If AMR is to be addressed effectively, communication must move beyond awareness and function as a driver of behavioural change

In a semi-urban primary health centre, a middle-aged man confidently speaks about how a tablet of azithromycin relieves him of his sore throat. In the same OPD, a young mother describes why she stops giving her three-year-old child the prescribed antibiotics as soon as the child begins to do better. She has heard of the word ‘resistance’ but in vague terms. On visits to hospitals and health centres, such stories are repeated with remarkable consistency. Antibiotics are overused and misunderstood, and the lack of clear communication about their purpose and risks allows half knowledge and habit to influence how they are consumed.

According to recent estimations, bacterial AMR was linked to 4.71 million fatalities in 2021, with 1.14 million of those deaths directly attributable to bacterial AMR and projections suggest that South Asia could face as many as 2.4 million AMR-related deaths annually by 2050. India has emerged as one of the largest consumers of antibiotics, having consumed 5,071 million daily defined doses of antibiotics in 2019 alone. More than half of this consumption was from the WHO’s Watch category. The Indian Priority Pathogen List has placed Klebsiella pneumoniae and Escherichia coli in the critical priority group, resistant to carbapenems, tigecycline and colistin. The consequences are profoundly economic too as extended hospital stays and repeated recourse to costly drugs push families into out-of-pocket expenditure.

Meanwhile, the declaration adopted at the UN General Assembly in September 2024 mandated the Quadripartite organisations to create an Independent Panel for Evidence for Action against AMR. With decisions now due at the 79th World Health Assembly this year, the global AMR agenda is being updated.

Health communication is not an accessory to AMR policy but a necessity. AMR is driven by indiscriminate self-medication, discontinuation of treatment, OTC sales, and non-therapeutic use of antibiotics in livestock. These are decisions made in households, pharmacies and farms and are shaped by perception, literacy and trust. Information alone is insufficient and what shifts practice are communication strategies that are sustained, locally adapted, and two-way in nature. India has long treated communication as a core instrument of public health. Family planning campaigns in the 1960s used radio and television for simple messaging. The Pulse Polio campaign utilised nationally recognised voices to create broad visibility while frontline health workers and ASHAs engaged households directly to address fears through dialogue. Tuberculosis control programmes too combined mass media campaigns with community outreach to promote early care-seeking and free treatment under DOTS. More recent initiatives like Nikshay Mitra have extended this model through digital platforms. Against this backdrop, communication around AMR feels muted. The National Programme on the containment of antimicrobial resistance that was launched during the Twelfth Five Year Plan (2013) did list awareness as one of its objectives but in practice, it hardly gathered the kind of energy seen in earlier national programmes. The 2017 National Action Plan on AMR placed awareness at the very top of its strategic priorities to improve understanding of AMR through communication, education and training for ordinary citizens and farmers.

AMR messaging remains largely standardised and top-down, assuming that uniform slogans can work across diverse social and cultural contexts but information alone is insufficient to change behaviour. Technical language around AMR often confuses the public and undermines adherence. Sustained engagement and social reinforcement are rarely built into AMR campaigns, which remain fragmented and short-lived. Public messaging further narrows the problem to human antibiotic misuse thus overlooking veterinary, agricultural and environmental drivers. This neglect of one health perspective coupled with weak evaluation of communication efforts continue to blunt India’s AMR response.

If AMR is to be addressed effectively, communication must move beyond awareness and function as a driver of behavioural change. This requires reframing AMR as a shared public health threat that affects communities and future generations and not just individual patients. India’s diversity demands tailored messaging for different populations, professions and settings rather than uniform campaigns. Equally important is a transition from one-way information dissemination to sustained community engagement. As the Pulse Polio programme demonstrated, trust is built by listening to local concerns and co-designing responses. Designating ASHA workers as AMR champions can promote responsible antibiotic use, vaccination and WASH practices. Communication should also be matched to different social and media context. Community radio, local theatre and storytelling are effective in rural settings, while digital campaigns are better suited to urban populations. Special attention can be paid to young mothers by integrating AMR related messages into antenatal care, immunisation drives and health camps. At the policy level, embedding antibiotic literacy in school curricula and professional training and extending the Red Line Campaign through AWaRe-based colour-coded labelling could provide clear guidance for responsible antibiotic use.

All these interventions need frameworks to evaluate outcomes and progress. Sustaining AMR communication requires rigorous evaluation focused on behavioural outcomes and not just reach or recall. A hub and spoke model in which tertiary care hospitals act as regional centres to provide training and technical guidance to district and primary healthcare facilities would build local capacity for evidence-based improvements.

Ultimately, how India communicates about antibiotics will determine whether they remain life-saving tools or not. Done right, AMR communication can advance multiple SDG and frame antibiotic preservation as a shared responsibility across generations.

Abhishek Kumar Singh is Research assistant at IISc Bengaluru and former policy and public health communication fellow at ICMR- NIRBI, Kolkata; LAMP fellowship Select 2024

Debjit Chakraborty is Scientist E, ICMR- NIRBI, Kolkata

Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth