The Looming Threat of Antimicrobial Resistance: A Call to Action

We very often read articles or hear news about “Doomsday Theory”. We usually pretend that doomsday would be happening due to World War, Pandemic or any other crisis which would be like a last straw event, but we usually tend to ignore small events or act by counting them as trivial things or procrastinating it as farfetched scientific theory which would never happen and even if it happens, it would be dealt by government or intergovernmental bodies. One such theory that demands our attention is Antimicrobial Resistance (AMR). So, what exactly is AMR?

About Antimicrobial Resistance

According to World Health Organization, Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

AMR is part of the evolutionary process, whenever we take medication for any issue, we are effectively providing reinforcement to our body cells to fight the bacteria, virus or pathogen. When we provide the same reinforcement frequently or even when it’s not required we end up accelerating the evolutionary process of the bacteria, virus or pathogen, due to which they become resistant to the those medication.

Knowing the facts, should we not take medication for fever or any other medical issue?

The clear answer is NO. Firstly, we should not self-medicate or overuse the dosage prescription given by medical professional. 

Due to adoption of hygiene hypothesis and also the COVID pandemic, we have tend to become over cautious, even for common fever including pain, constipation etc. we are self-medicating and rushing to over-the-counter medicines without addressing the under lying issues. For example, antibiotics are ineffective for viral illness but still we take antibiotics like azithromycin even when it won’t help.

Secondly, AMR is also accelerated when we don’t complete the prescribed dosage. Most of the medical professionals prescribes Fixed Drug Combinations (FDC) when they administer the drug dosage. These FDCs are meant for treatment of either single ailment or multiple comorbid conditions. Doctors always recommends to complete the dosage but we being ignorant don’t follow these guidelines, effect of which is that the remaining bacteria, viruses, or pathogens may not get fully eradicated. Incomplete treatment courses creates a survival advantage for the microbes, allowing them to adapt and develop resistance to the prescribed medications. 

Are only patients and common man responsible for AMR?

The clear answer is NO. The Government too is responsible. The waste water many times is released directly into water bodies, it’s the duty of government to put rules, regulation and infrastructure in place so that the waste water is properly treated.

According to a report titled Bracing for Superbugs by United Nations Environment Programme, it states that, ‘Antimicrobial agents are widely used in human medicine, aquaculture, livestock and crop production, and are also put into the feed and water of food animals. They are excreted in significant quantities into the environment as active molecules, or partially degraded, from various sources. The concentration of antimicrobials excreted unmetabolized in the faeces and urine of humans and animals is highly variable and is dependent upon the antimicrobial drug class, formulation, the route of administration, animal species and health status. Where provision of wastewater treatment is not adequate, close contact with polluted waters can result in a consumption-excretion cycle (WEF 2021). The consumption-excretion cycle occurs when containment, controls or barriers for these pollutants are lacking, such as pit latrines without confining barriers, or when inadequately treated or untreated wastewater is used to irrigate farmland, or animal manure or human waste is used to fertilize crops. This results in functional antimicrobials entering the environment unless waste management measures to address AMR development and spread are applied. Such releases transmit antimicrobial resistant microorganisms and ARGs, which can conditionally promote AMR, into the environment.’ So it’s the duty of government to have Sewage treatment Plant with proper capacity.

Secondly, having rules and regulation for over-the-counter medication also falls under responsibility of Government.

Thirdly, Climate change is also one of the driving factor behind AMR, according to National Institute of Health, Candida Auris is the first drug resistant fungal infection which is considered as consequence of Climate Change. Though talking climate change is not just government’s responsibility but lack of policy framework is.

Is there ray of hope?

Solutions exist at both national and international levels:

Solutions at national level:

1. Awareness programmes- Citizens should be made aware of this crisis which we would be facing.
2.  Policy formulation and data collection by government to understand the magnitude of the issue.
3. Scientific studies funded by government and private bodies.
4. One health approach, rather than compartmental approach or silo approach various department and ministries such Agriculture, Health, Fisheries, Scientific institution etc. should come together to address issues like AMR.

Solutions at international level:

1. Institutions like WHO are currently working on this, they published a report Global antimicrobial resistance and use surveillance system (‎GLASS)‎, they have studied more than 127 countries and created a database to study this crisis.
2. International awareness: Medical journal like lancet have series of report on AMR and allied issues, these are helping not just citizens but medical professionals also, by providing them latest information and case studies.
3. Funding the Low Income Countries, climate change is something which knows no boundary. Events like Conference of Parties under UNFCCC serves as a platform to not just discussion but to also mobilize fund for the cause.

In conclusion, raising awareness and implementing proactive measures at both national and international levels are imperative to combat the looming threat of Antimicrobial Resistance. It's a shared responsibility that demands collective action for a healthier and sustainable future.

Beyond Boundaries: Torts and Environmental Rights in India's Legal Landscape

A tort is an act or omission that constitutes a civil wrong for which a court can hold someone accountable that results in injury to another person. The word "injury" denotes any harm whatever illegally caused to any person, in body, mind, reputation or property.

The main objective of torts is to hold accountable to those persons who are liable for causing harm or injury and make them compensate for their act. The compensation can be anything like monetary compensation, injunction or restitute.

Torts are usually meant to protect private rights of individuals and provide relief to injury caused by violation of these private rights. The very next question which arises is, what is a private right? The private rights are the rights which are not conferred by the government i.e. these are the rights which we naturally inherent as a human, the objective of torts is to compensate the victim rather than punishing the wrongdoer, unlike the statutory laws which are meant not just to compensate the victim but also punish the wrong doer and set an precedent to discourage others from committing the same offense. Torts are usually uncodified principles evolved out of judicial precedents, these precedents are applied as per the case facts and applicability of the tort.

Applicability of Torts in Environmental issues

As mentioned earlier, torts aim to offer redress for the infringement of private rights. However, when discussing environmental issues, even if a court case revolves around the violation of individual rights, the scale of the problem is significant enough that it impacts everyone in the vicinity or even the population at large, so it is not just infringement of private rights but also violation of public rights.

Though torts deal violation of private rights, Environmental issues can be taken up under torts like Nuisance, Negligence, Trespass, Strict Liability, Constitutional Tort etc.

1. Nuisance can be divided into two parts, Private Nuisance:  A private nuisance is an activity or condition that interferes with the use and enjoyment of privately owned lands, without an actual invasion of the property. Public Nuisance: Public nuisance is causing harm to the morals, safety, or health of the community, is deemed an offense against the state. Examples of such activities include blocking a public road, contaminating air and water, running a house of prostitution, and storing explosives, all of which are considered public nuisances.

   When we talk about nuisance in environmental context we are usually talking about Public nuisance.

2. Negligence: Negligence may be defined as breach of duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would, do or doing something which a Prudent reasonable man would not do, actionable negligence consists in the neglect of the use of ordinary care or observing ordinary care and skill toward a person to whom the defendant owes a duty of observing ordinary care and skill.

   In the context of environmental issues, a company may be held negligent if its activities result in environmental damage or harm to individuals. This may include cases of soil contamination, water pollution, or other environmental harm.

3. Trespass: In torts, trespass to land means interference with another person's right to peaceful enjoyment of their property. A tort is a civil wrong that causes harm or loss to an individual, and trespass to land specifically addresses actions that involve unauthorized entry onto another person's land or property

4. Strict Liability: Strict liability is the principle according to which the individual is held liable for his action irrespective of his intent. In other words, under strict liability principle the plaintiff doesn’t need to prove whether the defendant had a wrong intent or his act was caused due to negligence, the defendant should compensate duly for his act.

5. Constitutional torts: The core of constitutional tort lawsuits is the infringement of rights, which are typically derived from the Bill of Rights or other constitutional clauses that shield people from excessive or improper use of government power. The idea is especially important in legal systems where people can file lawsuits against the government for violating their constitutional rights.

Environmental Cases in India which used principle of torts to deliver justice

In India time and again Courts had used torts principles to deliver justice which not just provided compensation to the victim but also protected environment and enforced certain principle like ‘Polluter must pay’ or ‘Right to clean environment’. The right to clean environment falls under Article 21 of Indian Constitution

Examples of environmental case laws in India which used torts principle-

1.  Endosulfan Case : Kerala Government until 2011 used to spray Endosulfan pesticide in cashew, cotton, tea, paddy, fruits plantation to protect it from pest, but the ill effect of this pesticide spray was the population that lived here suffered various serious medical issues. When the matter reached to Supreme Court of India, the court held that State of Kerala was liable for the plight of the affected people and ordered the government to pay monetary compensation to the affected population. Here court applied the various principles of torts like Negligence, Strict liability and constitutional torts.

2. M.C. Mehta v. Union of India: M.C. Mehta v. Union of India refers to series of environmental cases brought to Supreme Court by Public interest litigation. In these series of cases the doctrine of absolute liability and polluter must pay evolved in Indian context. In one of the judgment the then Chief Justice P.N. Bhagwati said that, “The measure of compensation in such cases must be correlated to the magnitude and capacity of the enterprise because such compensation must have deterrent effect.”

   Also in these series of cases court not just awarded compensation to the victims of the cases but also extend the purview of Article 21 of Indian constitution by incorporating Right to clean environment under Article 21. So in the future cases the plaintiff can not only demand for compensation but also demand justice under constitutional torts. 

3. Vellore citizens’ welfare forum v. Union of India: The case facts were, in State of Tamil Nadu many tanneries and industries were operating which were releasing untreated water in water bodies, due to which the drinking water of the city was getting polluted and the agricultural land was also getting degraded due to underground water pollution leaving the land unfit for agricultural purposes. Industries were contending that the safe limits standard given for untreated water disposal by the State Pollution Control Board were unjustifiable.

   Here the Supreme Court gave decision in favour of plaintiff and also applied the principle of strict or absolute liability but court also directed the state pollution control borad and state government to have “Precautionary Principles” in place to not let such incident happen again. The Precautionary principle can be align with a tort principle i.e. Breach of Duty of Care which is a fundamental unit of Negligence. 

4. Ram Bhaj Singh v. Babulal: In this case plaintiff was a practicing doctor and in front of his clinic defendant had built a Stone crushing machine unit due to which the plaintiff suffered noise pollution, air pollution and physical inconvenience. The Court categorized this as a disturbance caused by noise, deemed manageable within the scope of tort law. In various other instances, courts have adopted analogous reasoning when addressing issues concerning dust, fumes, and similar factors.

Conclusion

Finally, the relationship between environmental justice and tort law in India provides a way forward for compensation, responsibility, and the preservation of our natural heritage. These judicial precedents highlight the changing role of the law in shaping a sustainable future in addition to offering compensation for harm. Towards a peaceful cohabitation with our planet, the principles of torts serve as a lighthouse for us to follow as we negotiate the complex web of environmental concerns.