It is a tough lesson to learn even as people are beginning to neglect Covid appropriate behavior as the Covid-19 infection has eased to a great extent. Now, the Omicron variant has started to affect people across countries. This Covid-19 Pandemic has shown the world that how delicate the interconnections between animals, environment and human ecosystem are and will continue to be tested by climate change. SARs-CoV-2, the virus responsible for the recent pandemic originates from animals, while this zoonotic virus had pandemic potential.
Zoo noses like Severe Acute Respiratory syndrome (SARs), the Middle East Respiratory syndrome (MERs) and Ebola, among others have had a significant bearing on public health in the past. Further the degradation of the health of the three ecosystems will contribute to the spread and emergence of new pandemics. But there is another health crisis the world should be aware of.
Antimicrobial Resistance (AMR) is a silent pandemic that poses a huge threat to global health and development. The World Health Organisation (WHO) and its partner organisations are seeking to raise awareness about AMR and its threat to human lives.
Dubbed as the silent pandemic, studies show that AMR can induce up to 10 million global deaths every year by 2050 and force 28 million people across the world into poverty. Further our health system will be overburdened because drugs will lose their efficacy due to build up AMR as per expert’s opinion.
However, strategies to tackle environmental antimicrobial resistance have been limited. This is worrying because the progress in animals and human verticals of AMR can be eroded due to the interlinkage between the three ecosystems. In view of it, it is critical to have regulations limiting antibiotic concentration in hospitals wastewater and effluents from pharmaceutical manufacturing units.
Central wastewater treatment for hospital effluents in India is uncommon, and reportedly less than 45 per cent of hospitals have treatment facilities. Additionally poor hygiene standards and lack of access to clean drinking water and sanitation further facilitate the spread and emergence of Antimicrobial Resistance in the country. The overuse of antimicrobial like antibiotics in human medicine and improper usage of antibiotics in agriculture, aquaculture, livestock and poultry have been addressed through multi-sectoral practices approaches.
In the absence of standards, the high concentration of antibiotics in pharmaceutical effluents discharged into water bodies poses a grave healthcare threat to animals and humans both. Of late, several instances of hazardous pharmaceutical pollution across several states have been reported, the recent one being of the Baddi Pharma hub of Himachal Pradesh and antibiotic pollution of the Sirsa River. The heavy trace of antibiotics in the river water ultimately infiltrates the animals and human ecosystems through the food chain and silently drives up AMR.
Given that the Indian pharmaceutical industry’s spread across the corners of India and its expansionary outlook, the industry and the Central government must deliberate on this concerning health issue and formulate standards that limit the discharge of antibiotic residue into the environment. Untreated hospital’s wastewater is a heady cocktail of antibiotics and other drugs and if left untreated, it can become a hotspot for drug-resistant pathogens, known as superbugs, leading to health hazards.
It may be pointed that the blaNDM-1, superbug, more commonly known as the New-Delhi superbug was found in wastewater outfalls of hospitals and sewage drains of the country's capital. As expected, the concentration of superbug was much higher in the wastewater outfalls of clinical settings. Subsequently the superbug has spread over 70 countries, including the pristine Arctic Circle, according to reports. Such instances call for pronounced wastewater surveillance along with Antimicrobial Stewardship Practices (AMSP) to prevent hospitals and all kinds of health facilities from turning into hotbeds of AMR.
There is no denying that the ongoing SARCs-CoV-2 pandemic has highlighted the importance of the rapid development of vaccines and antivirals to counter virus attacks and infections. However, the potential for emergence of antibiotic resistances due to the increased use of antibacterial cleaning products and therapeutics present an additional under-reported threat. Most antibacterial cleaners contain simple quaternary ammonium compounds (QACs). However, these compounds are reportedly becoming steadily less effective as antibacterial agents.
The quaternary ammonium compounds are extensively used in SARs-CoV-2 related sanitization in clinical and household settings. Similarly due to the danger of secondary infections, antibiotic therapeutics are increasingly used as a compound of Covid-19 treatment regimens, even in the absence of a bacterial infection diagnosis by medical experts.
Improving WASH (Water, Sanitation and Hygiene) standards are the third area of concern for environmental AMR. Poor sanitation and hygiene coupled with unclean drinking water expedite the natural mutation process in microbes, thereby speeding AMR in humans.
A recent study by the University of Birmingham has revealed that poor WASH standards contribute to the uptick of AMR in under developed countries like Bangladesh.
While the sanitation and hygiene parameters have drastically improved in the country due to the Swachh Bharat Mission in India launched by the present government, the coverage of the ambitious Har Ghar Nal Se Jal, scheme can play a pivotal role in arresting environmental AMR. Har Ghar Nal Ka Jal is a cluster of four state schemes under various categories that were launched to provide clean drinking water to ensure public health.
In India, there has been an emphasis on improving antimicrobial stewardship practices (AMPSP) in hospitals, expanding the coverage of healthcare sites reporting data on AMR, bettering the capacity of health care professionals and focusing on R&D for discovery of new therapeutics.
To address the misuse of antibiotics in aquaculture, livestock and poultry, stringent measures like the ban on Celestin, an antibiotic medication and regulating the maximum permissible limits of antibiotics and veterinary drugs have been taken. The mitigation of AMR is underpinned by protecting the health of animal, environment and human ecosystems. Seizing the importance of the issue, global and national action plans on AMR have been drawn out.
Nestled in the one-Health approach, the action plans provide a framework to arrest AMR across ecosystems and it is pertinent that the policy framework is detached from a soiled approach and implementation of these policies is emphasized.
To facilitate the convergence and implementation of Multi-sectoral policies, AMR regulatory authority must be instituted.
Further, separation of veterinary drugs from human medicine, regulation of animal food by a competent authority and discouraging the sale of over-the-counter medication will ultimately protect against AMR in all three ecosystems.
The increased use of antibacterial agents, cleaners and therapeutic is anticipated to lead to novel resistance in the coming years. However, the administrative efforts will fall short unless supported by industry, civil society organisations and the public.
(The views expressed are personal)
