India’s Action Plan on antibiotic resistance (AMR) has made limited progress, says CSE assessment

As the world observes the ‘World Antibiotic Awareness Week’ from November 12-18, aimed at increasing global awareness of antibiotic resistance (AMR), Centre for Science and Environment (CSE) has done an assessment of India’s National Action Plan on Antimicrobial Resistance (2017-21) – the assessment finds limited progress on only a few critical activities to contain AMR from animal and environmental sources.

“Even after a year and a half after India’s National Action Plan on Antimicrobial Resistance (2017-21) came into being, there is at best limited progress on only a few critical activities to contain AMR from animal and environmental sources. Many of these were planned to be completed within a year. India is going to be heavily impacted by the AMR crisis and we cannot afford such delays,” says Chandra Bhushan, deputy director general, CSE.

The Indian action plan was released in April 2017 along with the ‘Delhi Declaration on Antimicrobial Resistance’ endorsed by 12 stakeholder ministries.

Resistance to antibiotics is now recognised as a public health threat of an unprecedented scale. Antibiotics are increasingly becoming ineffective. Common infections and diseases, which were earlier treatable, are now becoming difficult to treat. Globally, it is expected to lead to a 3.8 per cent loss in GDP and 10 million deaths annually by 2050.

Besides antibiotic use in human health, overuse and misuse of antibiotics in producing food from animals such as chicken meat, eggs, milk and fish is a key cause behind rising AMR. India will be heavily impacted by it due to its huge burden of infectious diseases, large-scale food animal production using antibiotics, and inadequate healthcare systems.

CSE researchers also point out that poor management of waste — which can contain antibiotics, antibiotic-resistant bacteria or genes transferring resistance — from farms, pharmaceutical factories, healthcare settings and households adds to the emergence and spread of AMR.

Many countries — such as those in the European Union — have already set up the necessary regulatory frameworks to address antibiotic misuse in animals. “India still does not have laws and systems to control use of antibiotic growth promoters in animal feed, or those which would help track the sale and use of antibiotics in food animals. All we have so far is a Central government advisory, which cannot be enforced in states,” says Amit Khurana, programme director, food safety and toxins, CSE.

“What India also needs is a clear roadmap for two things – one, to phase out use in animals of antibiotics which are critically important for humans, and two, to stop antibiotic misuse for mass disease prevention,” adds Khurana.

CSE researchers acknowledge that the Food Safety and Standards Authority of India (FSSAI) has recently notified the much required tolerance limits for antibiotic residues in food from animals such as meat, milk, egg and fish. On the other hand, the Indian Council of Agricultural Research (ICAR) has also initiated the Indian Network for Fisheries and Animal Antimicrobial Resistance (INFAAR) with 18 labs at ICAR institutes. However, a lot of planned activities on AMR surveillance have not yet been completed.

In March 2018, the Central Pollution Control Board (CPCB) prepared a set of draft standards for antibiotic discharge in pharmaceutical industry effluents. Says Khurana: “At present, it is being reviewed by the environment ministry and we expect stringent final standards to be set soon.”

“We have a lot of ground to cover towards strengthening laboratories, developing capacity, and finalising mechanisms and modalities for a nation-wide AMR surveillance in food, animals and environment,” says Rajeshwari Sinha, deputy programme manager, food safety and toxins, CSE.

Talking about the required action on environmental AMR, Sinha mentions: “The poultry farming guidelines of the CPCB need to be strengthened and made enforceable. Extended producer responsibility should be introduced to ensure appropriate drug take-back and drug disposal.”

The CSE assessment of the Action Plan points out that there is limited clarity on formal status, structure, roles, responsibilities and powers of a new authority – the National Authority for Containment of Antimicrobial Resistance (NACA) – which was planned as an overarching body for AMR containment activities and a stakeholder in implementing the Action Plan. It also highlights that Kerala is the only state so far which has released its own action plan, and that other states must actively come forward in order to ensure effective implementation of the plan on the ground.

The assessment has expressed its concerns over the limited focus in the budget on AMR. The Union budget of 2018-19 had no separate head for AMR under the Ministry of Health and Family Welfare. Instead, AMR was made part of a common pool allocated for different public health programmes.

“Sustained political will at the Centre and the states and adequate financing of the AMR Action Plan will be the key to address the AMR crisis in India. Centre must ensure that AMR activities are adequately funded. States should now come forward with their own plans like Kerala has done. Without their active participation, implementation of the Action Plan would be impossible,” says Bhushan.