Despite launching several initiatives to address antimicrobial resistance (AMR), inadequate coordination among programmes and sectors resulted in the weak implementation of the activities.

It has been found that activities were not carried out in a systematic manner and multi-sectoral collaboration was weak because of lack of national policy, limited capacity, and complexity of AMR.

National Action Plan on Anti-Microbial Resistance, 2018 – 2022 was launched on November 17 to operationalise and facilitate effective implementation of policies and plans to address AMR effectively through multi-sectoral and multidisciplinary collaboration under One Health approach.

The national action plan will be applicable to all sectors related to human health, animal health, and agriculture practice dealing with antimicrobials.

Agriculture Minister Yeshey Dorji said in Bhutan resistance to critical antibiotics was reported in some of the pathogens that were responsible for a range of life-threatening infections. “For instance, the rise in multi-drug resistant tuberculosis is a big concern for everyone.”

“The impact of AMR goes beyond human health as it impacts on animal health, agriculture, food security and economic development,” Lyonpo said. “The need for an integrated approach to deal with AMR issues at global, regional, and national level through One Health approach is crucial.”

Antimicrobials are drugs that destroy disease-causing microbes (pathogens). Antibiotics are important antimicrobials that treat bacterial infections. AMR occurs when pathogens undergo evolutionary changes that enable them to survive antimicrobials. People and animals that encounter resistant pathogens may then develop untreatable infections.

With the national action plan in place, health ministry and agriculture ministry have identified a focal person to institutionalise the action on AMR. The focal person will act as the national focal point for AMR. The action plan will ensure a designated focal person each for human and animal health to provide technical assistance related to AMR programme.

The Drug Technical Advisory Committee will function as the National Steering Committee because it has representation from all relevant agencies to advise the government on matters related to AMR.

To promote rational use of antimicrobial agents at all levels of healthcare and veterinary settings, the national antibiotic guideline will be reviewed and updated based on the antimicrobial resistance pattern in the country. The resistance pattern will be considered in the development of guidelines and procurement of antibiotics.

According to the action plan, rational use of antimicrobials will be included in the training workshops related to the rational use of drugs and the system of prescription monitoring on antimicrobial use will be strengthened in all the major hospitals in the country.

Under the initiatives of the essential drug programme, antibiotic guidelines were developed in 2007. However, the guidelines were adapted from the international guidelines and did not incorporate the antimicrobial resistance pattern in the country.

The organisms’ resistance pattern to antimicrobials will be monitored regularly to institute surveillance and monitoring system on AMR and antimicrobials use. The report will be shared with the prescribers regularly and presented to the National Medicines Committee meetings.

Health officials said the irrational use of antimicrobials was recognised as one of the main drivers of the emergence of resistance. Mild infections do not need antibiotics and it does not treat viral inspections like colds and flu.

Antibiotic resistance can be reduced by preventing infection through good hygiene, by not sharing antibiotics, and seeking the advice of a qualified healthcare professional before taking antibiotics.

To create and promote awareness on AMR through educational and public campaigns, the national plan will ensure that structured curriculum on AMR is developed and introduced in the curriculum of Khesar Gyalpo University of Medical Sciences of Bhutan. For the in-service professionals, a robust training programme will be initiated while the general public will be educated through regular awareness campaigns.

Adequate provisions in terms of fund and other resources will be made to encourage research on AMR. The findings will be utilised for policy and planning interventions in future. National and international collaboration will also be promoted to harness the expertise and to share knowledge, build capacity and to use data productively.

According to the action plan, regulatory process of ensuring quality, safety and efficacy of antimicrobials in the country will be implemented to strengthen control and regulatory system. Antimicrobial use in animal feeds and other non-therapeutic uses will be restricted.

Agriculture minister said combating AMR should not be as difficult as reported in other countries because Bhutan has a well-regulated system with the institution of Drug Regulatory Authority that is entrusted to regulate the prudent use of antimicrobials in both humans and animals.

Currently, the use of antibiotics is restricted to government hospitals and veterinary centres.

“Sale of antibiotics from the private pharmacies constitutes only a small fraction of antibiotics used in the country and the sale is well regulated,” minister said.

Minister added that the use of antibiotics in the agriculture sector has been kept to a minimum to focus on ensuring the rational use of antibiotics in the hospitals and veterinary centres.

According to a recent report by the World Bank, a high-impact scenario of AMR could cause low-income countries to lose more than five percent of their gross domestic product (GDP) and push up to 28 million people into poverty by 2050.

“Loss of drug-effectiveness because of AMR is increasing in both developing and developed countries. If this trend continues unchecked, the world will confront a reality where many infectious diseases have no cure and no vaccine,” the report states.

Dechen Tshomo