Superbugs and the looming public health crisis
LESS than a hundred years ago, antibiotics ushered in an era that transformed medical care. It saved millions of lives and accelerated the development and use of complex surgeries and improved management of ailments like cancer. The ability of antibiotics to destroy omnipresent germs gave them the title of “magic bullets”. Unfortunately, this euphoria has not lasted long. Human beings underestimated the ingenuity and survival capacity of the germs as they swiftly developed several arsenals to neutralise the lethality of antibiotics. This made germs resistant to the action of antibiotics, technically called antimicrobial resistance (AMR).
Indiscriminate use of antibiotics in various sectors, mainly human health, veterinary services and agriculture, has facilitated the selection of germs that are resistant to one or multiple antibiotics. Some of the germs have acquired resistance to almost all affordable antibiotics. These are the often-referred superbugs. Infections with resistant germs are difficult to treat, cause a longer stay in hospitals, result in greater mortality and morbidity and cause significant economic loss. This challenge is affecting the entire world.
The implications of AMR are huge at the global level, adversely impacting human development. The cost of inaction to contain AMR has been quantified. It is estimated that around 10 million people will succumb annually to diseases due to resistant pathogens by 2050 if concerted actions are not initiated now. This number shall be greater than those who will die due to road accidents and cancers put together. Within the same time frame, the global gross domestic product will decrease by 3.5 per cent and a cumulative financial loss of $100 trillion is anticipated. The livestock production will be reduced by 7.5 per cent, thus impacting global food security. An additional 28 million people will be pushed below the poverty line and global exports will see a reduction of 3.8 per cent by 2050.
The impact of AMR has been steadily increasing and is far greater in developing countries. In 2019, more than 1.27 million people died due to diseases caused by resistant pathogens.
It is estimated that in India, in 2019, as many as 2,97,000 deaths were attributable to AMR and 10,42,500 deaths associated with AMR. The number of AMR deaths in India is higher than the deaths from cancers, respiratory infections and tuberculosis, enteric infections, diabetes and kidney diseases, and maternal and neonatal disorders.
The United Nations General Assembly (UNGA) has recognised the impact of such a situation on human development and the attainment of Sustainable Development Goals. Through its high-level meetings in 2016 and 2024, the UNGA has given a call for urgent, globally coordinated national actions to reduce by 10 per cent the mortality due to resistant germs by 2030 from the baseline of 2019. Recent meetings of intergovernmental fora for economic cooperation, namely G20 (India, 2023) and G7 (Italy, 2024), have strongly articulated the importance of combating AMR.
Antibiotics are also extensively used in the veterinary sector to treat or prevent infections in animals. At times, these are used as growth promoters with the erroneous belief that this practice will enhance the body mass of the animal, thus giving a better economic return. This practice has been stopped in several countries but due to lack of awareness and poverty, it continues in India. Such an indiscriminate use of antibiotics in animals promotes the selection and transmission of resistant germs through the food cycle to humans and animals.
A recent study by the PGIMER, Chandigarh, on the surveillance of diarrhoea cases in humans in Chandigarh, Haryana, Himachal Pradesh, Punjab, Rajasthan and Uttarakhand demonstrated the causation of disease by germs that showed AMR against several antibiotics, including ampicillin, cotrimoxazole, ciprofloxacin, ceftriaxone, cefepime, levofloxacin, piperacillin-tazobactam, gentamicin and amikacin. In corresponding food-producing animals, high AMR was observed in the same germs against ciprofloxacin, ampicillin, tetracycline and third-generation cephalosporins.
With the ever-increasing demand for food of animal origin in India, there is a likelihood of greater use of antibiotics in the animal health sector, leading to the generation and transmission of resistant germs to humans through the food chain, resulting in difficult-to-treat diseases.
While AMR is receiving greater political, financial, programmatic, technical, regulatory and multi-sectoral attention, the public needs to be recognised as a major stakeholder in global efforts to contain it. Antibiotics prescribers and users across sectors must understand the implications of AMR. In the absence of affordable antibiotics, even a small injury can become fatal, diseases like typhoid fever, cholera, pneumonia, meningitis, etc. shall become untreatable, surgeries will carry a risk of failure and new medical interventions to save lives may become infructuous.
Every user of antibiotics must be educated in simple terms the havoc resistant germs are causing and what active role they can play towards mitigating this potential global disaster. Procuring antibiotics without any prescription, not taking antibiotics in recommended doses and duration, self-medication, using left-over antibiotics for any fever cause harm to the individual’s health as well as public health. This education needs to be firmly ingrained in the behaviour of the people.
This will require sustained and evidence-based efforts by the regulatory authorities and extensive outreach for behaviour change by the central and state health education institutions. The universities, civil society and NGOs can contribute significantly towards this end.
We need a national comprehensive risk communication and community engagement strategy that is relevant in our context, feasible for our diverse population, addresses the social myths and is implemented through experienced communication experts. Both Central and state governments should invest appropriately in this endeavour. No public health programme has ever succeeded without the active cooperation and participation of the people. It is truer for AMR containment and preventing the world from sliding into the dreadful post-antibiotic era.
