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Prevention is the most effective antidote for growing antimicrobial resistance (AMR) in low- and middle-income countries (LMIC), according to experts attending an international workshop spearheaded by the Centre for Science and Environment (CSE) spearheaded an international workshop in Nimli, Rajasthan on April 8-9, 2024.
These countries face the worst of the triple crisis of rising antimicrobial resistance, inadequate development of new antibiotics and a crisis of ‘access’ to effective antibiotics.
Prevention is particularly important for countries with limited resources, said Sunita Narain, CSE Director-General and member of the Global Leaders Group on AMR. Without a robust preventive strategy, these countries would be encumbered by the escalating menace of AMR, which is often dubbed a 'silent pandemic' due to its insidious and pervasive nature, she argued.
The workshop gathered over 45 renowned experts from 24 countries to deliberate on strategic approaches for LMIC to combat the growing crisis of AMR, which poses a formidable global health challenge.
A key objective of the workshop was to prepare a coalition of voices and recommendations from participating countries for the High-Level Meeting on AMR scheduled during the United Nations General Assembly later this year. The assembly is poised to establish ambitious, specific commitments related to curtailing antibiotic usage and the proliferation of AMR.
In line with the discussions, CSE unveiled a new report titled Challenges and possibilities to prevent and contain AMR: Key takeaways from the perspective of low- and middle-income countries. It highlighted that preventative measures, local solutions and global policy alignment are critical to containing AMR effectively.
The gravity of the situation was highlighted by the alarming statistics from 2019, which estimated that five million global deaths were associated with antibiotic resistance, with 1.3 million directly attributable to it.
International collaboration was a focal point, as exemplified by Malin Grape, Sweden's AMR ambassador. Grape emphasised the significance of the gathering, noting the unique positions of attendees to influence policy and align global focus on impactful measures.
“The key is to generate evidence, act on it and collaborate with stakeholders to handle the crisis,” said Rajeev Sadanandan, former additional chief secretary (health), government of Kerala. Sadanandan was instrumental in developing Kerala’s state action plan on AMR.
Meenesh Shah, chairperson of the National Dairy Development Board (NDDB), shared insights on alternative treatments in veterinary medicine, highlighting successful reductions in antibiotic usage through ethno-veterinary medicines.
NDDB in India treated about 780,000 cases of disease with ethnoveterinary medicines, achieving an overall cure rate of 80.4 per cent. “After a year-long observation in a district, it became apparent that 70-80 per cent of the cases, including mastitis, were treatable without antibiotics,” she added.
A pressing concern discussed was the dwindling antibiotic pipeline, with Amit Khurana, director of CSE’s sustainable food systems programme, pointing out the pharmaceutical industry's shift from antibiotic development to more lucrative sectors.
Among the 15 high-earning global pharmaceutical companies, only four were found to be developing a total of 13 antibacterial candidates, the authors of the CSE report highlighted.
The need for global funding to facilitate access to antibiotics in less affluent nations was underscored.
Jean Pierre Nyemazi from the World Health Organization (WHO) called for a global effort to ensure access to effective antibiotics, cautioning against leaving such a crucial matter to market dynamics alone.
The private sector's role was also explored, with Anand Anandkumar, CEO of Bugworks, India, commenting on the manufacturing challenges faced by small- and medium-scale antibiotic developers. Bugworks is one of the few small-medium scale antibiotic developer from India which has taken up the challenge.
Narain chaired a session on sustainable food systems, stressing the need for solutions that address food security while minimising antibiotic use. She advocated for a paradigm shift that places 'prevention' at the forefront of food-animal production systems.