive action against the erring pharmacies, raising the awareness among people against self-medication and purchasing medicines without medical prescription can contribute to prevent AMR by ending such an illegal practice. The growing food demand is mounting pressure on the livestock industry and Agriculture sector to produce more and also at a faster pace. Upscaling food production must be sustainable and using antibiotic to promote the growth will end up increasing the AMR. The world must rise to the challenge of this global crisis arising from the increasing incidence of AMR.