The looming crisis of Antimicrobial Resistance

The World Health Organisation marks November 18 to 24, every year, as World Antimicrobial Awareness Week. As we write this, ministers from across the world are discussing in Jeddah, Saudi Arabia, their commitment to act against antimicrobial resistance (AMR) – a commitment agreed upon in the second ‘Political Declaration on Antimicrobial Resistance’ by 193 member-states of the United Nations in September 2024. AMR – antibiotic resistance in particular – is a serious threat to humanity; at the UN meeting, countries have agreed on collective action until 2030.

Between 2016 (when the first political declaration on AMR was adopted) and today, about 180 nations have introduced national AMR action plans. India too has developed a comprehensive plan, but like many other resource-constrained countries of the Global South, its implementation has been far from successful.

There is global urgency to act because antibiotics are becoming ineffective in treating even common bacterial infections. Those meant to save lives in hospitals and intensive care units are also failing. In 2021, 4.7 million deaths were linked to antibiotic resistance and about 1.15 million were directly caused by it. In India, nearly 0.3 million deaths were attributed to bacterial AMR or antibiotic resistance in 2019 and over a million deaths were associated with it.

Antibiotic resistance is considered deadlier than HIV and malaria together and, perhaps, Covid which has caused nearly seven million deaths since early 2020. Known as a ‘silent’ pandemic, it is estimated to kill 39 million between 2025 and 2050. As bacterial infestation is common in animals and plants grown for food, unchecked antibiotic resistance is also expected to adversely impact food and livestock productivity and livelihoods of farmers, more so in low-and middle-income countries.

The crises can worsen, as the pipeline of new antibiotics is extremely weak. Over the last several decades, most of the big pharmaceutical companies involved in developing new antibiotics have moved away to develop new drugs for cancers as well as metabolic, autoimmune, and neurodegenerative diseases to high revenues and profits. Even if new drugs are developed, antibiotic manufacturers avoid selling them in low- and middle-income countries which can fail to offer enough sales and revenues, making new antibiotics inaccessible to people in such countries.

Antibiotics meant to kill bacteria are becoming ineffective because when they are overused or misused, bacteria can become resistant to their action. More overuse or misuse in human health, animal health, and crop and food-animal production, therefore, means more resistance in bacteria which can become multi-drug resistant or Superbugs and spread further through food, waste, and environment routes.

India produces large quantities of food from crops and animals, making it extremely important to keep checks on antibiotic overuse and misuse and prevent these food-animal and crop sectors from becoming a major source of antibiotic resistance spread through food and waste routes. About 62% of the 850 million poultry population is in the commercial segment which, typically, depends on antibiotics and chemicals to compensate for infection-friendly conditions. India is the biggest milk producer, accounting for over 20% of the global production, and has about 125 million milch animals in cows and buffaloes. It generates nearly 8% of the global fish production and is the 4th largest exporter of seafood.

The waste routes, especially those involving hospital waste, call for renewed focus as they are often a source of hard-to-treat multidrug-resistant bacteria. India is among the few countries that have not officially prohibited antibiotic use as growth promoters in poultry. Chicken feed, its antibiotic content, or labelling is not amply regulated. There is an urgent need to compile baseline data on the amount of antibiotics used in different food-animal sectors and on purpose-based classifications. Such data will offer a start to potential intervention and identification of national antibiotic reduction targets.

Need for multipronged approach

Mass use of antibiotics to prevent or control disease is still not actively discouraged. The Department of Animal Husbandry and Dairying came up with long-overdue standard veterinary treatment guidelines in October 2024. Now, the challenge is to ensure that these guidelines are adhered to. Critically important antibiotics used to save lives in hospitals must be conserved and phased out in food-animal sectors, especially for non-therapeutic purposes. A key issue pertains to a lack of monitoring of antibiotics in food, though the standards for antibiotic residues in food from animals and honey were set many years ago. The Food Safety and Standards Authority of India has not been able to instil confidence in consumers that their chicken, fish, or eggs are safe from antibiotics. India must also be able to use animal farm waste as manure in agriculture fields but this waste needs to be treated and made AMR-safe to avoid the spread of resistance.

Critically, India needs to develop a roadmap to scale up preventive approaches. It should spell out what needs to be done with animal housing, alternatives, vaccines, biosecurity, resilient breeds, and how they need to be invested in and promoted to reduce the need for antibiotics. There should be a renewed focus on a long-term approach towards scaling up local and decentralised food systems – backyard poultry, for instance – and reducing dependence on industry-intensive systems. It is time for an adequately funded AMR national action plan 2.0, with ministries and departments marked for accountability.

There is a silver lining in Kerala – the state runs the Antibiotic Literate Kerala campaign, the Antibiotic-Smart Hospital initiative to certify healthcare centres that have adopted a set of criteria, operation AMRITH – Anti-Microbial Resistance Intervention for Total Health – aimed at curbing over-the-counter sales of antibiotics, and ROAR (Rage On Antimicrobial Resistance), a programme that involves the sale of antibiotics in blue envelopes with statutory warnings and awareness messages.

India must come together to prevent and contain this big threat to humanity. There are huge expectations from us but a strong, coordinated, and timely action will be of immense global significance.

(Amit and Rajeshwari are Director and Programme Manager, respectively, at the Sustainable Food Systems Programme, Centre for Science and
Environment)