One health approach to contain antimicrobial resistance

The two articles from the prestigious Lancet, ‘Buden of antimicrobial resistance (AMR) in India: a systematic analysis of Global Burden of Disease Study 2019’ and ‘Preprocedural screening of multidrug-resistant organisms in endoscopic retrograde cholangiopancreatography: an international multi centre, cross-sectional observational study’ have cautioned India’s AMR situation very alarming compared to peers. Global Burden of Diseases quantifies the scale of crisis and estimated AMR linked deaths as 33 per cent of all sepsis fatalities. The second study reported that 83.1 per cent harboured multidrug resistant organisms. 

India leads the global AMR mortality is a big concern as well as challenges too. A recent study by Indian Council for Medical Research (ICMR) also reported that superbugs are resistant to common antibiotics and the many common infections are tougher to treat. It has cautioned further “urinary tract infection, pneumonia, sepsis, and diarrhoeal illnesses” are being increasingly difficult to treat. This is the report of ICMR’s AMR surveillance work based on 2024 data. This is India’s growing threat of AMR.  

Development of AMR is a natural process and this AMR has enormous impact in our life. Antimicrobials cover antibiotics, antivirals, antifungals, and anti-parasitics. Most of the time, we concentrate only on antibiotics. They are used to prevent and treat infectious diseases in humans, animals and plants. 

Antimicrobials are priority medicines and AMR threatens   our ability to treat common infections. Besides the issue of treatment of common infectious illnesses, the modern medical practice cannot think of life-saving procedures including cancer chemotherapy and caesarean section, hip replacements, organ transplantation and other surgeries in absence of effective antimicrobials. AMR makes our development in health science ineffective. Overall, it contributes adversely to health economics and national economy. It creates need for more expensive and intensive care, affects productivity of patients or their caregivers through prolonged hospital stays. It has reported to cause with an estimated 1.27 million deaths every year, a figure projected to rise to 10 million annually by 2050 if left unaddressed. Such a crisis is anticipated to reduce global Gross Domestic Product (GDP) by 2-3.5% due to healthcare burdens and productivity loss. 

Agriculture is the backbone of human sustainability. We need food that comes as a product of agriculture. Antimicrobials play a critical role in treating diseases of food-producing animals (aquatic and terrestrial) and plants, helping to ensure food security. Antimicrobials are indirectly responsible ensuring food security. Antimicrobials are used to treat animals that are already sick or to control the spread of a disease within a flock, herd or on a farm. They are also employed in aquaculture (e.g., fish farms) for similar purposes. They are also used to treat microbial diseases of plants. They are used prophylactically to prevent diseases that are anticipated in populations of animals or plants. A common practice in the past was to add antimicrobials in low concentrations to animal feed to stimulate growth and production. The estimates of the total annual global use of antimicrobials in agriculture vary considerably.  Only 89 countries have systems in place to collect data on the use of antimicrobials in animals. Very few countries record the use of antimicrobials in plant agriculture.  70-80 per cent of antibiotics given to fish are excreted into water and spread rapidly through water systems. As the demand for animal sourced food products projected to grow steadily over the coming decades, the demand for antimicrobial use in agriculture is also expected to rise. It is necessary to modify the production practices to reduce the consumption of antimicrobials. 

As antimicrobials are used increasingly, AMR in food and agriculture poses risks to food systems, livelihoods and economies.  In addition to impact on animals, animal diseases AMR has significant effect on food production, food security and farmer livelihoods. AMR increases these risks. The use of antimicrobials in agriculture contributes to the spread of AMR and undermines the effectiveness of veterinary medicines. The drug-resistant infection in humans may have origin to food borne and animal sources. Beyond more direct implications for food production and food safety, AMR threatens the livelihoods of millions who raise animals for subsistence. It is estimated that in just ten years’ time, 24 million more people may be forced into extreme poverty as a result of AMR, many of whom are in low-income countries- increasing the number of people going hungry and suffering from malnutrition. This risk is particularly high in countries where legislation, regulatory surveillance and monitoring systems pertaining to the use of antimicrobials and the prevention of AMR are weak or inadequate.

Human activity introduces resistant microbes to environment. The antimicrobials excreted from human and animal health management pollute the environment. The poor hygienic practice like open defecation pollutes. The Indian Swachh Bharat initiative has built toilets discouraging people from open defaecation. The antimicrobials too get excreted like other medicines in faeces.  Open defaecation plays a significant role in releasing resistant organisms into the environment. The antibiotics are excreted from animals un-metabolized and enter sewage systems and water sources. Poor sanitation, improper affluent management by the health care facilities, pharmaceutical and chemical industries contribute substantially to environment pollution.   

AMR is a complex issue. It does not restrict to geographical or political domain. It crosses boarders and sectors. A coordinated initiative is essential. In order to sensitize all stake holders, the ‘World AMR Week 2025’ was observed during 18th to 24th November with a theme “Act Now: Protect Our Present, Secure Our Future”. “World AMR Awareness Week reminds us that protecting antimicrobials is a shared responsibility. It is necessary to decisively act now to safeguard these life-saving medicines for ourselves and for future generations.”  The Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), WHO, and the World Organisation for Animal Health (WOAH) have joined together at global level. In India too, we have concerted efforts and launched National Action Plan (NAP) on AMR 2.0 recently focussing on one health approach. This includes strengthening awareness, education and training, enhancing laboratory capacity and infection control in healthcare facilities. The Ministries of Health, Ministry of Fisheries, Ministry of Animal Husbandry and Dairying, Ministry of Agriculture & Farmers Welfare, Ministry of Environment, Forests & Climate Change jointly working to contain AMR.  

AMR is an invisible health crisis. It has been identified as one of the top ten global threats. AMR is a big risk to human and animal health and welfare, agriculture and food security. Under use and over use of antimicrobials are the main triggering factors of AMR. It is possible to control the spread of AMR. The action is required at human, animal, agriculture and environment sectors who have been using antimicrobials. They must commit for action to contain AMR and one health approach is perhaps the best and effective weapon! One health concept’s basic philosophy is to show our concern not just for human health but also of animal and environment health. The Government of India has already established One Health Mission with many objectives besides containing AMR.