India, with its high population density, prevalence of infectious diseases, and over-the-counter availability of antibiotics, has a long and winding road to travel in order to counter AMR. Photograph used for representational purposes only
| Photo Credit: istock.com/Dr_Microbe
Antimicrobial resistance (AMR), often labelled as a silent pandemic, is one of the most pressing global health challenges of our time. As pathogens evolve to withstand the drugs currently available to counter them, our ability to treat infections is rapidly eroding. A recent study funded by Wellcome and the United Kingdom Department of Health and Social Care’s Fleming Fund, estimates that bacterial AMR alone will cause 39 million (3.9 crore) deaths between 2025 and 2050, which translates to three deaths every minute – a shockingly stark statistic. AMR also threatens to undo decades of progress made against infectious diseases such as tuberculosis, typhoid and pneumococcal pneumonia, among others, with new multidrug resistant strains now in circulation.
In 2016, in response to the continually escalating global threat of AMR, the United Nations General Assembly (UNGA) convened its first High-Level Meeting (HLM) to address the root causes of AMR, develop national action plans, regulate antimicrobials, and promote awareness and best practices. With this mandate, many countries prepared their national action plans. India launched its plan in 2017, a six-pronged approach including improving awareness, reducing infections, optimising antimicrobial use, strengthening surveillance, increasing investment, and enhancing India’s leadership in AMR.
Last year, the UNGA reconvened for a second high-level meeting to review global progress on AMR. Its outcome was a strong political commitment by the 193 member countries to identify gaps, invest in sustainable solutions, improve R&D, strengthen surveillance, and ensure constant monitoring in the lead-up to the next review in 2029.
The path to combating AMR in India
India, with its high population density, prevalence of infectious diseases, and over-the-counter availability of antibiotics, has a long and winding road to travel in order to counter AMR. It is meeting the challenge head-on. India has not only expanded and built on its genomic surveillance capabilities to stay ahead of AMR, but government bodies such as the Indian Council of Medical Research (ICMR), the National Centre for Disease Control (NCDC) and the Indian Council of Agricultural Research (ICAR) have also established surveillance networks that focus on priority pathogen groups and communicate critical data to policymakers and researchers. However, while genomic sequencing can help track how pathogens evolve and acquire resistance, it still doesn’t have direct utility in helping clinicians make difficult, and urgent, lifesaving decisions.
India’s genomic capabilities can be most effectively leveraged in two key ways. First, public health experts should use genomic data to anticipate microbial evolutionary trajectories and emerging AMR trends. This can inform the most appropriate choice of antibiotics when patients are treated empirically (which is mostly the case). Second, diagnostic companies should use large-scale population genomics to build precision tools that could be made available at, or near the point-of-care. For example, genomic studies on Salmonella enterica serovar Typhi (the bacterium causing typhoid fever) reveal how the H58 lineage has acquired multidrug resistance over time. Researchers identified single nucleotide polymorphisms (SNPs) from whole-genome sequencing data, which are now being used to create targeted molecular diagnostics. This enables faster and more cost-effective detection of drug-resistant strains, instead of sequencing each circulating strain.
At the Christian Medical College, Vellore (CMC), the country’s reference AMR institution, researchers are sequencing representative strains to generate important epidemiological data and trends. They are also using genomic markers for rapid and robust diagnosis, supporting the national AMR efforts under the mentorship of ICMR.
The urgent need for new drugs
In addition to enhanced surveillance and smart diagnostics, we urgently need new drugs. Developing new antimicrobials is scientifically complex, financially risky, and often commercially unattractive. India’s robust biotech ecosystem, high burden of endemic infectious diseases, and proven capacity for affordable manufacturing create the ideal environment for innovation. When these strengths are combined, they will not only accelerate India’s fight against AMR but also improve global access, especially for low- and middle-income countries (LMICs).
Recent breakthroughs from India, such as the introduction of novel antibiotics like cefepime-enmetazobactam, cefepime-zidebactam, nafithromycin, and levodifloxacin, mark a significant global advancement in the fight against multidrug-resistant pathogens, particularly the WHO’s critical priority threats. These drugs offer new therapeutic options that can reduce reliance on carbapenems and last-resort agents like colistin. At a time when the world is looking at a fast-drying antibiotic pipeline, this progress offers a glimmer of hope. Such leadership in developing new antibiotics underscores India’s growing scientific and regulatory capabilities, paving the way for increased international collaboration and faster global approvals.
A communication strategy
Given the magnitude of the AMR crisis, genomic surveillance and integrated public health systems can only work efficiently if they are supported by a carefully designed communication strategy to improve awareness. In India, where antibiotics can often be bought over the counter without a prescription, innovative and human-centered advocacy should be prioritised more than it currently is. This includes antimicrobial stewardship among healthcare professionals, including both physicians, pharmacists and other unorthodox or informal practitioners that form an important pillar of frontline healthcare delivery. Moreover, it should be reiterated that vaccination is not just important in preventing viral diseases that do not require antimicrobial treatment or multidrug resistant diseases, but also in reducing antimicrobial usage.
To communicate the gravity of the situation effectively, innovations that can simplify data and generate actionable evidence will play a central role. One such example is AMRSense, an award-winning collaboration between IIIT-Delhi, CHRI-PATH, and 1mg.com, which is using AI to collect data across the clinical, animal, and environmental axes in a true One Health approach and using predictive modeling to guide targeted interventions.
The challenge of tackling AMR is immense, and we are at an inflection point. Acting alone or in an uncoordinated and siloed fashion will not produce the desired results. India has the tools, the talent, and the urgency to lead the world in curbing antimicrobial resistance. But all scientific efforts need to be unified and communicated to the general public and experts alike, in ways that resonate with them. Only then will we be on our way to winning the fight against AMR.
(Dr. Ankur Mutreja is a genome scientist and microbiologist, and the Director, Strategy, Partnerships and Communications at PATH. amutreja@path.org Dr. Tikesh Bisen is a Public Health Specialist – Surveillance at PATH. tbisen@path.org Dr. Balaji Veeraraghavan is a Professor at the Christian Medical College & Hospital, Vellore. His research focus is on vaccine-preventable invasive bacterial diseases and Antimicrobial Resistance in clinically relevant pathogens. vbalaji@cmcvellore.ac.in)
Published – April 22, 2025 07:24 pm IST
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