Editorial 1 : The challenge of Antimicrobial Resistance (AMR) and how to confront it effectively
Context:
- Currently, Antimicrobial Resistance (AMR) is one of the most concern threats confronting Global Public Health. AMR implies that a pathogen sensitive to a certain drug cease to respond to that drug.
- While the more commonly known resistance is Antibacterial (ABR), the larger term AMR encompasses resistance to medicines for treatment of other pathogens too, which cause viral, fungal, and parasitic diseases.
AMR is a threat to global health:
- AMR is a global issue which is not confined by political boundaries but it is a threat to all humanity.
- Animals and plants are also afflicted by diseases caused by pathogens therefore they are vulnerable to AMR. Human beings are also victims of AMR due to the irrational and improper use of drugs.
- Additionally, AMR spreads in humans through their food, water, and from their environment.
A serious concern around the world to fight against AMR:
- Over the last ten years, the prevention, control, and response to AMR has been a high priority for most national governments, international organisations (such as the WHO, FAO, OIE), healthcare communities, and civil society, etc.
- Global action plan (GAP)of WHO:
- The WHO adopted global action plan (GAP) with the collective effort of its member countries which provides a road map to tackle antimicrobial resistance including antibiotic resistance.
- India’s National Action Plan (NAP) against AMR:
- India’s NAP includes coordinated action by the
- government and non-government sectors;
- a whole of government approach (Health, Animal Husbandry, Fisheries, Agriculture, Dairy, Pharmaceuticals and Biotechnology sectors);
- advocacy;
- awareness-building;
- involvement of the community;
- infection prevention and control;
- National AMR Surveillance Network (NARS Net);
- research and international collaboration.
- India’s NAP includes coordinated action by the
- Along with-it AMR is an important priority in the G20 health agenda under India’s presidency.
- As during the time of Covid-19 phase, as a consequence, most public health programmes, including AMR endeavours, suffered and timelines got extended. Hence, substantial effort is now needed to get back on track.
Need for a concerted, combined effort to check AMR:
- Despite the International ‘One Health’ initiative and India’s own vision of inter-ministerial coordination for AMR prevention and control, the war against AMR is largely construed as the burden of the health sector.
- It is vital that other stakeholders too, especially the sectors overseeing food, drinking water, and environment, shoulder equal ownership, failing which the achievement of India’s AMR objectives will be difficult.
- An area of immense concern is the apparently unregulated access to antibiotics for the animal husbandry, dairying, and poultry sectors.
- While there is rightly conscious and concerned about the sales of antibiotics without prescription to humans (and much more action is desirable in this regard) on the other hand regulating antibiotics sales for non-human consumption generally escapes our notice
- Prompt and effective action in this area is warranted. This should include not only regulated access, but also no over- or under-use of drugs for non-human consumption.
- Another important aspect that needs to be recognise and address is the role of the environment in the spread of AMR.
- Untreated wastewater and effluents, including such releases from antibiotics manufacturing units and healthcare facilities, can contaminate our environment, facilitating the propagation of AMR.
- Effective sanitation, sewage, and waste treatment infrastructure is required to keep the environment safe and prevent AMR contamination and transmission.
Role of state governments and local bodies in India’s AMR agenda:
- AMR containment measures including hospital infection and control, regulation of pharmacies/ pharmacists, treatment of sewage and pharmaceutical effluents, adoption of standard treatment protocols, AMR surveillance etc., are largely implemented by the state governments.
- Hence, efforts against AMR cannot be successful without the active and enthusiastic involvement of the states. This realisation must quickly resonate across the country.
Why there is need for urgent action against AMR
- AMR puts a huge economic burden on both individual families and society.
- Long periods of morbidity due to non-responsive medicines,
- increased mortality due to AMR,
- massive loss of productive man-days of work,
- wasteful expenditure on medicines which do not work,
- maintaining large ill populations, etc. put an enormous burden on national resources.
- This can be prevented by effectively neutralising the threat of AMR. Hence, investments in the AMR programme is not only a health necessity, it is also good economics.
Steps need to be taken to fight against AMR: The following steps can be taken in collective way in order to fight against AMR:
- First, prescription is prevention:
- Disease prevention and wellness are key to public health and thus preventing infections whenever and wherever possible is equivalent to averting resistance.
- We need to spearhead sanitation drives, ensure a clean water supply and support hospital-driven infection-control programmes.
- We need to spearhead sanitation drives, ensure a clean water supply and support hospital-driven infection-control programmes.
- Making effective us of India’s digital technology:
- India has achieved huge success in the application of digital technology.
- Leveraging such applications, especially conceived for the AMR programme, will yield good dividends. This can also add value to India’s contribution in the G20 collaboration.
- Applications can be for monitoring the use of antibiotics, prescription audits, movement of antibiotics from the production source to the ultimate user, for surveillance of incidence and prevalence of AMR including state-wise or interspatial variations, etc.
- Rational use of available antibiotics: Reducing AMR also requires prescribing antimicrobials judiciously and only when they are absolutely needed
- Coordination across the animal industry and environmental sectors to prevent the unnecessary use of antibiotics in farms; this nurtures drug-resistant organisms in our food supply
- More comprehensive vaccination programme: Vaccines are also a powerful tool to prevent infections and have the potential to curb the spread of AMR infections.
- However, immunisation programmes are not comprehensive and exhaustive yet for many infectious diseases.
- Robust surveillance system
- Closely connected with prevention is the development of robust surveillance systems that allow us to detect resistant pathogens of all kinds in the environment and hospitals that would eventually allow containment.
- Discovery and commercialisation of new antibiotics:
- Parallel efforts on a war footing are needed for the discovery and commercialisation of new antibiotics and new antimicrobials. Such efforts must be incentivised.
- This is an area where international cooperation will fetch high returns, and is an obvious candidate for both bilateral and multilateral agenda.
- Using the social media in effective way to aware the people about AMR:
- The social media has great influence over people’s mind and behaviour. Therefore, these platforms can be leveraged to spread the message of AMR.
- The objectives should be to inculcate community realisation for rational and correct use of antimicrobials. As without community participation, public health programmes may not succeed.
Editorial 2 : Internationalisation of rupee: Why and what are the benefits?
Recent Context:
- Recently, India is aiming to make the rupee a global currency.
- In order to internationalisation of the rupee, the Reserve Bank of India’s (RBI) inter-departmental group (IDG) said that India remaining one of the fastest-growing countries and showing remarkable resilience in the face of major headwinds and the rupee has the potential to become an internationalised currency.
- And These recommendations are significant, in light of the economic sanctions imposed by the US on Russia for invading Ukraine and the growing clamour for finding an alternative to the US dollar for international transactions.
What does internationalisation of the rupee mean?
- Internationalisation is a process that involves increasing the use of the rupee in cross-border transactions.
- It involves promoting the rupee for import and export trade and then other current account transactions, followed by its use in capital account transactions. These are transactions between residents in India and non-residents.
- The internationalisation of the currency, which is closely interlinked with the nation’s economic progress, requires further opening up of the currency settlement and a strong swap and forex market.
- More importantly, it will require full convertibility of the currency on the capital account and cross-border transfer of funds without any restrictions. But currently. India has allowed only full convertibility on the current account as of now.
- Currently, the US dollar, the Euro, the Japanese yen and the pound sterling are the leading reserve currencies in the world. China’s efforts to make its currency renminbi has met with only limited success so far.
The relevance of internalisation of Rupee:
- Currently, the US dollar is said to enjoy an ‘Exorbitant Privilege’, which refers to the innumerable benefits that accrue to the US on account of all other countries of the world are using US dollar as their currency in most of their international transactions, among global currencies.
- The dollar’s position is supported by a range of factors, including the
- size of the US economy,
- the reach of its trade and financial networks,
- the depth and liquidity of US financial markets, and
- a history of macroeconomic stability and currency convertibility.
- Dollar dominance has also benefited from the lack of viable alternatives.
- According to the RBI’s working group, the obvious challenger to the US dollar dominance is the Chinese Renminbi.
- However, its ability to rival the US dollar will depend on future policies in both the US and China and the ability of the Chinese economy and its financial system to demonstrate the same long-term resilience, integrity, transparency, openness and stability, which are characteristics of the US economy.
- In the wake of the sanctions imposed on the Russian government, its public sector and even individuals linked to the government, many countries have become cautious of the price they may have to pay if they are subjected to similar sanctions by the Western government
- They are making effort to reduce their reliance on the US dollar and its financial markets as well as their dependence on dominant international payment mechanisms based on the Society for Worldwide Interbank Financial Telecommunications (SWIFT) messaging system.
- Even the Asian crisis of 1997-1998 underscored the necessity of emerging market economies having strong foreign exchange reserves to manage external shocks, in an increasingly polarised world, it no longer seems a sufficient defence against the threat of economic sanctions.
Advantages of internationalisation of the rupee
- The RBI-appointed group feels that it is imperative for India to continue exploring alternatives to both the USD and the Euro.
- The use of the rupee in cross-border transactions mitigates currency risk for Indian businesses.
- Therefore, Protection from currency volatility not only reduces the cost of doing business but also enables better growth of business, improving the chances for Indian businesses to grow globally.
- While reserves help manage exchange rate volatility and project external stability, they impose a cost on the economy.
- Internationalisation of the rupee reduces the need for holding foreign exchange reserves. Reducing dependence on foreign currency will make India less vulnerable to external shocks.
- As the use of the rupee becomes significant, the bargaining power of Indian businesses would improve, adding weight to the Indian economy and enhancing India’s global stature and respect.
The major recommendation made by the working group for internalisation of rupee: (Way forward)
- The working group, headed by RBI Executive Director Radha Shyam Ratho, has recommended a slew of short to long term measures to accelerate the pace of internationalisation of the rupee.
- For the short term, the group has suggested
- adoption of a standardised approach for examining the proposals on bilateral and multilateral trade arrangements for invoicing, settlement and payment in the rupee and local currencies,
- encouraging the opening of the rupee accounts for non-residents both in India and outside India and integrating Indian payment systems with other countries for cross-border transactions.
- Strengthening the financial market by fostering a global 24×5 rupee market and recalibration of the FPI (foreign portfolio investor) regime.
- Over the next two to five years, the group has recommended a review of taxes on masala (rupee-denominated bonds issued outside India by Indian entities) bonds, international use of Real Time Gross Settlement (RTGS) for cross-border trade transactions and inclusion of Indian Government Bonds in global bond indices.
- For the long term, the group has recommended that efforts should be made for the
- inclusion of the rupee in IMF’s (International Monetary Fund) SDR (special drawing rights).
- The SDR is an international reserve asset created by the IMF to supplement the official reserves of its member countries. The value of the SDR is based on a basket of five currencies ; the U.S. dollar, the euro, the Chinese renminbi, the Japanese yen, and the British pound sterling.
- The SDR is an international reserve asset created by the IMF to supplement the official reserves of its member countries. The value of the SDR is based on a basket of five currencies ; the U.S. dollar, the euro, the Chinese renminbi, the Japanese yen, and the British pound sterling.
- inclusion of the rupee in IMF’s (International Monetary Fund) SDR (special drawing rights).
Conclusion:
- Therefore, Internationalisation of Indian rupee will help in mitigates currency risk for Indian businessmen and will also provide protection from currency volatility which will not only reduces the cost of doing business but also enables better growth of business, improving the chances for Indian businesses to grow globally.
- However, there is need for delicate balance to trade off rupee convertibility for exchange rate stability.