Context: Recently, the latest version of the draft Pandemic Instrument or the pandemic treaty was shared with member states at the World Health Assembly. While earlier drafts of the Pandemic Instrument drew on guidance from Antimicrobial resistance (AMR) policy researchers and civil society organizations, but after the closed-door negotiations by member states, these insertions are at risk for removal.
Anti-Microbial Resistance:
- Antimicrobial resistance (AMR) is the process by which infections caused by microbes become resistant to medicines/antimicrobial treatments (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) developed to treat them.
- Microbes include bacteria, fungi, viruses and parasites.
- As a result, traditional therapies are rendered ineffective, illnesses persist, and the risk of spreading the infection to others increases. Antimicrobial-resistant microorganisms are frequently referred to as “superbugs.”
Factors contributing to AMR:
- Misuse of antibiotics by buying over-the-counter/wrong prescription. Widespread use of antibiotics over the last years due to COVID-19.
- Rampant use of antibiotics in agriculture and farming sector. E.g., Streptomycin used for treating Tuberculosis is used indiscriminately to grow fruits & vegetables, Colistin is mixed in poultry feed to make chickens grow faster.
- Untreated waste from pharmaceutical manufacturing sites and hospitals releases large amounts of active antimicrobials into the environment.
- Incomplete course of antimicrobial drugs may develop drug resistance. E.g., MDR-Tuberculosis.
- Lack of hygiene and sanitation, infrastructural standards such as quality of drinking water and sanitation levels also contribute to AMR.
Rising Risk due to AMR:
- AMR is fueling the rise of drug-resistant infections, including:
- drug-resistant tuberculosis
- drug-resistant pneumonia
- drug-resistant Staph infections such as methicillin-resistant Staphylococcus aureus (MRSA).
AMR has made it harder to treat such infections and also, adds to the burden of communicable diseases and strains the health systems of a country.
- AMR has been named one of the top ten global health hazards by the World Health Organisation (WHO).
- In 2019, AMR was associated with an estimated 4.95 million human deaths.
- A 2018 report by the Organisation for Economic Co-operation and Development (OECD) warned of a phenomenal increase in resistance to backup antibiotics (second and third-line) by 2030.
- AMR imposes a huge health cost on the patient in the form of longer hospitalisation, health complications and delayed recovery. It puts patients undergoing major surgeries and treatments, such as chemotherapy, at a greater risk.
The Pandemic Instrument:
- In December 2021, the 194 World Health Organization (WHO) Member States agreed to draft and negotiate an international pandemic instrument/treaty.
- Aim: To strengthen and coordinate national and international efforts to prevent, prepare for, and respond to future pandemic emergencies.
Concern:
- However, the draft Pandemic Instrument is overly focused on viral threats and has ignored the “silent” pandemic of antimicrobial resistance and bacterial threats.
- But, it is a cause of concern as not all pandemics in the past have been caused by viruses and not all pandemics in the future will be caused by viruses. E.g., Plague and cholera have been devastating past pandemics due to bacteria.
- Even in the case of a viral pandemic, secondary bacterial infections will be a serious issue. E.g., COVID-19 patients were associated with pneumonia — a secondary bacterial infection that must be treated with antibiotics.
Way Forward:
- The “pandemic treaty” must plan, prepare and develop effective tools to respond to a wider range of pandemic threats, not solely viruses. Hence, there is a need to include bacterial pathogens in the definition of “pandemics”.
- AMR exceeds the capacity of any single country or sector to solve. Global political action is needed to ensure the international community works together to collectively mitigate AMR and support the conservation, development and equitable distribution of safe and effective antimicrobials.
- Treating bacterial infections requires effective antibiotics, and with AMR increasing, effective antibiotics are becoming a scarce resource. Hence, more government investment in research and innovation is needed to develop new antibiotics.
