United Nations

India has a massive antibiotic resistance problem, and it’s up to the states to solve it

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India has a massive antibiotic resistance problem, and it's up to the states to solve it

On September 21, United Nations had a high-level meeting on antimicrobial resistance, which required commitments from heads of state to address the causes of antimicrobial resistance. The declaration resulted from the meeting also requires countries to come up with a two-year plan to curb the use of antibiotics in humans, animals and agriculture.

The pressure is on India, the world’s largest consumer of antibiotics and where carelessness in antibiotic use and environmental antibiotic pollution has been documented.

While the government drafted policy measures to tackle the problem, it has not been so forthcoming on the issue.

In 2010, when the Lancet published a study identifying an enzyme that rendered bacteria resistant to broad spectrum of antibiotics as New Delhi Metallo-beta-lactamase-1, it raised the hackles of the Indian government. The authors had said that they detected the bacteria in patients from the United Kingdom who had been to India and Pakistan for treatments. The health ministry described the report as “malicious propaganda” at the time.

The following year, though, the health ministry released a policy document, the National Policy for Containment of Antimicrobial Resistance. However, little was done to implement the policy.

In August 2012, all major medical societies of India got together in Chennai to formulate a roadmap to tackle the challenge of drug resistance in India. The stakeholders, including policy makers, adopted a document called Chennai Declaration.

Just a year before the Chennai Declaration was formulated, the medical community and other organisations were dragging their heels on antimicrobial resistance, said Dr Abdul Ghafur, who co-ordinated the historic Chennai meeting. “It was a topic of stigma for everyone,” he said. “But for me, and other clinicians, management of patients was becoming very difficult. I am an infection expert in a cancer centre. I see people die everyday because of drug resistance. They are the worst hit in this crisis.”

At the time, no politician or pharmaceutical company came forward to support the cause.

In the past few years, the government has taken some steps to tackle the problem. In February this year, Union Health Minister JP Nadda launched a multimedia campaign called “Medicines with the Red Line” to raise awareness on the rational use of medicines which carry a red line on their strip. This was the first mass campaign by the government that acknowledged the public health crisis and attempted to address the issue.

Advisory from the Ministry of Health and Family Welfare.
Advisory from the Ministry of Health and Family Welfare.

While there are some policy level changes, the government is not committing to implementing these policies at the international level.

“We have not made any promises,” said Dr Jagdish Prasad, director-general of health services, referring to the commitment made at the United Nations high-level meeting. “In such a big nation, we cannot promise anything. We have promised surveillance, which we will follow through.”

Hospital surveillance

Prasad was referring to surveillance of hospital acquired infections conducted in 10 hospitals across the country by both the health department and by the Indian Council for Medical Research.

Hospital acquired infections refer to infections that develop as a direct result of healthcare interventions such as medical or surgical treatment or from being in contact with a healthcare setting. Surveillance would include monitoring the infection levels, their impact, and the intervention at various healthcare facilities.

The initial results of the survey are not good, Prasad said. While not disclosing more details, he said that the surveillance showed the presence of several bacteria in hospitals there are resistant to drugs. The health department has released hospital infection control guidelines and standard treatment guidelines, which are available online. They are also holding workshops for doctors from secondary and tertiary level hospitals.



“We will also start an awareness multimedia campaign for the public soon,” said Prasad.

In 2013, the Drugs and the Cosmetics Act has already introduced schedule H1 for third and fourth generation antibiotics for which the chemist has to maintain prescription records for a period of three years, which is open to inspection. There were already some drugs on schedule X that could only be stored in hospitals, and not be sold over the counter.

States not proactive

While the Centre can make policies and educate the states, it is finally up to the state administration to take up the cause. Health is on the state list and the final implementation of any policy is done by the states.

“We have put out guidelines for them,” said Prasad. “But implementation is very messy in this country. The state health secretaries keep changing.”

Whether it is the rational use of antibiotics, restriction of over-the-counter drug dispensation, self medication, or controlling the use of antibiotics to raise animals, the state has to take a stronger stand.

“With respect to state implementation, we see the maximum resistance,” said Ghafur. “If we go to the district level, there will be even amore resistance. We have to communicate with the grass root level people.”

The lack of medical education poses yet another problem. “You can pass a masters in medicine without answering a single question on antibiotics,” said Dr Chand Wattal, senior microbiologist with Sir Ganga Ram Hospital in Delhi. Wattal has conducted research in the area of drug resistance and was also part of the committee that drafted the 2011 policy.

There is some resistance from the unexpected quarters, like pharmacists. In Maharashtra, the pharmacists went on strike several times opposing the stringent implementation of antibiotic regulations, including that of the need for a pharmacist in each chemist shop.

Prasad said that formulating a law can also be completely useless in this respect. “We passed the Clinical Establishment Act in the Centre. Very few states have adopted it,” he said.

Kerala leads the way

The only way forward, Prasad observed, is to “educate, educate and educate.”

Some states though, have taken some initiative.

“Kerala came up with an antibiotic plan this year, Tamil Nadu is thinking of one, Sikkim knows that they have a hospital infection problem that politicians are very well aware of,” said Dr Ramanan Laxminarayan, Director of the Center for Disease Dynamics, Economics & Policy in Washington DC and Distinguished Professor at the Public Health Foundation of India, Delhi. “So we need to think of ways to bring this to the forefront, think of what the options are and act on them.”

Kerala seems ahead of others in this respect and has released a plan in January this year. For a few years now, Ghafur and Dr Sanjeev Singh, the medical superintendent of Amrita Medical Sciences in Kochi, have been lobbying with the government to take this issue seriously. The authorities have taken note.

“We have a five-pronged approach to tackle the problem,” said Singh. “We are training undergraduate, graduates, and postgraduates to understand the rational use of antibiotics and sensitising them about good practice. We are also training eight doctors in each district who in turn will train other doctors. We are also going to educate the patients and tell them that they do not need antibiotics for vomiting and diarrhoea.”

On September 23, 35 medical colleges changed their curriculum to include antibiotic stewardship, a programme that works for rational use of antibiotics.

For any policy against antibiotic resistance to work, there has to be multi-sectoral engagement of various departments including education, sanitation, animal husbandry, agriculture, and health among others. The key to tackling the issue head on is to engage politicians, feels Ghafur.

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The rise of ‘super bugs’ just prompted a UN General Assembly meeting

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While researchers have been hard at work looking for new kinds of medicine to treat pathogens, they have been fighting a losing battle to drug-resistant bacteria. A growing concern in many parts of the world, this drug-resistance problem has been festering due to a lack of joint efforts to combat the threat.

That may be about to change. This issue is so large now that the UN General Assembly will gather in New York to discuss and deliberate a response to the looming crisis of antimicrobial resistance.

Drug resistance has been an issue for a long time.

Even with the introduction of penicillin, bacteria have been adapting to resist the drugs formulated to fight them. However, the fast pace of drug development was able to counter this threat.

Unfortunately, we are now at the bottom of the barrel when we prescribe medicine.

Last year, doctors reported a new strain of bacteria resistant to the last-resort drug colistin. Found in Chinese meat products, a resistance to colistin represents a fear among physicians of even our strongest drug becoming ineffective.

Luckily, this colistin-resistant strain looks like it can be beaten with other drugs. But it is only a matter of time before different resistances meet in one bacterial strain.

This UN meeting may be a signal of the world finally being ready to take this issue seriously.

“The previous discussions have been held at the level of ministers of health and agriculture but this meeting will take this up to the level of prime ministers and presidents,” Keiji Fukuda, special representative of the WHO Director-General for Antimicrobial Resistance, told Scientific American.

While no actual formal declaration or commitment is expected from the meeting, it is a sign of political commitment to the issue, and could possibly trigger more financing.

Teams all around the world are looking at different angles to approach this matter.

Some are looking at boosting antibodies to combat the bacteria. Others see bacteriophages (bacterial parasites) as a good weapon against the bacteria. Still, others are researching probiotics to combat bacteria, or finding a way to starve the invaders.

Regardless of the avenues taken, more attention and cooperation is needed to resist further resistance.


Centres for Disease Control and Prevention

This article was originally published by Futurism. Read the original.


United Nations – International Day of Yoga

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The draft resolution establishing the International Day of Yoga was proposed by India and endorsed by a record 175 member states. The proposal was first introduced by Prime Minister Narendra Modi in his address during the opening of the 69th session of the General Assembly, in which he said: “Yoga is an invaluable gift from our ancient tradition. Yoga embodies unity of mind and body, thought and action … a holistic approach [that] is valuable to our health and our well-being. Yoga is not just about exercise; it is a way to discover the sense of oneness with yourself, the world and the nature.”

The resolution notes “the importance of individuals and populations making healthier choices and following lifestyle patterns that foster good health.” In this regard, the World Health Organization has also urged its member states to help their citizens reduce physical inactivity, which is among the top ten leading causes of death worldwide, and a key risk factor for non-communicable diseases, such as cardiovascular diseases, cancer and diabetes.

But yoga is more than a physical activity. In his statement before the vote on the resolution, the President of the 69th session of the General Assembly, Sam Kutesa emphasized this point: “For centuries, people from all walks of life have practiced yoga, recognizing its unique embodiment of unity between mind and body. Yoga brings thought and action together in harmony.”

In a statement UN Secretary-General Ban Ki-moon also pointed out the global benefits of Yoga: “Yoga is a sport that can contribute to development and peace. Yoga can even help people in emergency situations to find relief from stress.”

In the words of one of its most famous practitioners, the late B. K. S. Iyengar, “Yoga cultivates the ways of maintaining a balanced attitude in day-to-day life and endows skill in the performance of one’s actions.”

Secretary-General Ban Ki-moon’s Message on the 2016 International Day of Yoga

Yoga is an ancient physical, mental and spiritual practice that originated in India and is now practiced in various forms around the world. The word ‘yoga’ derives from Sanskrit and means to join or to unite, symbolizing the union of body and consciousness.

Yoga balances body and soul, physical health and mental well-being. It promotes harmony among people, and between ourselves and the natural world. Recognizing its universal appeal, the United Nations General Assembly proclaimed 21 June as the International Day of Yoga.

This year’s observance of the International Day of Yoga highlights the important role healthy living plays in the realization of the Sustainable Development Goals, adopted last year by all 193 United Nations Member States.

As exercise, yoga has multiple benefits. Physical inactivity is linked with a number of non-communicable diseases, such as cancer, diabetes and cardiovascular diseases, which are among the leading causes of illness and death worldwide. By improving fitness, teaching us how to breathe correctly, and working to diminish stress, yoga can help to cultivate healthier lifestyles.

Practicing yoga can also help raise awareness of our role as consumers of the planet’s resources and as individuals with a duty to respect and live in peace with our neighbours. All these elements are essential to building a sustainable future of dignity and opportunity for all.

On this International Day of Yoga, I urge everyone to embrace healthier choices and lifestyles and to commit to unity with our fellow human beings, regardless of ethnicity, faith, age, gender identity or sexual orientation. Let us celebrate this Day – and every day – as members of one human family sharing one common, precious home.

Disclaimer: All information and images sourced from the official UN website page for Yoga Day (Link)

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Experts want MoH to focus on interoperability

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With a view to ensure that the Indian eHealth initiative is on  par with the international standards, healthcare experts want the government to take pro active measures towards adopting and strengthening its eHealth programme by focusing on the need for setting up standards and interoperability for the same. Experts feel that it is high time for the government to formulate strong set of guidelines for eHealth programme, focused on providing technology driven healthcare services to larger spectrum of patients across the country.

Interestingly, earlier this month, the World Health Organization (WHO) had a joint inter-ministerial policy dialogue on eHealth standardisation and interoperability at its headquarters in Geneva. Wherein, the United Nations (UN) agency for health, and WHO equivocally recognised the strategic role of information and communication technologies (ICTs) and medical devices in support of health systems to achieve universal health coverage in countries.

Rajendra Pratap Gupta , chairman , of Continua Health Alliance -IWG who represented India at this international forum stressed that implementing health data standards to achieve interoperability is fundamental to harnessing the full potential of ICTs and medical devices in support of health systems in countries. He stressed that since India is in its nascent stage of adopting eHealth imitative, it would be imperative and more logical to adopt interoperability at at earlier stage when its easy to adopt, especially since it is already an accepted set of standards globally.

Gupta asserted,“Interoperability is a patient safety issue and any compromise will impact the diagnosis and treatment or both, putting the patients at risk. Today there is an urgent need for full adoption of standards for interoperability at national and sub-national levels. To attain this, it is essential for the government to first understand the key policy issues in eHealth standardisation and interoperability and also expert insights on how to overcome regulatory and administrative barriers in standards adoption.”

He further pointed out that now that the Continua Health Alliance guidelines have been accepted by ITU as the interoperability standard for eHealth globally, it would be the right step if the MOHFW also to accept the same, taking India at par with the global standards on interoperability. “Most importantly, we strongly feel that all medical devices and softwares must address this issue before getting into the solution development. If they fail to do so, and adopt these standards in the later stage of product or solution development, it would mean a lot of work, loss of time and additional investment for redoing the systems again,” Gupta added.

Continua Health Alliance (Continua), an international not-for-profit industry group, is the leading organisation convening global technology industry standards to develop end-to-end, plug-and-play connectivity for personal connected health .

Source: PharmaBiz

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