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Antimicrobial resistance (AMR) is the phenomenon where microorganisms evolve to withstand the effects of drugs that were previously effective in inhibiting their growth or killing them. It poses one of the most significant threats to global health today, with the World Health Organization estimating that AMR could cause 10 million deaths annually by 2050 if current trends continue (WHO, 2019). This escalating crisis is particularly acute in low- and middle-income countries (LMICs), where the burden of infectious diseases is high and resources to combat these threats are often limited. For instance, in India, in 2019, there were 297,000 deaths attributable to AMR and 1,042,500 deaths associated with AMR (The GRAM Project, University of Oxford).
AMR not only compromises the effectiveness of life-saving antibiotics but also threatens to reverse decades of medical progress. In LMICs, the impact is profound, as the lack of effective diagnostics, treatments and surveillance systems exacerbates the situation. To address AMR effectively in these resource-constrained settings, it is especially crucial to develop and implement strategies that are both accessible and affordable. This requires innovative approaches tailored to the unique challenges LMICs face, including the development of rapid diagnostic tools, integrated surveillance systems and robust infection control practices. Additionally, enhancing awareness, building capacity and ensuring sustainable funding are essential components of a comprehensive strategy to combat AMR.
Affordable and accessible point-of-care (PoC) diagnostic tools are crucial for controlling AMR, as they allow for timely, accurate diagnoses, leading to targeted treatments and reducing unnecessary antibiotic use. Rapid diagnostic tests (RDTs) for vector-borne diseases like SD Bioline Malaria Ag Pf/Pv, which provides results in just 15-20 minutes and tuberculosis diagnostics such as GeneXpert MTB and Truenat MTB, offering over 95% sensitivity and specificity within two hours, are excellent examples of how these tools can improve healthcare outcomes, particularly in LMICs. However, many diagnostic tools remain cost-prohibitive or overly complex, limiting their deployment in resource-limited settings. To bridge this gap, scalable, user-friendly diagnostics must be developed, adaptable to diverse healthcare environments, from local clinics to larger facilities.
Strategic investment in diagnostic technologies is vital to addressing AMR. Prioritizing the development of next-generation diagnostic tools using technologies like CRISPR, digital PCR and nanotechnology-based sensors is essential. Additionally, further investment in Loop-mediated Isothermal Amplification (LAMP), Next-Generation Sequencing (NGS)/Whole Genome Sequencing (WGS) and rapid immunoassays can enhance diagnostic capacity. Innovations in classical Antimicrobial Susceptibility Testing (AST) methods, rapid phenotypic AST and advanced PCR techniques will also contribute to tackling AMR at the point of care, ensuring timely and accurate treatment across different healthcare settings.
This integrated approach of developing cost-effective, scalable diagnostics combined with strategic investments in innovative technologies can significantly reduce diagnostic gaps, leading to better infection control and the effective management of AMR.
The establishment of robust AMR surveillance systems across multiple sectors — human, animal, food and environmental — is essential. For instance, the European Antimicrobial Resistance Surveillance Network (EARS-Net) and ANRESIS provides a model of integrated surveillance by combining data from different countries and sectors to monitor AMR trends comprehensively. In contrast, many LMICs face challenges due to fragmented systems where data collection and analysis lack cohesion. These countries often need standardized and integrated surveillance frameworks to improve data accuracy and response strategies. In India, the integration of AMR surveillance across sectors remains limited, necessitating substantial investment in infrastructure, training and technology to develop a cohesive system that can effectively monitor and address AMR.
Effective infection prevention is crucial in healthcare to reduce healthcare-associated infections (HAIs) and combat AMR. This involves a comprehensive approach, including improving infection control practices, optimizing hygiene and promoting immunization. WHO provides guidelines on measures like proper hygiene, sanitation and the use of personal protective equipment (PPE), which are essential for minimizing infection risks in healthcare settings. However, many LMICs face resource limitations and challenges in implementing these protocols. Addressing gaps in infrastructure, training and infection control resources through structured frameworks like the WHO’s Infection Control Assessment Tool can significantly improve healthcare delivery and patient safety.
Additionally, vaccines play a pivotal role in infection prevention by reducing the occurrence of vaccine-preventable diseases and lowering the need for antibiotic treatments, thus mitigating AMR. Expanding vaccine coverage and accelerating research into vaccines for high-priority pathogens, such as those contributing to AMR, can strengthen overall infection prevention efforts, leading to improved health outcomes and reduced strain on healthcare systems.
To effectively combat AMR, thorough impact assessments and improved data sharing mechanisms are essential. Programs such as the Global Antimicrobial Resistance Surveillance System (GLASS) by WHO illustrate the importance of comprehensive data sharing in monitoring AMR trends. Many LMICs, however, lack structured systems for data collection and sharing, which impedes effective response strategies. Implementing robust data sharing protocols, ensuring data privacy and standardizing data formats can enhance transparency, facilitate informed decision-making and optimize resource use in AMR management.
Increasing awareness and enhancing training for clinicians and the public are vital for effective AMR management. Initiatives like the “Antibiotic Stewardship Programs” in various hospitals aim to educate healthcare professionals about appropriate antimicrobial use. In many LMICs, however, there is a need for more comprehensive training programs and awareness campaigns. Conducting need assessments and improving educational efforts can address these deficiencies, promote better stewardship of antibiotics and foster a more informed approach to AMR management.
The development of diagnostic laboratories and ensuring a continuous supply of consumables are crucial for effective AMR management (GLASS Report, WHO, 2019). For example, the expansion of laboratory capabilities under initiatives like the Global Health Security Agenda (GHSA) provides a model for strengthening lab infrastructure. However, many LMICs face challenges related to inadequate lab capacity and frequent supply disruptions. Addressing these issues requires investment in upgrading lab facilities and establishing reliable supply chains for essential diagnostic materials and optimizing diagnostic networks to enhance efficiency and coverage
(Read more: Revolutionizing TB Diagnosis: The Power of Diagnostic Network Optimization (DNO) – India Health Fund)
Integrating artificial intelligence (AI) and digital technologies into diagnostics and clinical decision support systems is crucial for advancing AMR management because these technologies can enhance the accuracy of diagnostics, streamline data analysis and provide real-time decision support, ultimately leading to better antimicrobial stewardship and more effective monitoring of resistance patterns. Currently, the use of these technologies is limited in LMICs and there is a lack of comprehensive measures to assess their impact on prescribing practices and surveillance. Digital health technologies hold significant potential to improve decision-making and more effectively monitor antimicrobial use. Broadening the implementation of AI and digital tools could enhance decision-making processes, strengthen surveillance and foster more effective AMR stewardship.
Securing sustainable funding is crucial to ensuring the successful implementation of national efforts to combat AMR, as it enables the consistent rollout of interventions, research and policy initiatives. Globally, AMR threatens to undermine public health and healthcare systems, necessitating coordinated action, sufficient resources and long-term investment. Models like the Global Fund demonstrate the importance of multi-year, performance-based financing to achieve health outcomes and support countries in sustaining their national action plans against AMR (Global Fund, 2021). India’s National Action Plan on AMR (NAP-AMR) (2017–2021) is a strategic framework aimed at addressing AMR by focusing on surveillance, infection prevention, antibiotic stewardship and research into new treatments. The NAP-AMR emphasizes the need for a multi-sectoral approach, involving human health, animal health and the environment, to combat the rise of resistant pathogens. However, like many LMICs, India faces challenges in securing adequate resources to support these initiatives. Sustainable funding mechanisms are essential to maintain progress in AMR management and strengthen the capacity of healthcare systems. By leveraging international collaborations and adopting robust resource mobilization strategies, India can ensure the ongoing implementation of AMR efforts and contribute to global health security.
In conclusion, AMR in LMICs is not just a matter of healthcare; it is a global imperative with far-reaching consequences for public health and medical progress. The strategies discussed —ranging from rapid diagnostics and integrated surveillance systems to improving infection control and leveraging digital technologies — highlight the multi-faceted approach required to tackle AMR effectively. In LMICs, where resources are often constrained, these solutions must be tailored to local challenges, ensuring they are both feasible and impactful.
Investing in innovative tools, enhancing data sharing and strengthening healthcare infrastructure are critical steps towards building a robust defense against AMR. By prioritizing affordable, scalable solutions and fostering international collaboration, we can make significant strides in controlling AMR and safeguarding the efficacy of antibiotics. The fight against AMR is a shared responsibility and through concerted efforts and strategic investments, we can mitigate its impact and protect future generations from its devastating effects. Combating AMR effectively calls for a clear path of collective action, innovative approaches and sustained commitment from all stakeholders.
Dr. Kayzad Soli Nilgiriwala is a microbiologist with expertise in tuberculosis (TB) and SARS-CoV-2 genomics. He has contributed to major genomics projects, including sequencing over 7,000 clinical TB isolates and pioneering point-of-care TB sequencing. His work and research interests also span SARS-CoV-2 genomic surveillance, antimicrobial resistance (AMR) monitoring through wastewater and AI-driven pandemic preparedness. Dr. Nilgiriwala has held key roles at the Foundation for Medical Research and India Health Fund, where he focused on advancing TB genomics and diagnostics, as well as developing strategies for AMR diagnostic tools.
India Health Fund is registered as Confluence for Health Action and Transformation Foundation (CHATF), a Section 8
charitable company incorporated in India, supported by the Tata Trusts.
