AMR is a concrete threat to our future health

Niclas Jacobson, Deputy Director- General and Head of the Division for EU and International Affairs (Ministry of Health and Social Affairs) discusses the Swedish-Indian partnership in the healthcare sector so far, future collaboration prospects and the need for all countries unite on the AMR issue with Tarannum Rana

Sweden has provided India assistance on multiple healthcare platforms – from providing medical technology to disease eradication. What has been Sweden’s strategy to tap India’s healthcare market?
Our strategy has been to get different collaboration partners in the healthcare sector, and we started on that 10 years ago with an MoU between our respective ministries. Since then, a lot of things have happened. Under this MoU, we have a joint working group which I am co-chairing with my Indian colleague from the Ministry of Health. We meet at least once a year to go through this MoU, to see where is it working, where are the hiccups and how should we develop it further. Recently we have added ageing as an issue for mutual collaboration. Under this MoU, we also have working national authorities like Sweden’s National Board of Public Health Agency or the Medical Products Agency. These authorities have their own MoUs with their Indian counterparts to exchange knowledge and find common ground for collaboration. This is the working method. We also try to involve the private sector in some way. We have different Swedish companies coming in our delegations which can meet their Indian counterparts and find where their products can fit in the Indian Health System. More recently, not only have we tried to develop our partnership in sectors like research, public healthcare sector and private sector, but we have also expanded it more over the country. In February, for instance, our minister went to Jodhpur, Rajasthan, and there we tried to establish a collaboration with AIIMS Jodhpur. It is important for us to know the state of healthcare in India outside tier-one cities.

Of all the 12 areas which were mentioned in the MoU signed by India and Sweden in 2009, which is given top priority by Sweden?
One top priority for the Swedish Healthcare agencies is Anti Microbial Resistance (AMR) – this issue requires urgent attention. Even though India and Sweden come from different realities, AMR is very much a real problem threatening healthcare. Both countries have everything to gain from collaborating (on AMR). We can learn from each other and combat this situation as soon as possible. Coming back to the MoU, all the areas encompassed in it are important but certain parameters have changed over time. Some of the areas which we would like to get restarted are midwifery and women health. Moreover, when this memorandum was signed, India was still a recipient of our development aid, but now the equation has changed- both the countries are more like equal partners now. Though there is no more development aid, Sweden we can impart knowledge and innovation which can bolster India’s healthcare plans.

What does Sweden expect from India in terms of the MoU?
We expect a complete commitment to this collaboration, which I can happily state, we have received from India till now. A collaboration requires the partners to commit on equal footing and participate equally. I see this happening in this (India and Sweden’s) partnership and I hope to see this equation unchanged in the future. When we started-out with development aid, I feared that when these resources dry out, the partnering interest will die out as well, but that didn’t happen. Interestingly, from the last couple of years, the Indian side has increased its participation- India has now more resources, and has become a worthy partner. In fact, lately, I haven’t spoken to anyone who doesn’t want to collaborate with India.

What opportunities do you see for this collaboration to expand? Which areas will it focus on ?
I think that there will soon be a focus shift on technology- Artificial Intelligence being on the forefront. Also, areas like ageing will gain attention. Right now, India is very young in terms of population, but after some years, elderly care will become a poignant point of focus in healthcare which will need different kinds of services than what is largely needed now. We are also looking forward to take this collaboration outside the big cities and focus on towns and villages. India is a large country, both geographically and population-wise, and with it comes its own set of challenges and opportunities. We can work on them together. Data analytics is another area we can work on. Back in Sweden, we work with patient data in a very structured way and we have been able to tackle various medical emergencies in a better way using this data. For example, we recorded stroke cases across hospitals in Sweden, learnt which hospital and which procedure has proved more successful and strategise emergency-care accordingly. That has helped us reduce the mortality rate in stroke cases. Quality data can be used very efficiently and this system can be implemented in India as well.

How is India doing in terms of AMR surveillance? How can Sweden help India in this respect?
I am no expert on how exactly is India faring in terms of AMR, but I do know that India is devoting much attention to this issue – they have developed their own national plan against AMR. Also, Sweden- WHO’s Centre for AMR Surveillance has collaborated with CDSCO in India along with Safdarjung Hospital, New Delhi and with AIIMS, Jodhpur. This collaboration aims to understand the reality of AMR in India, apply lessons that we learned in Sweden to combat this issue and make AMR surveillance in India as effective as possible. In Sweden, we have managed to get from high usage and prescription of antibiotic drugs to very low compared to international standards. We have also been able to spread awareness in our society on AMR not only in the healthcare sector but also in the veterinary sector since this problem is prevalent across all living species. It is important that all affected sectors work towards this. Sweden has acquired significant knowledge on the issue which can help India manage AMR surveillance satisfactorily.

What is ‘Alliance of Champions’?
‘Alliance of Champions’ is a group of countries that, on the initiative of Sweden and United Kingdom, came into being in 2015 with the aim to control AMR, if not eradicate it completely. A country may not necessarily be a part of the Alliance to benefit from its findings/activities. In fact, we would like to spread awareness on AMR as much as is possible. Any country that is committed to AMR surveillance has the Alliance’ support. The same stands for India. We are currently in touch with the Indian government on the possibility of them joining the ‘Alliance of Champions’ as well. The member list includes China, Russia, the US, and we would like for India to join soon.

How can India benefit from joining the ‘Alliance of Champions’?
The nature of collaboration of the ‘Alliance of Champions’ works on mutual commitment. It doesn’t require for a member to donate money or sign any papers. It only requires a moral commitment to work against AMR and pull your country’s attention to this issue. This group meets regularly and also attends the World Health Assembly in Geneva. We were also able to raise the issue AMR during the General Assembly in New York, to much benefit to the cause. If India joins, it will be joining an empowered group that is completely dedicated to the AMR issue. AMR is a concrete threat to our future health and we need to act now.

Alliance of ChampionsAnti-microbial resistanceCDSCOMoUNiclas JacobsonSweden's National Board of Public Health Agency or the Medical Products AgencyTarannum RanaWorld Health Assembly
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