Antimicrobial resistance on account of inappropriate use of antibiotics is a public health challenge in India. Last month, to address this challenge, the Centre banned the manufacture, sale and distribution of colistin, an antibiotic, for food producing animals including poultry. Dr Abdul Ghafur, an infectious disease expert and technical advisory member of the National Antibiotic Policy, talks to Pushpa Narayan about the ban
Why do you think the health ministry banned colistin and its formulations in animal and aqua farms?
Colistin is a last resort drug for several multi-drug resistant infections. The increasing rate of colistin resistance is a serious challenge in clinical practice and it has major public-health implications. One of the main reasons for resistance to this precious drug is extensive use of colistin as growth factors on animal and aqua farms. In 2017, China, one of largest manufacturers, banned the use of colistin for any food producing animals or fish. But it continued to export colistin and its formulation to animal farms in other countries. Those products were available at low cost in India. Soon, almost 95% of colistin and its formulations used by Indian farmers were imported from China. We had to lobby for the ban and I am glad the ministry agreed and notified the ban on July 19.
Why were you so keen on pushing this ban?
In 2015, a Lancet study showed how extensive use of the antibiotic in animals and fish showed the presence of drug resistant colistin strains in their guts. In 2018, a group of scientists, including me, tested samples of chicken, fish, meat and vegetables from Chennai’s supermarkets. Results showed the presence of colistin resistant strains in half of the raw food samples. Yes, cooking food may kill the bacteria, but storage and handling of the food products can contaminate kitchens and can pass on the strains to people. This could make them helpless when they need the colistin antibiotic to save their lives. Worse, if this strain mixes with the existing drug resistant human strain, we could have a superbug. So, all public health experts were keen on pushing the ban.
You are the technical advisory member of the National Antibiotic Policy. Did that help you get the notification through?
The government was studying the use of colistin and its effect. Our study provided evidence to the policy. The Drugs Technical Advisory Board recommended the prohibition after a detailed analysis and discussions with the agriculture and health ministries. It was after they were satisfied that it is necessary and expedient in the public interest to prohibit the drug for animal rearing, that the notification was issued. The poultry and drug industries were both resisting the ban. But when we explained to them they agreed.
If implemented successfully do you think the ban will bring down antibiotic resistance?
The ban will certainly not end antibiotic resistance. We already have the resistant strains in the community. But if the ban is implemented well, it will show us the path to success. India banned over-the-counter sale of antibiotics, but it hasn’t been able to implement this successfully. When we target one drug and ban rampant misuse of it in one sector, there is good chance for a long term impact. There are several ministries – commerce, law, agriculture and health – that will be responsible for this.
Why did the technical advisory committee choose colistin when several other high-order antibiotics are under threat of resistance?
Colistin is a last resort drug. So, it was higher on the priority list. Use of several other antibiotics in both humans and animals must be monitored carefully. We don’t need studies all the time to do this. For instance, a registry under the health ministry can collect data on five resistant strains and drugs they are resistant to from NABH-accredited hospitals. Since they all follow standard international protocol, the source of information can be trusted. The data government collects will tell experts and the government what more should be done.
Do you think India is doing enough to prevent antibiotic resistance?
India now takes antibiotic resistance more seriously than it did a decade ago. We have antibiotic stewardship policies and guidelines. But that alone will not be enough. We must control antibiotic resistance in hospitals through stewardship programmes where use of high end antibiotics is monitored. In some hospitals, experts even review prescriptions. But we will not be able to prevent resistance if we don’t have an effective sanitation programme. We must have a national action plan for sanitation and promote good hygiene practice among individuals. A combined effort from government, public and medical community can bring down antibiotic resistance.