Diagnostics, drug resistance and commitment to combat AMR

Antimicrobial resistance (AMR) is one of the top 10 global health threats facing humanity today. More than 20 years since the first WHO Global Strategy for action, new data published in the Lancet – widely acknowledged as the most robust estimates to date – show that 1.27 million people every year are losing their lives because of AMR, meaning the annual death toll for AMR now exceeds that of HIV and malaria combined.

Fuelled by the misuse and overuse of antibiotics, researchers believe that AMR could ultimately take more than 10 million lives per year by 2050. While the burden is universal, a fifth of those deaths – 2 million every year – are expected to occur in India, with some seeing the country on track to become the “AMR capital of the world”.

While this fortune is by no means inevitable, the consequences of AMR are undeniable. In December 2021, research published by the Indian Council for Medical Research (ICMR) showed resistance to broad-spectrum antimicrobials increasing 5–10% every year. Even more sobering was a recent analysis of sepsis cases across 35 intensive care units that revealed drug-resistant infections in almost every second patient (~45%).

Diagnostics at community and hospital levels are key to improving both patient care and the stewardship (use) of new and existing antibiotics. India is a long-standing champion for diagnostics, being the first country in the world to launch a National Essential Diagnostics List (NEDL). Building on this commitment to testing, the Government of India is not shying away from the immense challenge of AMR. From the Jaipur Declaration of 2011 to the launch of the National Action Plan in 2017, there is a clear commitment to action.

Undeterred – or perhaps further motivated – by the events of COVID-19, December 2021 saw the Office of the Principal Scientific Advisor support the launch of the ground-breaking India AMR Innovation Hub (IAIH). A unique platform designed to bring together national and global stakeholders, the IAIH unites members around a single common objective: to contribute to the fight against AMR.

India is also at the forefront of AMR research, and in 2018 joined a landmark multi-country study led by FIND, the global alliance for diagnostics, to evaluate the impact of diagnostic testing on clinical decision-making in primary care settings (the AMR Dx Use Accelerator). With the final report due to be published later this year, early results indicate that diagnostic tools can reduce the reliance on antibiotics without adversely affecting patient outcomes.

Improving diagnostic capacity in primary care and community settings is a clear priority. Systematic testing is critical here not only because it enables informed prescribing (a vital step to improve antimicrobial stewardship), but also because it makes it possible to identify unusual disease patterns and contain potential outbreaks before they take hold.

Diagnostic testing also needs to be prioritized in hospitals, to support the identification and management of severe drug-resistant and healthcare-associated infections (HAIs). In every instance, data from primary, secondary and tertiary settings can (and should) be used to support local and national disease surveillance activity. For without these systems – and the digital tools to support them – governments and policy-makers do not have the information needed to drive policy developments and public health action forward.

We must be proactive. India could well be the “AMR capital of the world”, but perhaps we can make that true for a different reason. As the country prepares to assume the G20 presidency in December this year, we have a unique opportunity to “reinvigorate, reinvent and re-centre the multilateral order” – doubling-down on a number of high priority issues, including global public health and pandemic preparedness.

In the context of diagnostics, this means supporting:
• Supporting the move to improve diagnostic testing at the primary care level, including cross-cutting solutions that bring public and private sectors together and improve antimicrobial stewardship
• Broader health system strengthening, including the introduction of affordable diagnostic tools to improve the identification and management of severe drug-resistant and HAIs
• Implementation of digital tools and strong data management systems for clinical decision making and disease surveillance for national and global health security
• Accurate solutions for monitoring and reporting drug resistance so that policy decisions can be based on real-world data rather than estimates.

Drug resistance is on the rise, and losing our precious antibiotics is not an option. If we want to protect tomorrow, we need to act on diagnostics for AMR today.

Dr Sanjay Sarin is the Vice President, Access & Country Programmes at FIND, the global alliance for diagnostics, based in New Delhi, India. He has over 20 years’ experience in health policy, market development, and business management with specialization in the development of strategic initiatives for driving access in emerging markets.

Dr Cecilia Ferreyra is Director of AMR at FIND, the global alliance for diagnostics, based in Geneva, Switzerland. She is a Medical Doctor specialized in infectious diseases with over 17 years of experience, including 14 years with Médecins Sans Frontières in low- and middle-income countries such as Kenya, China, Somalia, DRC, South Sudan and Uganda, implementing HIV/TB activities in the field.

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