The silent crisis: 50% of humanity is resistant to antibiotics, who's to blame?

Once hailed as the “magic bullets” of modern medicine, antibiotics transformed the human experience, turning fatal infections into manageable setbacks and making surgery and childbirth safe. Today, that shield is shattering. We are entering the era of antimicrobial resistance (AMR), a silent pandemic where evolving microbes are outpacing our most sophisticated pharmaceutical defences.

The human cost is already staggering: in 2019 alone, bacterial resistance directly claimed 1.27 million lives and played a role in nearly 5 million more deaths globally. If this trajectory remains unchecked, we face a projected 39 million additional deaths over the next 25 years. While the notion that “half of humanity” is resistant may sound like hyperbole, it reflects a terrifying shift: for millions, common infections are once again becoming death sentences.

According to the WHO’s 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS), the median resistance rate for a key antibiotic against E. coli is 42%. In certain regions and for specific pathogens, resistance rates already exceed 50%. This hidden public health emergency threatens to reverse decades of medical progress, from complex surgeries and chemotherapy to routine childbirth.

Global hotspots of AMR: India, China, Sub-Saharan Africa

The burden of AMR is not evenly distributed across the globe. Areas with high population density, fragile healthcare systems, and widespread access to unregulated antibiotics have become epicenters of resistance. India, China and Sub-Saharan Africa are identified as major hotspots.

In India, the scale of the problem is staggering as nearly a million people die annually from drug-resistant infections. Gujarat shows over 90% resistance in typhoid bacteria (Salmonella Typhi) to frontline antibiotics like ceftriaxone and ciprofloxacin.

“Resistance knows no borders or status,” said Dr Tushar Tayal, Consultant of Internal Medicine, CK Birla hospital (Gurugram). “It cripples ICUs in Delhi as much as hospitals in London. From urinary tract infections to tuberculosis, frontline treatments are failing everywhere.”

The country’s battle is compounded by the easy availability of counterfeit or over-the-counter (OTC) antibiotics, which fuels misuse. Patients can obtain these drugs without a prescription, often taking incomplete courses that only allow the most resilient bacteria to survive and multiply.

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How overuse in humans and animals’ fuels resistance

The primary culprit behind AMR is the widespread misuse and overuse of antibiotics. This occurs on two major fronts: human medicine and agriculture. In human medicine, antibiotics are often prescribed inappropriately for viral illnesses like colds and flu, where they have no effect. A lack of proper diagnostics and time-pressed physicians contribute to a culture of over-prescription. In India, for instance, up to 80% of patients with respiratory or diarrheal symptoms receive unnecessary antibiotic prescriptions.

Pharma waste, over-the-counter misuse and polypharmacy in aged-care settings accelerate resistance, Dr Neha Rastogi, Consultant, Infectious Diseases, Fortis Hospital (Gurgaon) said, adding “Even everyday drugs like ibuprofen, when combined with antibiotics can worsen resistance. The chain is complex from prescribers to end users to caretakers. Every link must be aware of the threat.”

The agricultural sector is an even larger driver of the crisis. Antibiotics are routinely used in livestock, aquaculture and even crops, not just to treat disease but as growth promoters and for disease prevention in healthy animals. This creates a fertile breeding ground for resistant bacteria, which then enter the food chain, water systems and the environment. Microbes are highly adaptable and they fight back with potent tools. They can produce enzymes that dismantle antibiotics or transfer resistance genes to other bacteria via mobile DNA segments.

“Resistant bacteria from farms infiltrate our food, water and environment, perpetuating the cycle,” says Dr Tayal.

Which infections are becoming untreatable and where?

The clinical fallout of AMR is profound. Infections once considered minor are now becoming “death sentences,” according to Dr. Tayal. This includes:

*Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB), which reverses decades of progress against the disease.

*Urinary tract infections (UTIs), which are increasingly resistant to first-line drugs like fluoroquinolones.

*Life-threatening bloodstream infections caused by pathogens like Klebsiella pneumoniae and Acinetobacter baumannii, which are becoming resistant to our “last-line” antibiotics, carbapenems.

*Even common infections like gonorrhea and typhoid are now entering the realm of being untreatable.

“In parts of India, Klebsiella pneumoniae is now resistant to meropenem in nearly half of the cases,” said Dr Rastogi, Consultant, Infectious Diseases at Fortis Hospital, Gurgaon. She further said that Acinetobacter baumannii, a leading cause of ventilator-associated pneumonia, shows only 10-15% sensitivity to carbapenems in some regions.

Economic cost of inaction by 2050

The cost of inaction is catastrophic. Estimates from the World Health Organisation (WHO) and the World Bank paint a grim economic picture, estimating that unchecked AMR could claim 10 million lives a year by 2050 and push 28 million more into poverty.

Dr Tayal warns, “Without urgent intervention, in 25 years, we are looking at 39 million deaths directly due to AMR—three lives lost every minute.”

Without intervention, the global economy could lose a staggering $100 trillion by 2050, with a loss of up to 3.8% of global GDP. The cost of healthcare would also skyrocket, with a potential increase of over $1 trillion per year by 2050, largely due to prolonged hospital stays and second-line treatments. These economic impacts would be felt most acutely by low- and middle-income countries. The WHO cautions that routine surgeries like C-sections or hip replacements could soon carry the same risk of fatal infection as in the pre-antibiotic era.

India’s struggle with counterfeit/over-the-counter antibiotic sales

India faces a unique hurdle: widespread ‘over-the-counter’ (OTC) and counterfeit antibiotic access. This informal market bypasses the need for prescriptions and healthcare professionals, allowing for uncontrolled and often incorrect usage. The lack of robust regulatory enforcement means that anyone can buy powerful antibiotics, using them to self-medicate for conditions where they are not needed.

Many die each year untreated due to lack of proper drugs while others accelerate resistance through misuse, Dr Tayal said.

Recognising the gravity of this problem, the Indian government has launched several initiatives under the National Action Plan on Antimicrobial Resistance (2017–2022, now extended). The National Centre for Disease Control (NCDC) functions as the national coordinating body for AMR containment.

Surveillance, policy and solutions

Surveillance is improving, with fewer than half of countries globally participating in the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) system. Stronger data is driving reforms: UN leaders endorsed a declaration in 2024 to cut AMR-linked deaths by 10% by 2030. But both experts agree, it’s not enough and governments must ban non-therapeutic antibiotic use in farming, improve diagnostics, shut down counterfeit sales and promote public awareness.

The NCDC leads the National AMR Surveillance Network (NARS-Net), which now includes over 35 laboratories across the country, systematically collecting and analysing resistance data to inform policy and clinical guidelines.

Last year, the Ministry of Health stressed that India’s AMR strategy is anchored in a “One Health” approach that links human health, animal health and environmental drivers of resistance. Programmes such as the National Programme on AMR Containment (launched in 2012) focus on strengthening infection prevention and control, improving prescription practices, training microbiologists and clinicians and monitoring antimicrobial consumption patterns.

Despite these efforts, ground-level challenges persist. Enforcement of Schedule H1 of the Drugs and Cosmetics Rules which restricts OTC sales of certain antibiotics — remains patchy. Many pharmacies continue to sell critical drugs without prescriptions, undermining stewardship programmes. At the same time, counterfeit or substandard antibiotics in the market not only fail to cure infections but also accelerate the spread of resistance by exposing bacteria to sub-lethal doses.

In short, while India has created a robust surveillance and policy framework against AMR, the gap between regulation and enforcement continues to drive misuse. Unless this leakage is plugged, especially in community-level pharmacies and informal medicine markets, the country’s public health system will remain under siege from drug-resistant pathogens.

Who’s to blame and way forward?

Solving this crisis requires a multi-modal, “One Health” approach that addresses the problem in humans, animals and the environment. “We must treat antibiotics not as endless weapons but as precious finite tools,” said Dr. Tayal.

“The silent crisis of AMR demands our loudest response,” Dr. Tayal said, adding “Antibiotics are finite resources. Without stewardship, even minor infections could again become fatal.”

International and national initiatives are underway. The WHO’s GLASS provides a standardised framework for countries to collect and share data, though fewer than half of nations currently participate fully.

The roots of antibiotic resistance run deep and cut across multiple sectors. Doctors often face pressure from patients demanding quick relief, leading to unnecessary prescriptions, while some patients add to the crisis by self-medicating or discontinuing treatment midway.

In agriculture, the misuse of antibiotics as growth promoters and feed additives continues to fuel resistant strains. Governments, despite policy efforts, struggle with enforcement, and pharmaceutical companies remain reluctant to invest in antibiotic research, given the limited profitability compared to chronic disease drugs.

Yet, global health experts believe the situation is far from hopeless. WHO and UN agencies advocate a comprehensive “One Health” approach that recognises the interconnectedness of human, animal, and environmental health. This means banning non-therapeutic antibiotic use in livestock, strengthening stewardship programmes in hospitals and expanding access to rapid diagnostics so that antibiotics are prescribed only when truly needed.

Dr. Rastogi said “The ‘50% resistant humanity’ claim may not be literally universal, but it reflects a tipping point. For many pathogens, half of the world’s patients already face antibiotics that simply don’t work. The crisis is here and the window to act is closing.”

Equally crucial is enforcing safe disposal of pharmaceutical waste, which often seeps into waterways and spreads resistant bacteria. Looking ahead, innovation will be vital from developing new classes of antibiotics to exploring bacteriophage therapies and preventive vaccines that can reduce dependency on these drugs altogether.