 "How antimicrobial resistance is a silent pandemic")
Antimicrobial resistance (AMR) became one of the most pressing public health threats. India and the world celebrated World Antimicrobial Resistance Awareness Week from November 18 to 24, 2024, under the theme “Educate. Advocate. Act now”. Antimicrobials are drugs—such as antibiotics—that kill or control disease-causing microbes. Antimicrobial resistance occurs when microbes mutate or adapt in ways that enable them to withstand antimicrobials, rendering treatments ineffective. AMR is dramatically accelerated by the overuse and misuse of antimicrobials, including antibiotics, in people and animals.
AMR is the ability of microorganisms like bacteria, viruses, fungi, and parasites to resist the effects of medications that were once effective in treating infections caused by them. This makes infections harder to treat, leading to longer illnesses, increased medical costs, and a higher risk of death.
AMR is caused when antibiotics are used too often or incorrectly, such as taking them without a doctor’s advice or not finishing the full course. Poor hygiene and sanitation in hospitals and homes allowing resistant bacteria to spread easily. The use of antibiotics in farm animals to promote growth or prevent disease also contributes to AMR. Pollution from antibiotic waste in water and soil further helps bacteria develop resistance. Travelling and global trade can spread resistant bacteria quickly across countries. A lack of awareness about how to use antibiotics properly makes the problem worse.
Antimicrobial resistance, often referred to as the “silent pandemic”, is accelerating at an alarming rate, endangering lives, burdening healthcare systems, and imposing significant economic costs worldwide. In recent years, India is becoming a world health tourism hub given its low-cost health care system; the AMR may pose a threat not just to public health but also affect crores of health care businesses.
Impact Shorts
More ShortsGlobally, in 2019, drug-resistant infections were a significant contributor to mortality, with around 5 million people losing their lives due to such infections. Out of these deaths, almost 1.3 million were directly attributable to AMR. The impact of AMR is not limited to human health. In 2017, the World Bank estimated that by 2050, unchecked AMR could wipe away 3.8 per cent of global gross domestic product each year and push 2.8 crore people into poverty.
A recent analysis by the EcoAMR Series projects that if left unaddressed, antibiotic-resistant infections could lead to more than 3.9 crore human deaths between 2025 and 2050 in the world. Losses resulting from the impact of drug resistance on livestock could cost global GDP up to $950 billion, while the spread of resistant pathogens from livestock to humans could cost up to $5.2 trillion due to productivity losses, increased healthcare costs, and reduced agricultural output driven by AMR.
A report by the Indian Council of Medical Research (ICMR) in 2023 highlighted that over 70 per cent of bacterial infections in India are resistant to at least one commonly used antibiotic, making previously treatable diseases such as pneumonia, tuberculosis, and urinary tract infections far more difficult and expensive to manage.
For India, where healthcare expenditures are already high and largely borne out of pocket by individuals, the financial burden of AMR is devastating. A single hospital stay for a drug-resistant infection can cost three to four times more than treatment for a non-resistant infection. For example, treating a drug-resistant bloodstream infection with last-resort antibiotics like colistin can cost over ₹2,00,000 compared to ₹30,000 for a non-resistant infection. These rising costs are pushing hundreds of thousands of families into poverty, exacerbating the existing healthcare inequities in the country.
One of the key drivers of AMR in India is the rampant overuse and misuse of antibiotics. In both rural and urban areas, antibiotics are frequently prescribed for viral infections such as the common cold and flu, against which they are completely ineffective. Self-medication is another widespread problem, with antibiotics often available over-the-counter without a prescription. According to one study published in the Indian Journal of Medical Research, nearly one in every two medical prescriptions issued in India deviates from standard guidelines, some of which may end up developing AMR. Compounding this issue is the lack of adherence to prescribed treatment regimens, which contributes to the development of resistant bacterial strains.
The agricultural sector also plays a significant role in the spread of AMR. Antibiotics are extensively used as growth promoters in livestock and poultry farming, leading to the emergence of resistant bacteria that can be transmitted to humans through the food chain. A survey by the Centre for Science and Environment (CSE) in 2023 found antibiotic residues appeared in a few chicken samples tested in Delhi, highlighting the urgent need for stricter regulations on antibiotic use in agriculture. In addition, untreated pharmaceutical waste from manufacturing plants has been found to contaminate water bodies, further contributing to the spread of resistant bacteria.
Another critical factor exacerbating AMR in India is the lack of robust infection prevention and control (IPC) measures in healthcare settings. Hospital-acquired infections, which are often resistant to multiple antibiotics, are a growing concern. The ICMR’s 2023 report revealed that at least some of the hospital-acquired infections in India are caused by multi-drug-resistant organisms, leading to longer hospital stays, higher treatment costs, and increased mortality. The absence of adequate sanitation, clean water, and hygiene in many healthcare facilities further compounds the problem, making it easier for resistant bacteria to spread.
Addressing the AMR crisis requires a multi-faceted approach. Education is a crucial first step in combating AMR. Public awareness campaigns must be scaled up to inform individuals about the dangers of antibiotic misuse and the importance of completing prescribed courses of treatment. Schools, colleges, and community organisations can play a vital role in spreading this message, particularly in rural areas where awareness levels are often low. Healthcare professionals also need continuous training on antibiotic stewardship to ensure that they prescribe antibiotics judiciously and adhere to infection control protocols.
Advocacy is equally important in driving policy changes that address the root causes of AMR. India’s National Action Plan on AMR (2017-2021) laid out a comprehensive strategy to tackle the issue, but its implementation has been uneven across states. Civil society, healthcare organisations, and the media must work together to advocate for stricter regulations on the sale and use of antibiotics, both in human and veterinary medicine.
Additionally, increased investment in research and development (R&D) of new antibiotics, diagnostics, and vaccines is critical. According to the WHO, the global pipeline for new antibiotics remains insufficient, with only a handful of new drugs approved in recent years.
Immediate action is needed to strengthen infection prevention and control measures in healthcare settings. The government must allocate more resources to improve sanitation, hygiene, and access to clean water, which are essential for preventing infections in the first place. The pharmaceutical industry also has a role to play by adopting responsible antibiotic production, disposal, and marketing practices to minimise environmental contamination and misuse.
The economic and social costs of inaction are simply too high to ignore. AMR not only threatens public health but also undermines the achievement of several Sustainable Development Goals (SDGs), including those related to health (SDG 3), poverty reduction (SDG 1), and economic growth (SDG 8). As India aspires to become a $5 trillion economy, addressing AMR must be a national priority. By educating the public, advocating for robust policies, and taking immediate action, we can slow the spread of AMR and safeguard the health and well-being of future generations.
India, with its scientific expertise, vibrant civil society, and rich tradition of public health innovation, can lead the global fight against antibiotic resistance. The time to act is now—before it’s too late.
The author is Joint Director, Policy Support Research, Indian Council of Agricultural Research. Email ID amarender.reddy@icar.gov.in. Views expressed in the above piece are personal and solely those of the author. They do not necessarily reflect Firstpost’s views.
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