Why India needs its own Priority Pathogen List in its fight against AMR

Antimicrobials have revolutionised modern medicine. Since the early 1940s, antimicrobials, including antibiotics, antivirals, antifungals and antiparasitic drugs have significantly reduced morbidity and mortality associated with communicable diseases and have contributed to a range of technological advances, including cancer therapy, transplantation, and surgery. However, misuse of antimicrobials in human medicine, animal health and agriculture are rapidly contributing to the emergence of antimicrobial resistance (AMR), and without urgent action, the world faces the real threat of a post-antimicrobial world, where simple infections once again kill millions every year.

The rise of AMR is already having significant implications for global health. This is especially true in India which has one of the highest AMR rates globally. In 2010, India became the world’s largest consumer of antibiotics, with a record of 12.9 billion units of antibiotic consumption. In the decade between 2010 and 2020, the total use of antibiotics in the country increase by 47%. This increase has been largely attributed to regulatory issues, easy access to medicines over the counter in medical stores, and unethical commercial practices promoting the large-scale sale of antibiotics.

To address the growing challenge of AMR, on 4th March 2021, the Government of India published its Indian Priority Pathogen List (IPPL), which complements the global priority pathogen list developed by the World Health Organization (WHO) in 2017. Both lists recognize 12 families of antimicrobial-resistant bacteria, grouped according to species and type of resistance, and then categorized into 3 priority tiers: critical, high and medium. The priority pathogen lists (PPL) are aimed to guide discovery, research and development of new drugs, which is often impeded by the large expenses and complexity involved in research and development. Moreover, the PPL was created to highlight the critical and time-sensitive nature of the threat that AMR posed, and to act as a call to action for pharmaceutical companies, research institutions and universities to focus their attention on the issue.

The government of India has designed a ‘Make in India’ national programme to facilitate investment, foster innovation, protect intellectual property and build the manufacturing industry in the country. The major objectives of the IPPL were to support these Make in India priorities, help align research and development on AMR with national and global public health needs, and incentivise funding support to help contain the spread of antibiotic-resistant pathogens in the country. The containment of AMR within the country would require a One Health approach requiring the unification and support from all adjunctive sectors. This would be essential in attaining any progress towards India’s Sustainable Development Goals.

Infections caused by drug-resistant bacteria could lead to increased mortality, longer durations of hospitalisations and prove to be a huge financial burden to the patients as well as the health systems. Low-income countries are specifically vulnerable due to the conditions that enable the spread of the disease. As per a warning issued by The World Bank, antimicrobial resistance could cause more economic damage than the 2008 financial crisis. The consequences of AMR for a country like India would prove to be detrimental and an expensive affair due to the high costs of second and third line antibiotics. While research and development for new antimicrobials is extremely crucial in the fight against AMR, a change in the way they are administered and made available is also vital to the long-term solution.