On Sunday, June 30, 2024, Bengaluru city launched the first series of workshops for joint dialogue between scientist-clinicians, policy makers and government officials for antimicrobial resistance (AMR) surveillance strategies and clinical approaches. The workshop, offered to clinicians and practicing physicians across Bengaluru as a Continuing Medical Education-CME, was held under the banner of the Rockefeller Foundation-Alliance for Pathogen Surveillance Innovations-India (RF-APSI-India) at the Smrithi Auditorium, Bangalore Baptist Hospital (BBH). With a full attendance of more than 150 people, the one-day workshop was the first capacity-building and dialog platform in Bengaluru under the RF-APSI-India program, to incorporate molecular diagnostic and wastewater-based epidemiology (WBE) for routine public health surveillance.
For the workshop, the RF-APSI-India’s Bengaluru teams and partners, the TIFR-National Centre for Biological Sciences (NCBS), Tata Institute for Genetics and Society (TIGS), the BBH, outreach partner Superheroes against Superbugs and the Bengaluru Science and Technology (BeST) cluster in collaboration with the World Health Organisation (WHO)-India and the Government of Karnataka (GoK), Health and Family Welfare, came together on a singular platform. The mentors included research scientists at TIGS (Dr. Farah Ishtiaq, Dr. Shivranjani Moharir and Dr. Mansi Malik), clinicians from BBH, Aster-CMI, Bengaluru and Christian Medical College, Vellore as well as the State Surveillance officer, SSO, Dr. Ansar Ahmad, Project Director, Interdisciplinary surveillance program (PD-IDSP) from the Directorate Unit, Health and Family Welfare, GoK.
The RF-APSI-India is a multi-city consortium focused on conducting disease surveillance in India. It is spread across four nodal cities in India (Hyderabad, Delhi, Pune and Bengaluru), and comprises of several academic, research and clinical institutes, including CSIR-Centre for Cellular and Molecular Biology in Hyderabad, CSIR-Institute of Genomics and Integrative Biology in New Delhi; Ashoka University in Sonepat, the Pune Knowledge Cluster, Indian Institute of Science Education and Research and CSIR- National Chemical Laboratory in Pune along with NCBS and TIGS in Bengaluru. Each of these institutions have several other partners across the country. While initial efforts of the consortium were directed towards surveillance of SARS-CoV-2 variants circulating in India during the second wave of COVID infections in 2021, APSI is now developing monitoring and detection systems for robust surveillance of other pathogens of public health concern, through clinical and wastewater-based epidemiology (WBE). These include detection of signatures of AMR in pathogens via genome sequencing, molecular biology tools, bioinformatics, data analytics and disease-trend predictive models integrating data dashboards. With the help of local municipal and public health departments, these data are shared for timely measures to mitigate the disease spread. APSI-India aims to provide guidelines to the public and government stakeholders to mitigate serious public health issues related to AMR in India.
Unregulated usage of antibiotics in healthcare, animal health, aquaculture, food industry and agriculture along with environmental factors such as poor waste management has led to dissemination and increased AMR across diverse habitats. Despite the efforts to solve the long-standing problem of AMR across the country, research on pathogens contributing to AMR and safer prescription policies, gaps still exist in scientific surveillance strategies, clinical application and implementation of policy actions at the public health and government levels. APSI-India, as part of its outreach and community engagement and education efforts has conducted AMR educational and awareness workshops across the country to sensitise the community about the issues and ways in which these gaps can be minimised.
During the workshop, Dr. Rakesh Mishra, Chief Principal Investigator-APSI, and Director, TIGS summarised the pioneering role of APSI-India consortium and the Bengaluru teams ongoing efforts. He said, ‘Since July 2021, APSI-India has been engaged with novel environmental surveillance for disease causing pathogens. In Bengaluru, with the help of local municipality, Bruhat Bengaluru Mahanagra Palike (BBMP), Bangalore Water Supply and Sewage Board (BWSSB) and Biome trust, APSI-India’s team of scientists have been using the WBE as disease monitoring strategies, initially to monitor SARS-CoV-2 positivity and later to monitor pathogens contributing to AMR and several other respiratory diseases. Our ongoing efforts are to develop WBE surveillance protocols, indigenized low-cost and high efficiency kits, and rapid molecular-biology tools for clinical diagnostics. We are connecting with the Public Health authorities at the central government, state and local city governments to hand over our assays for integration into the existing health strategies and action-policies’.
Sharing the various ongoing programmes run by the central government, the state government and the local municipality, Dr. Ansar Ahmad, SSO, PD-IDSP, at the Directorate Unit, Health and Family Welfare, GoK, mentioned about the National Centre for Disease Control surveillance programs, awareness drives for safe and regulated antibiotic prescription/consumption, healthy hygiene practices and policies to minimize prescriptions for antibiotic use.
Dr. Anuj Sharma, National Professional Officer and Team Focal Point for AMR and IPC at WHO Country Office for India, who joined as a panelist, stated that ‘Amidst the rising global AMR trends and WHO’s efforts at global, national and facility levels, it is essential to approach this problem with a One Health approach, covering all relevant sectors. It is essential to foster collaborations amongst scientific, clinical, industrial and government bodies as well as engage and include communities to fight off AMR’.
What ensued during the scientific panel presentations were a series of engaging talks and discussions on wastewater surveillance of pathogens contributing to AMR from diverse sources including open drain samples from Hyderabad and samples collected across the sewage network in Bengaluru, emphasising the strategic sewage-site selections to represent the underlying AMR hotspots and disease-trends. Using genomic sequencing of the pathogens, across various sewage inlets, outlets and drains, the scientists at TIGS elaborated the need for in-depth knowledge of emerging AMR pathogen trends for any policy-based actions and informed-prescription of antibiotics. For example, to minimise AMR pathogen presence in water, a change in water treatment can contribute to reducing the AMR arising from the consumption of water. It is necessary to integrate the AMR pathogen data and predictive models for computing trends and hotspots with the existing health portal and dashboard with the GoK.
To assist the clinicians to prescribe the appropriate antibiotic(s), the TIGS scientists are developing polymerase chain reaction (PCR) based rapid-molecular biology tools which will amplify antimicrobial resistance genes contributing to AMR. PCR will have high-sensitivity and will generate rapid AMR information as compared to long-duration culture-based AMR detection. However, these must be correlated with the periodic genomic sequencing of the wastewater and clinical samples from specific cohorts, e.g. resistance data from hospital care settings should be correlated with molecular biology data generated. Utilizing the novel surveillance strategies, APSI-India consortium along with its partners and collaborators is paving way in trying to fill some of the gaps that exist in tackling and mitigating AMR.
Dr. Carolin Elizabeth George, Head, Community Health Palliative care & Research Division at the BBH, emphasized upon the clinical dilemma which can further increase AMR, such as non-availability of clinical tests, people’s demands for antibiotic consumption for rapid interventions/recovery, ease of availability of antibiotics in pharmacies and the revenue potential, i.e., the profitability of drugs based on consumption and demand. The clinical experts presented issues that they encounter in specialized fields including surgery, ailments in diabetes, urinary tract infections and multi-drug resistance. They discussed targeted approaches to tackle specific antibiotic resistance and the need for enhanced methods for clinical diagnostics. The panel discussions revolved around measures to enrich education about controlled prescription practices, sensitivity testing to administer targeted antibiotics to prevent and control infections, and the ongoing AMR stewardship programs to educate the medical community. In addition, the panel also led detailed clinical case- studies with experts to teach deliberations and careful assessments of antibiotic usage in real-life clinical settings. Involving the local community, the BBH team also launched a short film addressing the easily available antibiotics for human and animal consumption, these were followed by messages from the medical community to exercise caution and reduce unregulated antibiotic prescription and consumption.
In line with the Superheroes against Superbugs team, APSI’s outreach partner for AMR awareness, the BBH team put together a variety of engaging activities including crosswords and picture games.
Moving forward, the RF-APSI-India team at Bengaluru is working towards charting several outreach workshops for capacity-building, training and educational/awareness for public health officials, ground-workers, medical fraternity and continuing the advocacy for implementation of the novel surveillance tools with the public health authorities and policy makers. Under the guidance and mentorship of Prof. LS Shashidhara, Director, NCBS and Co-Principal Investigator, RF-APSI-India, the workshops for outreach programs in Bengaluru will serve as a role model for public health projects.
Representing the RF-APSI’s teams for outreach & public health advocacy in Bengaluru, Dr. Sufia Sadaf, Program Manager, Outreach, Public Health Surveillance at NCBS, is thrilled to witness & share the successful completion of this workshop and gearing up for several skill-enhancement and educational workshops in the pipeline.
APSI-India website
Outreach Lead :
Dr. Carol George,
Head of Community Health ,
Palliative care and Research Division
AND
Dr. Sufia Sadaf,
RF-APSI