Six years after India developed a National Action Plan (NAP) to combat antimicrobial resistance (AMR), Karnataka has not developed its state action plan that's essential for implementation on the ground.
AMR, a scenario where microbial infections no longer respond to medicines, is expected to cause 10 million deaths annually by 2050, with a large proportion from India. Irrational and unnecessary use of antibiotics is a major reason for bacteria developing resistance to these drugs, but there is little action in the state to prevent this.
A state-level action plan would have measures to restrict the prescription and sale of antibiotics, restricting antibiotic use in animals, surveillance of residual antibiotics in the environment, creating awareness, etc.
As per the global action plan on AMR endorsed by WHO in 2015, India developed its national action plan (NAP) in 2017. As per NAP, each state should have its own action plan for implementation locally, since health is a state subject.
Kerala published its action plan back in 2018 and has been implementing it, while Madhya Pradesh and Delhi published their plans more recently.
In Karnataka, the process started around 2018 but the draft plan is yet to be finalised. Officials at the state health department say that the process got stalled during Covid.
According to a department official, the draft is likely to be finalised in another three months. However, implementation will depend on whether the government will allocate funds in this year’s budget.
As per the draft plan, coordination will be required between various departments, including animal husbandry, agriculture and drugs control, along with hospitals and pharmacists. "This is a long-term process requiring systemic change. Awareness and capacity building will have to be done at different levels," says the official.
Currently some hospitals in the state are following their own protocols for AMR, since that's a requirement for accreditation purposes. But the state health department has no data on this.
Molecular biologist Dr Varsha Sridhar, who has been tracking antibiotic resistance in Bengaluru, says, "Anecdotal evidence indicates that the resistance to common antibiotics like doxycycline and azithromycin has increased because of their widespread use during Covid. But we have no data to start with." Lower efficacy of drugs increases risk, especially for critically ill patients whose disease may progress quickly.
A health department official said, "This is a long-term process requiring systemic change. Awareness and capacity building will have to be done at different levels."