Antimicrobial Resistance (AMR): An Invisible Pandemic

While the COVID-19 pandemic is still in its acute phase, the extremely dangerous but undetectable antimicrobial resistance (AMR) pandemic is, sadly, here to stay. The clear and present danger of COVID-19 was recognised by the majority of nations in 2020, compelling governments—including India’s—to act quickly and accurately. A multi-sectoral, expedited reaction is also required for the nation and the world’s fast increasing AMR rates.

What is Antimicrobial Resistance (AMR)?

Antimicrobial resistance (AMR) is a natural phenomenon that occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve to become resistant to antimicrobial drugs such as antibiotics, antivirals, antifungals, and antiparasitics that were previously effective in treating infections caused by those microorganisms.

The Threat of Antimicrobial Resistance

Human deaths: In 2019, AMR caused approximately 4.95 million human deaths worldwide, highlighting the urgency of addressing this issue.

Report by OECD: A 2018 report by the Organisation for Economic Co-operation and Development warned that the world could experience a significant rise in resistance to second and third-line antibiotics by 2030.

Resistance increases by 5% to 10% every year: A 2022 study by the Indian Council of Medical Research (ICMR) revealed that resistance to broad-spectrum antimicrobials increases by 5% to 10% every year.

High rate of resistance found in commonly used drugs: The Indian Network for Surveillance of Antimicrobial Resistance (INSAR) also found a high rate of resistance to commonly used drugs such as ciprofloxacin, gentamicin, co-trimoxazole, erythromycin, and clindamycin, underscoring the importance of taking steps to combat AMR.

High levels of resistance: WHO has increasingly expressed concern about the dangerously high levels of antibiotic resistance among patients across countries.

For example: Ciprofloxacin, an antibiotic commonly used to treat urinary tract infections. According to WHO, resistance to ciprofloxacin varied from 8.4% to 92.9% for Escherichia coli (E. coli) and from 4.1% to 79.4% for Klebsiella pneumoniae (a bacteria that can cause life-threatening infections such as pneumonia and intensive care unit- related infections). The global epidemic of TB has been severely impacted by multidrug resistance patients have less than a 60% chance of recovery.

Adds burden to communicable disease: AMR adds to the burden of communicable diseases and strains the health systems of a country, making it even more challenging to address health crises.

What is Muscat conference is about?

Ministerial Conference on AMR: Third Global High-Level Ministerial Conference on Antimicrobial Resistance (November 24-25, 2022) held in Muscat where over 30 countries adopted the Muscat Ministerial Manifesto on AMR.

The conference focused on three health targets:

Reduce the total amount of antimicrobials used in the agri-food system at least by 30-50% by 2030;

Eliminate use in animals and food production of antimicrobials that are medically important for human health;

Ensure that by 2030 at least 60% of overall antibiotic consumption in humans is from the WHO Access group of antibiotics.

Muscat Manifesto:

Need to accelerate One Health action: The manifesto recognised the need to accelerate political commitments in the implementation of One Health action for controlling the spread of AMR.

Need to address the overall impact of AMR: It also recognised the need to address the impact of AMR not only on humans but also on animals, and in areas of environmental health, food security and economic growth and development.

Government efforts so far

The National Action Plan on Antimicrobial Resistance (2017-21): The National Action Plan on AMR emphasised the effectiveness of the government’s initiatives for hand hygiene and sanitation programmes such as Swachh Bharat Abhiyan, Kayakalp and Swachh Swasth Sarvatra.

Increasing community awareness: The government has also attempted to increase community awareness about healthier and better food production practices, especially in the animal food industry.

Specific guidelines regarding use and limiting use of antibiotics: The National Health Policy 2017 also offered specific guidelines regarding use of antibiotics, limiting the use of antibiotics as over-the-counter medications and banning or restricting the use of antibiotics for growth promotion in livestock.

Called for scrutiny of antibiotic prescriptions: It also called for scrutiny of prescriptions to assess antibiotic usage in hospitals and among doctors.

Latest spike in Inflation and RBI’s efforts

Despite three straight months of softening, India’s post-pandemic economic recovery has been hampered by the reappearance of inflation. The Reserve Bank of India adopted an inflation-targeting strategy by hiking interest rates in response to the recent large surge in inflation. Even still, the fight to control inflation is still ongoing, and the most recent data casts doubt on the effectiveness of the RBI’s efforts.

What is Inflation?

Inflation is an increase in the level of prices of the goods and services that households buy. It is measured as the rate of change of those prices.

Typically, prices rise over time, but prices can also fall (a situation called deflation).

Consumer Price Index (CPI)

CPI is used to monitor changes in the cost of living over time.

When the CPI rises, the average Indian family has to spend more on goods and services to maintain the same standard of living.

The economic term used to define such a rising prices of goods and services is Inflation.

Inflation outlook

RBI’s Inflation target: The inflation targeting framework mandates the RBI to achieve a CPI consumer price index inflation target of 4 per cent.

Inflation during the pandemic was still within the target band: During the pandemic period of March 2020 to September 2021, CPI inflation averaged 5.9 per cent. This was higher than the point target of 4 per cent but still within the inflation targeting band of 2-6 per cent.

Inflation outlook has been worsening: In 2022, CPI inflation was above the upper threshold of the RBI’s targeting band for 10 consecutive months, which meant the target was not achieved for three quarters in a row.

Optimism that the Inflation began softening: By December 2022, CPI inflation was down to 5.7 per cent. This led many to believe that the inflation peak had passed, and that inflation was on its way to the official target.

This optimism was misplaced: Underlying inflationary pressures still persist. The softening of inflation in November and December 2022 was largely driven by a steep fall in vegetable prices. Excluding vegetables, CPI inflation was in fact more than 7 per cent.

The misplaced optimism has now become evident: The January 2023 CPI inflation came out to be 6.5 per cent, once again crossing the upper threshold of the RBI’s inflation targeting band.

What contributed to the latest spike in inflation?

Rise in food prices: With food accounting for 46 per cent of the overall CPI basket, a rise in food inflation from roughly 4 per cent in December 2022 to almost 6 per cent in January 2023 has played an important role in overall inflation going up.

Cereal inflation is soaring high: Within food, one component that has proved rather stubborn is cereal inflation. Between May and December 2022, year-on-year cereal inflation nearly doubled from 5 per cent to 14 per cent. In January 2023, this increased to 16 per cent. Within cereals, inflation in wheat has been steadily going up. Between May and December 2022, wheat inflation increased from 9 per cent to 22 per cent. It increased even further to 25 per cent in January 2023.

The steep rise in wheat prices reflects shortages: Data from the Food Corporation of India shows that stocks in government warehouses declined. The government has recently approved a release of three million tonnes in the open market. However, this is insufficient to restore market supplies.

Persistently high core inflation: Second, core (non-food, non-fuel) inflation in January came out to be 6.2 percent. This is consistent with the unyielding core inflation of 6 per cent for nearly three years now. A persistently high core inflation implies that price pressures have become entrenched in the system.

External factors also play a role: Inflation in developed countries continues to be high (6.4 per cent in the US; 8.5 per cent in the EU; 10.5 per cent in the UK). India is importing some of this elevated inflation through international trade in goods and services. Moreover, with China gradually opening up its economy after nearly three years of zero-Covid restrictions, commodity prices are likely to go up, which could exert renewed pressures on India’s inflation.

What have the policymakers been doing to address the inflationary concerns?

The government has done its bit by announcing a conservative Union budget for 2023-24: It has accorded primacy to much needed fiscal consolidation, and has refrained from announcing populist measures that could have arguably fuelled demand, and hence inflation.

The RBI has been doing its job as well: It increased the policy repo rate from a pandemic low of 4 per cent to 6.5 per cent in a span of 10 months. Unlike last year, when despite rising inflation, the monetary policy statements did not contain any forward guidance, the RBI, in its February 2023 statement, emphasised the importance to remain alert on inflation, thereby hinting that the monetary tightening cycle is not over yet.

Startup20 Engagement Group On India’s Proposal

By approving India’s proposal to establish the Startup20 Engagement Group, the G20 has transformed itself into an ambidextrous institution where both large corporations and startups have an equal voice in moving the economies forward. This is the only new group that has been created. In the new architecture, the Startup20 takes on the policy concerns pertaining to the global startup ecosystem, with the essential linkages between the two groups, while the previous B20 Engagement Group continues to focus on corporations.

What is the mean by ambidexterity?

Ambidexterity is the ability to use both hands with equal skill and ease.

In the context of organizations, it is the ability to simultaneously pursue both exploratory and exploitative strategies. This means being able to balance the need for innovation and new opportunities with the need for efficiency and optimization of current operations.

For example, Indian IT services companies like TCS and Infosys are investing in areas like artificial intelligence, blockchain, and the IoT, even as they continue to deliver traditional IT services to their clients.

What is B20 Engagement Group?

Official G20 dialogue forum representing the global business community: The B20 (Business 20) Engagement Group is a forum for international business leaders from the G20 countries.

Established in 2010: It is among the most prominent Engagement Groups in G20, with companies and business organizations as participants.

A single voice for the entire G20 business community: The B20 leads the process of galvanizing global business leaders for their views on issues of global economic and trade governance and speaks in a single voice for the entire G20 business community.

Aim is to provide recommendations: The group’s aim is to provide recommendations to the G20 on issues such as economic growth, trade, investment, digitalization, sustainability, and job creation.

Platform for different stakeholders: The B20 is one of several engagement groups, which also include groups representing civil society, labor, think tanks, and youth, that provide a platform for different stakeholders to share their views and insights with the G20.

B20 Secretariat: Confederation of Indian Industry (CII) has been designated as the Business 20 (B20) Secretariat for the India’s G20 Presidency.

What is Startup20?

Initiated under India’s G20 Presidency: The Startup20 Engagement Group has been initiated under India’s G20 Presidency in 2023.

Aims to support Startups: The group aims to create a global narrative for supporting startups and enabling synergies between startups, corporates, investors, innovation agencies and other key ecosystem stakeholders.

Three taskforces: The engagement group comprises of three taskforces, namely Foundation & Alliance, Finance, and Inclusion & Sustainability, where delegates will come together to discuss efficient policy frameworks to promote scaling up of startups in the G20 nations.

How these taskforces will work?

Foundation and Alliances Taskforce:

Promotes consensus-based ecosystem: The Foundation and Alliances Taskforce will work to harmonize the global Startup ecosystem through consensus-based definitions and promote a global community of knowledge sharing among the Startup ecosystems to explore opportunities.

Help to bridge the knowledge gaps: It will also bridge the knowledge gap between the Startup ecosystems of G20 member countries and emerging economies through partnerships to enable more industry players across G20 nations to work with Startups and concrete solutions.

To create supportive policies and point of contact: It will aim to create supportive policies for industry players and government organizations to work with Startups and provide points of contact for the participating G20 countries sustained collaboration.

The Finance Taskforce:

To provide financing and investment platforms: The finance taskforce will aim to increase access to capital for Startups by providing financing and investment platforms specifically for early-stage Startups to broaden the array of financial instruments available to Startups.

Networking opportunities: It will also create pitching and networking opportunities for Startups with the global investor community.

Best practices for funding ecosystem: It will work to provide a framework built upon best practices for global investors to fund Startups across G20 member nations, helping build suggestive frameworks that could be implemented in emerging ecosystems for building investment capabilities.

Taskforce for Inclusion and Sustainability

Women led startups and community inclusive: For Inclusion and Sustainability, the roadmap involves increasing support for women led Startups and organizations; promotion of Startups working on making communities more inclusive and to promote Startups working on SDGs in areas of global interest.

Encouraging investors to invest in startups built upon sustainable practices: This Task Force aims to enable more investors to invest responsibly in Startups built upon sustainable practices and to encourage mentorship support to the Startup ecosystems of the G20 member countries and emerging economies.

Understanding India’s Mental Healthcare Act, 2017

The Mental Healthcare Act of 2017 is a comprehensive piece of law that guarantees the rights of people with mental illness and promotes those rights. The Act’s primary components include the following:

Decriminalization of suicide: The Act decriminalises suicide and forbids the treatment of persons who attempt suicide with cruel or degrading behaviour.

The Act enables people to give prior directives outlining the kind of care they want to receive in the case of a mental health problem.

The Act requires that patients have the right to grant or withhold consent to treatment and that they are informed of the advantages, drawbacks, and available treatment options.

Informed consent: The Act mandates that patients have the right to give or refuse consent to treatment, and to be informed about the benefits, side effects, and alternatives of the treatment.

Mental health review boards: The Act establishes Mental Health Review Boards at the national and state levels to oversee the implementation of the Act and protect the rights of people with mental illness.

Prohibition of inhuman treatment: The Act prohibits the use of inhuman treatment methods, including chaining, electroconvulsive therapy (ECT) without anaesthesia, and solitary confinement.

Right to access mental healthcare: The Act guarantees the right to access mental healthcare services, and mandates the establishment of mental health services in every district.

Protection of rights and dignity: The Act aims to protect the rights and dignity of people with mental illness, and prohibits discrimination and stigmatization on the basis of mental illness.

Establishment of a Central Mental Health Authority: The Act establishes a Central Mental Health Authority to regulate mental health services in the country.

NHRC flags alert

Pity over healthcare institution: The National Human Rights Commission (NHRC) in a report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country.

Prolonged hospitalization: The report notes that the facilities are “illegally” keeping patients long after their recovery, in what is an “infringement of the human rights of mentally ill patients”.

Need for Assessment: These observations were made after visits to all operational government facilities, to assess the implementation of the Mental Healthcare Act, 2017 (MHA).

Major issue: Lack of implementation

Despite the act’s provisions, mental health institutions in India have been plagued by a lack of adequate infrastructure, staff, and training.

Patients have reported human rights violations, including abuse, neglect, and violence.

Need for effective implementation

The Mental Healthcare Act needs effective implementation and oversight to ensure that patients receive the care and treatment they need with dignity and respect.

This requires increased investment in mental health infrastructure, including facilities, staff, and training.

Way forward

Ensuring proper implementation of the Act: There is a need for proper implementation of this act across the country, with a focus on ensuring the rights and dignity of patients in mental healthcare institutions.

Increasing awareness: Awareness needs to be raised about the Act, and the rights of mental healthcare patients among the general public, healthcare professionals, and law enforcement agencies.

Providing training and capacity building: Healthcare professionals, including doctors, nurses, and caregivers, need to be trained and equipped with the skills and knowledge to provide quality care and support to mental healthcare patients.

Strengthening mental healthcare infrastructure: There is a need to strengthen the infrastructure and facilities in mental healthcare institutions, including better staffing, improved physical facilities, and access to quality medication.

Encouraging community-based care: Community-based care for mental health patients can help reduce the burden on mental healthcare institutions and provide a more supportive environment for patients.