Certainly, the author agrees that India is one of the developing country in the globe and preparing to achieve the target of 3rd position as an economic power by 2027.Though the political turbulences and blame game back fired our economic growth for decades, now we are at a rate of 6 times than other countries. A million dollars question arise here that are we going on the right direction without providing health safety to its citizens?

Sudden deaths of people around us might raise our eyebrows whereas we continue life, expecting that the death will never reach us.

At this contest, I would like to bring the attention of the political willfulness on improving the living standards of the citizens and their health safety. Recently one of the elected governments ordered to stop selling meat in public or in a designated space for which it was again a problem for some section of political individuals. The reason for such confusion among people is that the government did not try to educate the people about the decisions taken by them. The communication gap between the governance and the citizens might be using some divisive forces to publicize their agenda in terms caste, religion or gender sentiments to provoke a section of people.

Educating the citizens on health safety and its fatal implications are obvious for them to understand the good act of the government.

The following facts will make the citizen alert about their health safety. According to WHO, in 2020, India was ranked in the third position in the world, for cancer affected cases. The rapid rate of the development in financial condition of the citizens especially post-independence made Indian adults in a threat of deadly cardiovascular diseases (CVD). This is mainly due to lifestyle, food habits and zero physical activities. Currently 60% of the death rate among Indian adults is due to CVD. This rate will definitely increase further due to demand in white collar jobs by Indians also their unhealthy lifestyle.

We have enough stringent regulations in food safety, but our bureaucrats never want to implement any regulations due to political chaos. Their blame is always on Poor sanitation habits of our citizens, and overcrowded population etc and claims to be the major hurdles for Health safety and reasons for its further complications In India.

The Center for Science and Environment (CSE) on performing a study in India in 2017 have released an alarming count that considerable amounts of antibiotic residues in poultry and multidrug-resistant bacteria swept in nearby farms. The chicken/meat litter are thrown away in public spaces, water bodies and hence the contamination helps the human to collapse. The similar meat litter-based organic fertilizers are often used in agriculture and hence the same resources also be contaminated.

Samples of litter and soil was collected randomly from a dozen of poultry farms from four main poultry producing states in northern part of India, namely Haryana, Uttar Pradesh, Punjab and Rajasthan reveal that the antibiotics were being used in the meat and the same litter was being utilized as manure in nearby agricultural farms could found 217 isolates of three types of bacteria, namely E.coli, Klebsiella pneumoniae and Staphylococcus lentuswere obtained and examined for resistance against 16 antibiotics. Out of these, ten antibiotics have been professed by the World Health Organization (WHO) as critically important ones.

The study revealed that 100% of the E.coli, 92% of K. pneumoniae, and 78% of S. lentus isolated were found to be multidrug resistant. E. coli and K.

pneumoniae exhibited very high resistance to antibiotics such as penicillins, fluoroquinolones, and third- and fourth generation cephalosporins and carbapenems, which are the last resort antibiotics in hospitals. Summarizing, the study revealed that high degree of resistance to all critically important antibiotics.

The study also found that there is existence of a strong resemblance in the pattern of resistance in E. coli isolated from litter and neighboring farms where litter was utilized as manure. This showed that multidrug-resistant E. coli produced in the poultry were gaining entry into the environment through litter. When Raw food samples were taken from different parts of a metropolitan city, Chennai, out of 110 samples in total, 46.4% of them had colistin resistance organisms. Many more studies if conducted would definitely reveal the emergence of resistant pathogens in other parts of the country.

The high resistance of antibiotics will be a threat for Indians to treat any diseases. It obvious that huge numbers of clinics and hospitals mushrooming due to the poor health conditions of the citizens.

Tuberculosis (TB) in India has also become one of the biggest threats for Indian lives. In 2019, the Ministry of Health and Family Welfare of India reported that 2.15 million new TB cases have been discovered in 2018. The issue of drug-resistant TB began with multidrug-resistant TB and extensive drug-resistant. The most dangerous form of TB now in India is totally drug resistant. A study conducted by Qumar et al. in Hyderabad on Helicobacter pullorum isolates found that free-range and broiler chickens were resistant to different antibiotics such as fluoroquinolones, cephalosporins, sulfonamides, and macrolides. Hence, consumption of animal food containing such resistant bugs would definitely cause a hindrance in the therapy of TB as some of these drugs are second-line drugs in TB therapy.

Besides colistin, it is also important for India to reserve antibiotics such as fourth- and fifth generation cephalosporins, polymyxins, carbapenems, linezolid, tigecycline, and daptomycin, exclusively for human use. Resistance makes conditions such as pneumonia, urinary tract infections, and bloodstream infections difficult to treat. Urgent interventions in the medical settings as well as in public are essential to preserve the usefulness of antibiotics.

Unfortunately, in our country, none of the protocols were strictly implemented because of lack of willfulness to implement stringent regulations, citizen’s ignorance, bureaucratic arrogance and political convenience. Nontherapeutic uses such as prevention of infections or for growth promotion which is one of the chief causes for misuse of antibiotics.

A major drawback is that there is no proper coordination between the human and animal health sectors with respect to collection of data regarding the usage of antimicrobials. In addition, the Food Safety and Standards Authority of India (FSSAI) established under the Food Safety and Standards Act, 2006, mainly looks after food safety and regulations in India. In the year 2017, after the amendment of the regulation, it was anticipated that the tolerance limits of the antimicrobials in food obtained from animals will be clearly stated. This was to ensure that antimicrobial residue in animal food does not affect human health. The amendment laid down the maximum permissible limits of 21 antibiotics and other 77 more drugs used in veterinary for animal food production.

However, it is sad to know that none of the action plans were implemented strictly due to lack of awareness and proper knowledge of this “farm-to-fork” transmission process. In addition, there is lack of routine testing of animal food, which often makes the general population to consume foodstuffs containing antibiotic residues, which is more than the maximum permissible level. Lack of proper data regarding antibiotic usage in food of animal origin due to poor surveillance systems will ultimately lead to failure of appropriate designing and evaluation of interventions. There is lack of proper registries and surveillance systems for properly recording and reporting the usage of antibiotics in farm animals. Hence, there is an urgent need to establish Veterinary Pharmaco vigilance Programme in India to monitor the usage of antimicrobials in animals as various countries have already established it.

Media has also reported that some of the worlds’ largest animal drug companies have been accused of supplying antibiotics to Indian farmers although the practice was banned worldwide by the WHO. They claimed to advertise that “antibiotics will make the animals grow bigger and faster,” thus supplying the antibiotics to Indian farmers, and also reported that antibiotics, when used properly for approved indications and under the supervision of a veterinarian, do not pose a threat to public health. Even, over-the-counter prescriptions is a common practice in India which could be dangerous. It was found that veterinary drug stores in India were selling antibiotics to fatten the animals without a prescription. In addition, Neftin-T which has been in sale in India contains an antibiotic tylosin. This is believed to enhance weight and feed conversion ratio. Tylosin as a growth promoter was banned by the EU in 1998 because of the fear of erythromycin resistance. The WHO classifies erythromycin as critically important as it is commonly used to treat chest infections. Media has also reported cases where few pharmaceutical companies have been found supplying colistin to farmers for making the chickens grow faster without a prescription. Furthermore, in India, at few places, the shopkeepers were found to sell the antibiotics loosely in a polythene bag without any details such as date of manufacture, date of expiry, or cost.

India has been under severe international pressure, with the reason being a drastic increase in the emergence of superbugs. Keeping in mind the current scenario and challenges faced, the FSSAI in the year 2018 decided to fix “tolerance limits” for antibiotic use in animal food such as meat, eggs, sea foods, and milk. Apart from the medical fraternity, proposed regulations involve participation of veterinarians and animal handlers to make sure that the products produced by them are drug free before marketing them for consumption. The FSSAI also highlights the imposition of drug withdrawal period for the animals, or the products treated with antibiotics before they are marketed for human consumption.

Drug withdrawal period ensures that the antibiotic residues are swept away from the animal body, making it fit for human consumption. The new regulation will also involve surprise inspections and sampling at random intervals to ensure that the products do not contain residues of antibiotics beyond the permissible level. The FSSAI also insists on maintaining a manual of the antibiotics and identification of a list of chemicals that are found in animal products as residues. This will help in proper designing of interventions to overcome the challenges faced in the current scenario. There is a need to control the usage of antibiotics in animal food sectors and aquaculture and prevent pollution of environment.

The measures mainly include establishment of nationwide surveillance systems with close monitoring of antibiotic usage; adequate allocation of funds in implementing such measures; educating farmers, veterinarians, and consumers regarding the threat of misuse of antibiotics and subsequent consequences; avoiding nontherapeutic use of antimicrobials in animals; maintenance of proper hygiene and sanitation; prohibition of usage of critically vital antibiotics in animal food sectors; and promotion of usage of alternative growth promoters wherever necessary.

Research & Development department of AIIMS Technology Council

The data mentioned in this writ-up is reported by various organizations as mentioned.