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Antimicrobial resistance (AMR) presents a formidable challenge to human and animal health, food safety as well as environmental sustainability. India, like many nations, is grappling with the rapid escalation of AMR due to the overuse and misuse of antibiotics across multiple sectors, including healthcare, animal husbandry and agriculture.
The National Action Plan on AMR (NAP-AMR) provides a framework for addressing AMR through a coordinated approach across human, animal and environmental health sectors, embracing the One Health concept.
However, significant challenges persist in policy formulation, practical implementation, governance, technology and financing.
With the United Nations General Assembly’s (UNGA) recent high-level meeting on AMR emphasising prevention, this article explores the challenges faced in implementing India’s NAP-AMR across various sectors and outlines potential solutions.
India’s regulatory oversight of antibiotic use spans across multiple departments in the ministries of health and family welfare, agriculture and environment. This approach leads to fragmented policy responses.
Harmonising regulations and fostering inter-departmental collaboration are critical to developing a coherent AMR strategy.
AMR surveillance in India is still nascent, with limited data from veterinary, agricultural and environmental sectors. The absence of a centralised, cross-sectoral data repository hinders comprehensive policy development and effective monitoring.
Further, while India has taken strides in regulating human antibiotic use, there is less progress in curbing antibiotic misuse in animal husbandry and agriculture. Establishing stringent guidelines and policies for veterinary and agricultural use of antibiotics is crucial for addressing AMR.
There are certain challenges within the healthcare practice itself that exacerbate AMR. Most prominent among them is the antibiotic overprescription in human health and self-medication practices in rural areas. Awareness programmes and strict prescription regulations are necessary to curb misuse at the community level.
Moreover, the excessive use of antibiotics in animal husbandry to promote growth and prevent diseases is also dangerous. Implementing stringent regulations, educating farmers and promoting good livestock management practices are essential steps toward sustainable antibiotic use.
Finally, inadequate AMR training for healthcare and veterinary professionals limits the effective application of NAP-AMR. Tailored training programmes focused on AMR prevention and management are essential for improving practices across sectors.
India's strategy to fight AMR also suffers from limited technological and governance support. Rapid diagnostic tools, for instance, are essential for reducing inappropriate antibiotic use. But access to such technology is limited, particularly in rural healthcare settings. Investment in affordable diagnostic tools and expanding their availability can significantly impact AMR prevention.
Then, the sector also lacks a strong enforcement mechanism, because despite regulations, enforcement remains weak due to limited manpower, resources and decentralised governance. Strengthening regulatory agencies and ensuring accountability in antibiotic use in both human and veterinary sectors is critical.
Moreover, pharmaceutical waste, particularly from healthcare and animal husbandry, contaminates water and soil, contributing to AMR. Effective waste management protocols and robust environmental regulations are needed to mitigate AMR proliferation in the environment.
India's AMR initiatives also see limited funding. Implementing AMR interventions, particularly at a large scale, requires substantial funding. Increased budget allocation toward AMR research, surveillance and public health interventions is essential to sustain the momentum against AMR.
The One Health approach, though crucial, is also often underfunded. Dedicated financial frameworks and public-private partnerships could be leveraged to support coordinated AMR interventions across human, animal and environmental health sectors.
Lack of access is a major impediment for the success of AMR initiatives. Rural healthcare facilities often lack access to essential resources, including diagnostic tools and trained personnel, leading to inappropriate antibiotic use. Improving rural healthcare infrastructure and ensuring equitable access to AMR-related resources is essential for effective implementation.
Further, alternative treatments or preventive measures such as vaccines are limited, especially in the animal health sector. Promoting vaccination and other preventive health measures could reduce reliance on antibiotics and thereby reduce AMR.
The recent high-level meeting on AMR at the United Nations emphasised preventive approaches, acknowledging that prevention should be the cornerstone of AMR strategies. In light of this, India could take the following steps to enhance its NAP-AMR:
1. Strengthen preventive strategies in the animal sector: Investing in biosecurity measures and vaccination programs in animal husbandry can significantly reduce antibiotic reliance. Developing farmer-friendly policies that encourage responsible use of antibiotics could foster a shift toward preventive healthcare.
2. Expand community-based awareness and education programmes: Implementing community-based AMR awareness campaigns can address public misconceptions about antibiotic use. Fostering behavioral changes around antibiotic usage and disposal practices at the grassroots level could further amplify preventive efforts.
3. Adopt advanced surveillance and data analytics: Utilising AI-driven data analytics and electronic health records could improve surveillance of AMR patterns across human and animal health sectors. A centralised AMR database can enable real-time monitoring and better policy responses.
4. Invest in sustainable waste management: Implementing green practices for waste management, particularly pharmaceutical waste, can minimise environmental AMR contamination. Stringent regulations and incentivised initiatives to curb AMR in the environment could align India’s efforts with global AMR prevention targets.
India’s fight against AMR requires a holistic approach, encompassing robust policies, practical interventions, advanced technology and financial resources, while emphasising prevention across all sectors.
By fostering a preventive approach and promoting the One Health concept, India can make significant strides in combating AMR. With coordinated action and sustained political will, the NAP-AMR has the potential to curb the threat of AMR and safeguard the future of human, animal, and environmental health.
Babu Beri is assistant director (veterinary & animal husbandry), Telangana. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.