2025-04-02

India is confronting a grave public health emergency—antimicrobial resistance (AMR). With the highest incidence of bacterial infections and widespread, in many cases unregulated, application of antibiotics, the emergence of drug-resistant "superbugs" has become a significant concern. According to the World Health Organization (WHO), AMR is a top global health threat, responsible for 1.27 million deaths worldwide in 2019 and contributing to another 4.95 million deaths. A sharp rise in mortality from bacterial AMR is predicted, with 39 million deaths expected between now and 2050—an average of three deaths per minute.

Unless checked, the world economy could lose as much as $3.4 trillion each year by 2030. In India, the sales of over-the-counter antibiotics, self-medication, and the lack of public awareness have only aggravated the situation. The increasing inefficacy of life-saving medicines for ailments such as pneumonia, urinary tract infections, and even surgical site infections proves that India requires a more extensive, holistic approach to AMR, apart from new antibiotics alone.

Why AMR is a Growing Threat in India

AMR doesn’t just make infections harder to treat—it also puts routine surgeries and life-saving treatments at risk. When antibiotics fail, even minor infections can be fatal. Antibiotics are essential tools in modern medicine, preventing and treating bacterial infections, saving lives, and reducing risks in surgeries, childbirth, and chemotherapy. However, overuse and misuse of antibiotics—such as prescribing them unnecessarily or using the wrong antibiotic—are the main drivers of AMR. According to a study published in 2022 by the Indian Council of Medical Research (ICMR), most patients in India are no longer responding to carbapenems, a potent last-line antibiotic reserved for critical patients. 42% of E. coli infections and 35% of Staphylococcus aureus infections are resistant to third-generation cephalosporins and methicillin, respectively, worldwide, as per WHO reports.

India’s high antibiotic consumption is a big part of the problem, especially with weak regulations allowing over-the-counter sales and poor infection control in healthcare settings. Beyond human health, overuse of antibiotics in livestock and agriculture contributes to resistance. Additionally, pharmaceutical manufacturing has played a role, as the release of antibiotics into the environment from waste products encourages the development of resistant bacteria. The economic consequences are severe—the World Bank estimates that AMR could add $1 trillion in annual healthcare costs by 2050 and cause GDP losses of up to $3.4 trillion per year by 2030. To address these challenges, we need a more holistic strategy that goes beyond just prescribing antibiotics.

What Can Be Done: Better Surveillance, Smarter Use, and More Awareness

A key part of fighting AMR is improving surveillance—tracking where and how resistance is spreading. India should invest in a national AMR database that collects data from hospitals, clinics, and local healthcare providers to detect trends and help policymakers make better decisions. Using advanced technologies like AI can further improve this monitoring process.

Antibiotic stewardship programs are another critical tool. Such programs ensure that antibiotics are prescribed only when absolutely needed, and patients complete their entire course of the drug to avert resistance developing. Hospitals should also emphasize more infection control measures, such as providing sterile surroundings and encouraging hand hygiene, in order to avert infections in the first place.

Public education plays an equally key role. Many individuals are unaware that antibiotics cannot cure viral infections such as the common cold, and stopping antibiotics too early contributes to resistance. Additionally, responsible disposal of unused antibiotics is crucial to minimizing environmental contamination. Adhering to WHO's One Health model—interrelating human, animal, and environmental health—is crucial to confronting AMR on all fronts.

The Role of Responsible Manufacturing in Combating AMR

Pharmaceutical companies also play a significant role in controlling AMR. Responsible manufacturing practices must be followed to ensure antibiotics do not enter the environment through waste discharge. The AMR Industry Alliance has developed a science-based standard known as the Predicted No-Effect Concentration (PNEC), which sets discharge limits for antibiotic manufacturing. A few leading manufacturers have already implemented stringent wastewater treatment processes to comply with these targets.

Looking Ahead

India's battle against AMR must be multi-faceted. In addition to gearing up regulations and enhancing public education, India must invest in sustainable waste management to avert contamination by pharmaceuticals and enhance vaccinations in animal husbandry to minimize the use of antibiotics. Hospitals must implement tighter infection control practices, and policymakers must put their foot down on selling antibiotics over the counter.

International collaboration is also key. The AMR Industry Alliance, which includes over 100 biotech, diagnostics, generics, and research-based pharmaceutical companies, has been instrumental in setting standards for responsible manufacturing and encouraging collaboration between governments and industry.

Through prevention and education, India can truly make headway in the battle against AMR. It's not merely a matter of creating new medicines; it's a matter of creating a system that prevents resistance in the first place. Working together across healthcare, policy, and community, India can decelerate the growth of AMR and create a healthier tomorrow for all.