WAAW 2024: Collaboration is key for AMR containment in India

It is time to reflect, renew and reignite India’s commitment to antimicrobial resistance (AMR) containment efforts on the occasion of World AMR Awareness Week (WAAW) 2024. Since the launch of the National Action Plan on AMR in 2017, significant progress has been made in addressing some of its strategic objectives, thanks to the relentless efforts of key organisations within and outside the government, civil society groups and academic entities.

At the national level, India has implemented several significant initiatives to combat AMR. These include enrolment in the Global Antimicrobial Resistance and Use Surveillance System, the establishment of surveillance networks by the National Centre for Disease Control (NCDC) and the Indian Council of Medical Research and the adoption of policies on Infection Prevention and Control (IPC) and Antimicrobial Stewardship (AMS).

Other achievements include the inclusion of AMR in the Integrated Disease Surveillance Programme, the launch of the Indian Network for Fishery and Animal Antimicrobial Resistance under the FAO and ICAR, a ban on the use of the antibiotic colistin in the animal sector and the establishment of India’s AMR innovation hub.

Among the various sectors, progress in the environmental sector has been slow despite efforts from many organisations. The environment, especially water, is contaminated by inadequately treated pharmaceutical effluents, hospital waste and waste from animal and agricultural farms. The improper disposal of expired or unused antibiotics is also a major concern. The environment acts as a platform for drug-resistant strains to emerge and spread, although more data is needed on the value chain analysis for each contributor.

India's role as a major global manufacturer and exporter of medicines, coupled with its large pharmaceutical market, adds another layer of economic complexity. Ensuring sustainable access to effective antibiotics, particularly from the access and watch groups, is a global priority. At the same time, innovative models are needed to support methods that minimise environmental pollution.

To date, only a few Indian states have introduced state action plans (SAP) on AMR, while others are still in the drafting stage. Except for Kerala, many states continue to face challenges such as mobilising adequate resources and funding, ensuring intra-sectoral and inter-sectoral coordination and engaging broader civil society organisations and private entities. Most SAPs adopt a top-down approach, making it difficult to implement measures effectively at the grassroots level.

Moreover, there are gaps such as the lack of good-quality representative data on antibiotic consumption and resistance in human and animal sectors (both nationally and at the state level) and limited awareness of the economic consequences of inaction against AMR. Such data, if available, could guide policymakers in prioritising AMR interventions.

The recent United Nations General Assembly High-Level Meeting on AMR in September 2024 adopted a declaration aiming to reduce deaths caused by drug-resistant infections by 10 per cent by 2030 compared to the 2019 baseline. While having a common unifying target is a good starting point, given India's diverse contexts, each state must generate context-specific data and continuously adapt its targets as part of monitoring and accountability.

Data on antibiotic consumption by the AWaRe category (a tool for monitoring antibiotic consumption, defining targets and monitoring the effects of stewardship policies) in humans, surveys on the implementation of AMS and IPC practices in hospitals and the use of medically important antimicrobials in animals should be collected. This will help prioritise efforts across sectors and allocate resources effectively.

These efforts should go hand in hand with addressing the social determinants of health, such as poverty, malnutrition, access to healthcare, access to standard antibiotics, safe drinking water, sanitation services and improved childhood vaccination rates.

Given that a significant proportion of India’s population relies on agriculture and livestock for their livelihoods, there is an urgent need to sensitise farmers about AMR. Innovative models must be scaled up to promote biosecurity measures, along with designing incentives to mitigate economic losses from livestock mortality due to infections during the transition phase.

Further research is needed on alternatives to antibiotics, the role of vaccines in the animal sector, cost-benefit analyses, capacity building among veterinary workers and farmer associations.

In addition to high-quality representative data on antibiotic consumption and resistance in human and animal sectors, initiatives that promote behavioural change in communities — such as the Antibiotic Smart Communities programme piloted by ReAct Asia Pacific in rural Kerala — are essential. These efforts should engage diverse stakeholders, particularly students, communities, civil society organisations, professional associations and consumer groups.

We need more AMR champions across sectors to initiate, educate, advocate and implement on-ground action.

Furthermore, strategies should focus on preventive measures by promoting investments in WASH and IPC at all levels across sectors, adopting a One Health approach with intra-sectoral and inter-sectoral collaboration, strengthening healthcare systems through universal health coverage, increasing budget allocations for health and intensifying efforts to mobilise funds. These measures are critical to ensuring that current and future generations continue to benefit from the life-saving efficacy of antibiotics.

Jaya Ranjalkar is former deputy director, ReAct Asia Pacific

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