How ‘one health approach’ can help curb antimicrobial resistance

While gobbling up the crispiest fried chicken or popping antibiotic pills for a little sneezing, did it ever occur to you that your food or medicine might make your body unresponsive to antibiotics one day?

If this isn't making sense then let me tell you about Antimicrobial Resistance(AMR).  

Say, Abdur Rahim is a farmer who takes antibiotics even at the slightest sign of physical distress and he injects his poultry with high antimicrobials and sells them to a overcrowded city. 

The city people consume these chickens and the remnants of these antimicrobials are transferred from the chicken to their bodies, even though they did not need them.

With plenty of time and opportunity to mutate, these pathogens - supposed to be eradicated in the presence of certain antimicrobials - may become immune to their actions and exhibit antimicrobial resistance.

Analysing this chain of actions, it is evident that unsupervised use of antimicrobials instigates pressure on the microbes for which organisms create adaptive solutions to antimicrobials.

For instance, the classes of antimicrobials like cephalosporins, tetracyclines used to treat bacterial infections in humans are also used in animals. Industrial-chemical, domestic-farm wastes are making microbes resistant to heavy metals while UV rays are aiding to mutate highly adaptive modules.

Residuals of these resistant pathogens in the food supply are transmitted to people. Thanks to globalisation and rapid urbanisation, antimicrobial-resistant pathogens can proliferate globally attacking more hosts leaving antimicrobials, e.g., Antibiotics, Antivirals and Antifungals  ineffective. Ultimately, this results in the implementation of less effective options to fight infectious diseases which burdens the healthcare system.

This is where One Health Approach comes into play. 

The US Centres for Disease Control and Prevention and the One Health Commission says, "One Health is defined as a collaborative, multi-sectoral, and multidisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognising the interconnection between people, animals, plants, and their shared environment".

As the human-animal-environmental interaction may be one of the underlying factors behind antimicrobial resistance, the multifaceted one health approach may be a perfect fit to curb this menace. 

The WHO has launched new guidelines to curb routine use of antimicrobials in food-producing animals by the livestock industry. It has developed Antimicrobial stewardship in hospital antibiotic policy and treatment policy. One Health approach may come handy in the implementation of these guidelines. 

One health provides a multidisciplinary network that follows a bottom-up approach. This approach integrates veterinarians, wildlife experts, environmental experts, community health workers, community-based animal health workers, NGOs, clinics, hospitals, farmers etc. to collaborate on the surveillance of antimicrobial resistance and their usage. 

By combining inter professional exchanges, upgraded communication, research, innovation, student engagement, public awareness, policy  development on food safety, tackling corporate campaigns on antimicrobials, reducing the use of antimicrobials on animals and dissolving environmental threats, it is possible to remove all causal factors simultaneously. 

Now the question arises: why is it so important for Bangladesh?

Let me give you a quick example, in a study performed in Chattogram in 2003, Typhoid patients were found to be unresponsive to second-line therapy (ciprofloxacin). First-line therapy was not even attempted because of existing resistance.

There is a shortage of new antibiotics but controlled and lowered use of antibiotics can abate resistance. That being said, is there any national regulation for Antimicrobial resistance?

Answer is yes. Are the regulations properly implemented? 

That will be a 'No'. 

Bangladesh is a member of 'Global Antibiotic Resistance Partnership (GARP)' and it has a National Plan for containment of AMR developed in March 2018 which is predominantly based on regulating productions and dispensing of medicines in stages of manufacturing, procuring, supplying and end use. 

Yet according to the Journal of Global Antimicrobial Resistance, only 35% of the recommended global action plan was implemented in February 2019. Moreover, only eight out of 20 actions of the Bangladesh National Plan were executed by the end of 2018.

It is the demand of the hour that an integrated and holistic approach should be taken by the Ministry of Health and Family Welfare, the Ministry of Fisheries and Livestock, the Department of Livestock, Bangladesh Veterinary Council, the education ministry, the National Parliament and the Ministry of Finance. 

The approach will include one health steps like- integrated disease surveillance in animals, human and agriculture; improvement of awareness and communication among environmental, animal and human health professionals; adopting one health study in university and pre-university education; and safe use of animal and meat consumption. 

Overall encouragement of more research, innovation and inter-professional collaboration along with international academic partnership is also necessary to tackle poverty, lack of education, sanitation, consumer awareness, human animal proximity as well as other associated factors which aid in the up-scale of antimicrobial resistance.

According to a 2017 report titled, "Drug-Resistant Infections: A Threat to Our Economic Future," each year seven lakh people die of AMR and without intervention, it will rise to one crore annually accompanied by a gross loss of 3.8% GDP. But we can save these precious lives and one healthy approach might be the biggest weapon at our disposal to take down Antimicrobial Resistance now and in the days to come.

Shirazum Munira is a 3rd Year M.B.B.S Student at Shaheed Suhrawardy Medical College, Dhaka.

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.