United action is warranted for antimicrobial resistance which threatens everyone

Bobby Ramakant *

When misuse and overuse of medicines is making infections difficult or impossible to treat, then are not we all at risk? rightly asks Bhakti Chavan, a survivor of extensively drug-resistant TB or XDR-TB (one of the severest forms of TB which has very limited treatment options) and a member of World Health Organization (WHO) Task Force of antimicrobial resistance (AMR) Survivors.

Bhakti had no prior history of TB disease but got infected with TB bacteria, which was extensively drug-resistant. If infection prevention and control had been optimal at all healthcare settings, society, community and homes, then no one should get infected with a preventable disease like TB. Bhakti is cured now and risen to help raise awareness and protect others from AMR.

If we do not act now, we can go back to pre-antibiotic era

“Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and become resistant to (or no longer respond to) medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, medicines become ineffective, and infections become increasingly difficult or impossible to treat. AMR is a problem driven by misuse and overuse of antimicrobial medicines - including antibiotics, antivirals, antiparasitics and antifungals - and results in critical medicines losing effectiveness to treat infections,” said Dr SS Lal, a distinguished global health leader who serves as Director of ReAct Asia Pacific.

“AMR is associated with around 5 million deaths a year. Besides this, there is the huge burden of morbidity and healthcare expenditure that can affect household welfare severely. We all need to realise that if we do not act now, we could go back to a pre-antibiotic era, when even simple infections become untreatable,” said Dr Lal.

Dr Lal reminded that first antibiotic was discovered in 1928 – almost 100 years ago, which has saved several millions of lives. But first sign of antibiotic resistance became apparent soon after the discovery of penicillin. The spread of penicillin resistance was already documented by 1942, when four Staphylococcus aureus strains were found to resist the action of penicillin in hospitalised patients.

We all are at risk of AMR

“Antimicrobial Resistance (AMR) affects each one of us – directly or indirectly – and all of us are at risk of AMR. AMR is among top 10 global health threats as well as an emerging threat to food security and SDGs. Economic toll of AMR is astronomical too. There is no excuse for inaction but to save the medicines that protect us,” said Shobha Shukla, SDG-3 Lead Discussant at the United Nations intergovernmental High Level Political Forum (HLPF 2025). Shobha leads CNS and is also the Chairperson of Global AMR Media Alliance (GAMA).

Shobha commended journalists and other communicators from the Global South nations who, despite limited access to resources, have covered AMR consistently and helped raise awareness and increase accountability in health responses. GAMA is majorly led by journalists from the Global South nations. Indian chapter of GAMA, formally called as India Media Alliance on AMR, was also launched at Press Club of India in a national media workshop organised by ReAct Asia Pacific. Dr Ijyaa Singh of ReAct Asia Pacific stressed that media engagement remains one of the key priority action areas for strengthening AMR responses at all levels.

AMR is a brewing pandemic

AMR is a pandemic in making, said Dr Narinder Saini, former Secretary General of the Indian Medical Association (IMA) and Chairman of the IMA AMR Standing Committee. "If we do not act now to prevent AMR, then by 2050, every year almost 10 million will die due to it."

Change is possible when people unite and lead

Over 1860 young people living with HIV in India know their status, receive lifesaving antiretroviral therapy and continue to remain virally suppressed with viral load undetectable since at least last one year, said Pooja Mishra, Coordinator of Youth Lead Voices and General Secretary of National Coalition of People living with HIV in India (NCPI Plus). This means all of them had the right diagnosis and are adhering to daily therapy diligently - thereby minimising their risk of developing AMR or HIV virus becoming drug-resistant. Undetectable viral load means they are healthy and infection stops spreading too - so treatment works as prevention.

We need person-centred and community-led health responses to support people through their journeys of diagnosis to treatment and self-care, said Pooja.

AMR and environment: Connected?

"AMR and climate change - both are big challenges confronting us today. Both of them are interconnected too. Climate impacts AMR but we also need to realise that antibiotic use can impact climate change too," said Dr Rajeshwari Sinha who leads AMR programme at the Centre for Science and Environment (CSE).

With warmer climate temperatures, microbes are growing more. If these microbes are drug-resistant, then the threat of drug-resistant infection outbreak increases. Extreme weather events, such as flood or heavy rainfall, impact water, sanitation and hygiene infrastructure, thereby increasing the risk of vector-borne and water-borne disease outbreaks, said Rajeshwari.

Unsafe waste disposal is a major threat. "Because of unsafe disposal from antibiotic-making factories or disposal of used or unused antibiotics in homes and hospitals, antibiotics are present in waste residue. When antibiotics reach the enviornment, environmental load of AMR causing determinants – residues or reminiscent bacteria or AMR causing genes - increases, added Rajeshwari.

"Antimicrobials we consume are not fully metabolised and are excreted out in form of excreta or urine and reach the affluents, sewage system, and eventually end up reaching our water canals or rivers or other water bodies," said Satish Sinha, Executive Director, Toxic Links.

When Toxic Links did a study involving 4 rivers (Gomti river in Lucknow, Yamuna river in Delhi, Zuari river in Goa which is near pharmaceutical industries, and Cooum river in Chennai), they found antibiotic traces in different water concentrations in all of them. Source of these antibiotics could be hospitals, pharmaceutical companies or industries or waste disposal from homes and communities, said Satish Sinha.

Toxic Links did another study in Baddi, a major hub of pharmaceutical industries in Himachal Pradesh state of India. This report was cited by National Green Tribunal and then in Supreme Court too, said Satish Sinha. Toxic Link report from Baddi is on pharmaceutical pollution, a significant environmental concern in the region. The report highlights issues related to the pharmaceutical industry's impact on water quality and the role of Common Effluent Treatment Plans in managing wastewater.

Animal husbandry and AMR

Satish Sinha highlighted misuse and overuse of medicines in poultry and other forms of animal husbandry. "We found alarming levels of antibiotic traces in feeds and excreta when we studied poultry farms in Andhra Pradesh state of India. Waste of poultry is often used as manure for fish farming and shrimp culture."

"We also found antibiotic traces in water sources in animal husbandry. Antibiotics are also used as growth promoters in animal husbandry and end up reaching our water systems, rivers, lakes and air. This has widespread ramifications on the environment as microbes become resistant. We do not have optimal waste management system and affluent management system," said Toxic Links lead Satish Sinha.

Agrees Dr Chanchal Bhattacharya, noted expert on animal health, AMR and One Health, who currently serves as a Senior Adviser, Livestock Technology and One Health at Heifer International. "Antibiotics are often used as growth promoter in animals which is the major source how antibiotics get in the human food chain. There are antibiotic residues found in meat, egg or milk samples. Those who consume milk which is not pasteurised, or half boiled eggs or not fully cooked eggs or meat, could be at a risk of acquiring infections or even drug-resistant infections."

Dr Chanchal calls for improving standard veterinary medicine and healthcare practices. "Veterinary practice is often done by unqualified people in villages."

Antibiotic use in animals and agriculture is 4th highest in India

Dr Chanchal Bhattacharya said that use of antibiotics in animals and agriculture is 4th highest in India worldwide. 70% of antibiotics are used in animal husbandry globally. Indiscriminate antibiotic use is rampant in dairy culture, poultry and aquaculture.

Dr Chanchal called for stronger measures to control antimicrobial use in animal health, food and agriculture sectors. "Vaccination is also not done properly in animal sector due to negligence. We need to raise awareness and build capacities so that animals can be protected from vaccine-preventable illnesses. Engaging, educating and informing farmers and paramedical veterinary healthcare staff is also important."

Dispose antimicrobials safely

"There are ways of safe disposal of antimicrobial waste in homes, communities and healthcare facilities," said Dr Sangeeta Sharma, President of Delhi Society for Promotion of Rational Use of Drugs (DSPRUD). "80% of antimicrobial use is used in communities. Either we self-medicate or get over the counter medicines on advice by pharmacist or others. This is a big way how misuse and overuse of medicines happen."

Almost 80% or 90% times when we get cough, cold or diarrhoea, these are viral infections and self-limiting ones - and get resolved without any medicines. But if we take antibiotic (which acts against a bacterium and not a virus) we are misusing it and risking AMR, said Dr Sharma.

Dr Sharma and DSPRUD is credited to publish 7th Edition of the "Standard Treatment Guidelines: A Comprehensive Resource for Informed Clinical Decision-Making." These guidelines encompass over 350 priority diseases across 11 medical super-specialties, providing medical experts with invaluable insights into clinical manifestations, therapeutic advances, patient management, and patient education.

Right diagnosis is the stepping stone towards right treatment

Unless we diagnose people with diseases - early and accurately - how will we ensure they get treated with right medicines and get cured? Right diagnosis is a critical entry-gate towards treatment care pathway and helps stop spread of infection, reduce unnecessary human suffering and untimely death. Also, helps stop AMR, said Dr Sarabjit Chadha, Country Director and Asia regional Director, FIND.

Media should not just report numbers but connect them to people's lives

"Media should not just report numbers or data but connect them to people's lives. When we do this, we impact change and are more likely to influence people's behaviours for good," said Dr Salman Khan, Senior Technical Advisor and Resource Mobilisation Lead, ReAct Asia Pacific.

We need to implement the national and state action plans on AMR, said Dr V Sam Prasad who leads AHF India Cares. "Let us address AMR using One Health approach across sectors including human health, animal health and livestock, food and agriculture, and our environment."

"We can do better to prevent AMR because we have no choice – we have to save the medicines that protect us, our loved ones, our animals and plants and help save our environment, as there is no planet-B," said Shobha Shukla.