Policies and Interventions to Improve Access to Next-Generation Antimicrobials in Low and Middle-Income Countries (Assess AMR situation in India)
Policies and Interventions to Improve Access to Next-Generation Antimicrobials in Low and Middle-Income Countries (Assess AMR situation in India)
Year: March 2022
Collaborator: Centre for Global Development, Europe
Team: Parshuram Hotkar, Deepak Jena, Mohammad Abdul Rahman, Snigdha Das, Sweety Shreyasi, Sarang Deo
Background
India grapples with high levels of drug-resistant pathogens due to unregulated use of antimicrobials in agriculture, human behaviour, and overuse in homes and hospitals. There is a need to bridge knowledge gaps about AMR, boost innovation and accessibility, and improve stewardship practices.
About the Study
The study aims to propose policies to enhance innovation, increase access, and reduce misuse of high-end antimicrobials for critical pathogens by understanding the AMR situation in India through an assessment of the National Action Plan and the challenges in the antimicrobial market.
Methodology
The methodology used in this study involved several approaches, including the compilation of an antimicrobial surveillance database using data from two sources—the mapping of the Indian surveillance list against the World Health Organization’s (WHO) classification of antimicrobials, and the creation of the Indian Priority Pathogen List (IPPL). The study also involved the creation of a drug pipeline and approval database, which compared the IPPL list with the drugs approved by the Food and Drug Administration (FDA) and the Central Drugs Standard Control Organization (CDSCO) in the same period.
The researchers also reviewed the Nation Action Plan on Antimicrobial Resistance and state action plans and performed systematic literature reviews. Finally, 32 stakeholder interviews were conducted using snowballing techniques to explore viable solutions to reduce the risk of antimicrobial resistance.
Key Recommendations
India's healthcare system struggles with accessibility, affordability, and drug procurement, due to a decentralized regulatory process, causing inefficiencies and delays. To overcome these challenges, we recommend:
Enhancing Access to High-End Antimicrobials:
- Use alternate channels for procurement (state-owned pharmacies, private aggregators, or incentivizing Jan Aushadhi Kendras for low-volume drugs).
- Ensure hospitals follow stewardship practices beyond accreditation programs.
- Improve diagnostic facilities and enhance surveillance of high-end antimicrobials to prevent resistance.
- Modify action plans for Watch and Reserve antimicrobial procurement and include them in state drug procurement lists. Improve inter-state coordination for transparency and efficiency.
- Use AB-PMJAY to introduce essential Watch and Reserve antimicrobials.
Creating an Innovation Ecosystem for Antimicrobial R&D:
- Develop targeted antimicrobial profiles for India.
- Implement changes to facilitate high-end antimicrobial innovation.
- Innovative financing models to boost drug development and reduce out of pocket expenditure.