Antimicrobial resistance (AMR), typically labelled as a silent pandemic, is one in all the most urgent international well being challenges of our time. As pathogens evolve to face up to the medicine presently out there to counter them, our potential to deal with infections is quickly eroding. A latest examine funded by Wellcome and the United Kingdom Department of Health and Social Care’s Fleming Fund, estimates that bacterial AMR alone will trigger 39 million (3.9 crore) deaths between 2025 and 2050, which interprets to three deaths each minute – an incredibly stark statistic. AMR additionally threatens to undo many years of progress made against infectious illnesses resembling tuberculosis, typhoid and pneumococcal pneumonia, amongst others, with new multidrug resistant strains now in circulation.
In 2016, in response to the frequently escalating international menace of AMR, the United Nations General Assembly (UNGA) convened its first High-Level Meeting (HLM) to deal with the root causes of AMR, develop nationwide motion plans, regulate antimicrobials, and promote consciousness and finest practices. With this mandate, many international locations ready their nationwide motion plans. India launched its plan in 2017, a six-pronged strategy together with bettering consciousness, decreasing infections, optimising antimicrobial use, strengthening surveillance, rising funding, and enhancing India’s management in AMR.
Last yr, the UNGA reconvened for a second high-level assembly to overview international progress on AMR. Its final result was a powerful political dedication by the 193 member international locations to determine gaps, put money into sustainable options, enhance R&D, strengthen surveillance, and guarantee fixed monitoring in the lead-up to the subsequent overview in 2029.
The path to combating AMR in India
India, with its excessive inhabitants density, prevalence of infectious illnesses, and over-the-counter availability of antibiotics, has a protracted and winding street to journey so as to counter AMR. It is assembly the problem head-on. India has not solely expanded and constructed on its genomic surveillance capabilities to keep forward of AMR, however authorities our bodies resembling the Indian Council of Medical Research (ICMR), the National Centre for Disease Control (NCDC) and the Indian Council of Agricultural Research (ICAR) have additionally established surveillance networks that target precedence pathogen teams and talk crucial information to policymakers and researchers. However, whereas genomic sequencing may help monitor how pathogens evolve and purchase resistance, it nonetheless doesn’t have direct utility in serving to clinicians make troublesome, and pressing, lifesaving choices.
India’s genomic capabilities will be most successfully leveraged in two key methods. First, public well being consultants ought to use genomic information to anticipate microbial evolutionary trajectories and rising AMR developments. This can inform the most applicable alternative of antibiotics when sufferers are handled empirically (which is usually the case). Second, diagnostic firms ought to use large-scale inhabitants genomics to construct precision instruments that may very well be made out there at, or close to the point-of-care. For instance, genomic research on Salmonella enterica serovar Typhi (the bacterium inflicting typhoid fever) reveal how the H58 lineage has acquired multidrug resistance over time. Researchers recognized single nucleotide polymorphisms (SNPs) from whole-genome sequencing information, which are now getting used to create focused molecular diagnostics. This allows quicker and more cost effective detection of drug-resistant strains, as an alternative of sequencing every circulating pressure.
At the Christian Medical College, Vellore (CMC), the nation’s reference AMR establishment, researchers are sequencing consultant strains to generate necessary epidemiological information and developments. They are additionally utilizing genomic markers for speedy and strong analysis, supporting the nationwide AMR efforts below the mentorship of ICMR.
The pressing want for new medicine
In addition to enhanced surveillance and sensible diagnostics, we urgently want new medicine. Developing new antimicrobials is scientifically advanced, financially dangerous, and typically commercially unattractive. India’s strong biotech ecosystem, excessive burden of endemic infectious illnesses, and confirmed capability for inexpensive manufacturing create the preferrred surroundings for innovation. When these strengths are mixed, they won’t solely speed up India’s fight against AMR but additionally enhance international entry, particularly for low- and middle-income international locations (LMICs).
Recent breakthroughs from India, resembling the introduction of novel antibiotics like cefepime-enmetazobactam, cefepime-zidebactam, nafithromycin, and levodifloxacin, mark a major international development in the fight against multidrug-resistant pathogens, significantly the WHO’s crucial precedence threats. These medicine supply new therapeutic choices that may scale back reliance on carbapenems and last-resort brokers like colistin. At a time when the world is a fast-drying antibiotic pipeline, this progress gives a glimmer of hope. Such management in growing new antibiotics underscores India’s rising scientific and regulatory capabilities, paving the approach for elevated worldwide collaboration and quicker international approvals.
A communication technique
Given the magnitude of the AMR disaster, genomic surveillance and built-in public well being programs can solely work effectively in the event that they are supported by a rigorously designed communication technique to enhance consciousness. In India, the place antibiotics can typically be purchased over the counter and not using a prescription, revolutionary and human-centered advocacy must be prioritised greater than it presently is. This contains antimicrobial stewardship amongst healthcare professionals, together with each physicians, pharmacists and different unorthodox or casual practitioners that type an necessary pillar of frontline healthcare supply. Moreover, it must be reiterated that vaccination isn’t just necessary in stopping viral illnesses that don’t require antimicrobial remedy or multidrug resistant illnesses, but additionally in decreasing antimicrobial utilization.
To talk the gravity of the scenario successfully, improvements that may simplify information and generate actionable proof will play a central position. One such instance is AMRSense, an award-winning collaboration between IIIT-Delhi, CHRI-PATH, and 1mg.com, which is utilizing AI to accumulate information throughout the scientific, animal, and environmental axes in a real One Health strategy and utilizing predictive modeling to information focused interventions.
The problem of tackling AMR is immense, and we are at an inflection level. Acting alone or in an uncoordinated and siloed style won’t produce the desired outcomes. India has the instruments, the expertise, and the urgency to lead the world in curbing antimicrobial resistance. But all scientific efforts want to be unified and communicated to the common public and consultants alike, in ways in which resonate with them. Only then will we be on our approach to successful 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 analysis focus is on vaccine-preventable invasive bacterial illnesses and Antimicrobial Resistance in clinically related pathogens. vbalaji@cmcvellore.ac.in)
Published – April 22, 2025 07:24 pm IST
