The challenge of Antimicrobial Resistance (AMR) and How to confront it effectively


  • Currently, Antimicrobial Resistance (AMR) is one of the most concern threats confronting Global Public Health. AMR implies that a pathogen sensitive to a certain drug cease to respond to that drug.
  • While the more commonly known resistance is Antibacterial (ABR), the larger term AMR encompasses resistance to medicines for treatment of other pathogens too, which cause viral, fungal, and parasitic diseases.

AMR and global health:

  • A global issue which is not confined by political boundaries but it is a threat to all humanity.
  • Animals and plants are also afflicted by diseases caused by pathogens therefore they are vulnerable to AMR.
  • Human beings are also victims of AMR due to the irrational and improper use of drugs.
  • AMR spreads in humans through their food, water, and from their environment.

Efforts around the world to fight against AMR:

  • Over the last ten years, the prevention, control, and response to AMR has been a high priority for most national governments, international organisations (such as the WHO, FAO, OIE), healthcare communities, and civil society, etc.
  • Global action plan (GAP)of WHO:
    •  The WHO adopted global action plan (GAP) with the collective effort of its member countries which provides a road map to tackle antimicrobial resistance including antibiotic resistance.
  • India’s National Action Plan (NAP) against AMR:
    • India’s NAP includes coordinated action by the
      • government and non-government sectors;
      • a whole of government approach (Health, Animal Husbandry, Fisheries, Agriculture, Dairy, Pharmaceuticals and Biotechnology sectors);
      • advocacy;
      •  awareness-building;
      • involvement of the community;
      •  infection prevention and control;
      • National AMR Surveillance Network (NARS Net);
      • research and international collaboration.
  • Other than it, AMR is an important priority in the G20 health agenda under India’s presidency.
  • As during the time of Covid-19 phase, as a consequence, most public health programmes, including AMR endeavours, suffered and timelines got extended. Hence, substantial effort is now needed to get back on track.

What efforts can be done to check AMR?

  • Despite the International ‘One Health’ initiative and India’s own vision of inter-ministerial coordination for AMR prevention and control, the war against AMR is largely construed as the burden of the health sector.
  • It is vital that other stakeholders too, especially the sectors overseeing food, drinking water, and environment, shoulder equal ownership, failing which the achievement of India’s AMR objectives will be difficult.
  • An area of immense concern is the apparently unregulated access to antibiotics for the animal husbandry, dairying, and poultry sectors.
  •  While there is rightly conscious and concerned about the sales of antibiotics without prescription to humans (and much more action is desirable in this regard) on the other hand regulating antibiotics sales for non-human consumption generally escapes our notice
    • Prompt and effective action in this area is warranted.
    • This should include not only regulated access, but also no over- or under-use of drugs for non-human consumption.
  • Another important aspect that needs to be recognise and address is the role of the environment in the spread of AMR.
    • Untreated wastewater and effluents, including such releases from antibiotics manufacturing units and healthcare facilities, can contaminate our environment, facilitating the propagation of AMR.
    •  Effective sanitation, sewage, and waste treatment infrastructure is required to keep the environment safe and prevent AMR contamination and transmission.

Role of state governments and local bodies in India’s AMR agenda:

  • AMR containment measures including hospital infection and control, regulation of pharmacies/ pharmacists, treatment of sewage and pharmaceutical effluents, adoption of standard treatment protocols, AMR surveillance etc., are largely implemented by the state governments.
  • Hence, efforts against AMR cannot be successful without the active and enthusiastic involvement of the states.
  • This realisation must quickly resonate across the country.

Reasons for urgent action against AMR

  • AMR puts a huge economic burden on both individual families and society.
    • Long periods of morbidity due to non-responsive medicines,
    • increased mortality due to AMR,
    • massive loss of productive man-days of work,
    • wasteful expenditure on medicines which do not work,
    • maintaining large ill populations, etc. put an enormous burden on national resources.
  • This can be prevented by effectively neutralising the threat of AMR. Hence, investments in the AMR programme is not only a health necessity, it is also good economics.

Steps to fight against AMR:

First, prescription is prevention: 

  • Disease prevention and overall wellness are essential components of public health; consequently, preventing infections whenever and wherever they can be avoided is analogous to avoiding the development of resistance.
  • We need to spearhead sanitation drives, ensure a clean water supply and support hospital-driven infection-control programmes.

Making effective us of India’s digital technology:

    1. India has achieved huge success in the application of digital technology.
    2. Leveraging such applications, especially conceived for the AMR programme, will yield good dividends. This can also add value to India’s contribution in the G20 collaboration.
    3. Applications can be for monitoring the use of antibiotics, prescription audits, movement of antibiotics from the production source to the ultimate user, for surveillance of incidence and prevalence of AMR including state-wise or interspatial variations, etc.

Rational use of available antibiotics:

Antimicrobials should only be prescribed when absolutely necessary and with caution to cut down on AMR.

  • Coordination across the animal industry and environmental sectors to prevent the use of antibiotics in farming operations that is not necessary; such practices foster the growth of drug-resistant organisms in our food supply.
  • More comprehensive vaccination programme: Vaccines are also a powerful tool to prevent infections and have the potential to curb the spread of AMR infections.

However, immunisation programmes are not comprehensive and exhaustive yet for many infectious diseases.

Robust surveillance system

  • Coordination across the animal industry and the environmental sectors to prevent the use of antibiotics in farming operations where they are not required; such practices foster the growth of drug-resistant organisms in our food supply and need to be stopped.
  1. Discovery and commercialisation of new antibiotics:
    1. Parallel efforts on a war footing are needed for the discovery and commercialisation of new antibiotics and new antimicrobials.  Such efforts must be incentivised.
    2. This is an area where international cooperation will fetch high returns, and is an obvious candidate for both bilateral and multilateral agenda.
  2. Using the social media in effective way to aware the people about AMR:
  • The social media has great influence over people’s mind and behaviour. Therefore, these platforms can be leveraged to spread the message of AMR.
  • The objectives should be to inculcate community realisation for rational and correct use of antimicrobials. As without community participation, public health programmes may not succeed.