COVER STORY/ANTIBIOTIC
when it was recognised that AMR could derail the progress towards meeting SDGs. To ensure all countries had coordinated action on antibiotic resistance, WHO, along with the Food and Agriculture Organization (FAO)
and the World Organisation for Animal Health (OIE) proposed the Global Action Plan on antimicrobial resistance at the 68th World Health Assembly in May 2015, which urged member nations to develop national action plans on antimicrobial resistance by 2017. WHO, FAO and OIE provided a common template which the countries could use and prepare their National Action Plans (NAP)
suited to domestic conditions. By January 2019, 117 countries had prepared NAPs, and another 62 had plans in progress.
In response, China roped in 14 ministries to initiate a five-year national action plan from 2016 to 2020 in continuation with their existing plans. The 2019 annual report from CARSS shows a significant decrease in antimicrobial consumption in the country. Among inpatients in hospitals, usage decreased 0.5 percentage points from 36.9 per cent in 2018. The decadal comparison shows a much stronger picture; it declined from 59.4 per cent in 2011 to 36.4 per cent in 2018. The use of antibiotics in surgeries decreased from 41.5 per cent in 2011 to 21.9 per cent in 2018. However, antibiotic use in tertiary general hospitals remains high. “In the case of China, population and geographical size make the job of tackling the antibiotic resistance a challenging one. But the slowdown in antibiotics consumption is happening with the joint action by government, medical staff including doctors and even patients,” C K Lee of the World Health Organization China Office told
But it took the country more than a decade to achieve this.
India too worked quickly in 2015 to prepare the NAP on AMR. It set up the Intersectoral Coordination Committee, Technical Advisory Group and Core Working Group on AMR for technical coordination and oversight in September 2016 and the National Action Plan on Antimicrobial Resistance (NAP-AMR) was
AS OF JANUARY 2019, 117 COUNTRIES HAD PREPARED NATIONAL ACTION PLANS ON AMR AND ANOTHER 62 HAD PLANS IN PROGRESS
released by this group on April 20, 2017. The National Health Policy, 2017, also addressed
AMR and gave priority to the development of guidelines on antibiotic use. To promote appropriate use of antibiotics in humans, the Red Line campaign was launched in India in February 2016 to curb over-thecounter sale of antibiotics. Under this campaign, a red line is printed on antibiotic packages as warning.
Most countries in Africa started working on AMR only after WHO’s intervention. In November 2016, an AMR coordinating body was set at the Nigeria Centre for Disease Control (NCDC). In January 2017, the “OneHealth” AMR Technical Working Group was launched to conduct a situation analysis on AMR and the NCDC developed the Antimicrobial Resistance National Action Plan (AMR-NAP). Inweregbu Stella of NCDC says the government conducted a situation analysis in 2017 and found there was no
AMR laboratory surveillance system, no dedicated funding to control AMR and limited collaboration among the health, animal-health and environmental health sectors on AMR. Since then, NCDC has established nine surveillance sites to begin collection of AMR data.
Zambia too has prepared an elaborate Multisectoral National Action Plan, which was launched in November 2017. One of the focus areas of Zambia’s NAP is to collect high quality data on the prevalence of AMR and drug resistant infections and on the use of antimicrobial medicines in humans and animals. The Zambia National Public Health Institute, the technical disease intelligence arm of the ministry of health is establishing a national public health laboratory network that will further improve the ability to monitor AMR. “We have mounted a very effective surveillance system, which at hospital level, routinely collects specimens to check how effective our drugs are to the various diseases,” says Kennedy Malama, permanent secretary, Ministry of Health. This has already yielded results as data shows that while there is resistance to some antibiotic drugs in one
Including probiotics in diet can help. It was seen that when infants and children consumed foods rich in bacterium like Lactobacillus and Bifidobacterium, they were at least 29 per cent less likely to need antibiotics.