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)

The World Health Organization has sought to eliminate filariasis, globally, by 2030, a decade later than its original target of 2020. While India’s target year is now 2027, this deadline has been arrived at after several revisions: the National Health Policy had originally set the goalpost for 2015. Filariasis, clearly, has been difficult disease to eradicate.

While pioneering experiments by vector specialists over the years have helped India reduce its disease burden, consistent efforts are needed to eliminate the disease, reports have acknowledged. 

“Filariasis is the common term for a group of diseases caused by parasitic nematodes belonging to the superfamily Filarioidea. Adult worms of these parasites live in the lymphatic system, cutaneous tissues or body cavity of the humans and are transmitted through vectors”, explains a documents from the National Centre for Vector Borne Diseases Control.

Filariasis caused by nematodes that live in the human lymph system is called Lymphatic Filariasis (LF). The burden of lymphatic filariasis is massive in India, with as many as 670 million persons at risk for the disease, according to a report published in the Indian Journal of Medical Research in 2022. 

While the disease has been around for decades in India, there still exist many misconceptions about it, says S. Sabesan, former director of the Indian Council of Medical Research — Vector Control Research Centre, Puducherry.

Kerala’s story with filariasis

Kerala  was instrumental in spotlighting filariasis in India. In 1984-85, a group of filariasis affected persons in Alappuzha formed an association, and its president contested the general election that year, aiming to attract the attention of politicians and bureaucrats. It bore fruit. A Member of Parliament from Kerala S. Krishna Kumar, became the deputy minister in the Union Health Ministry. He called for action against filariasis in Kerala, which set the ball rolling, recalls Dr. Sabesan. 

Kerala’s culture of associations helped to further the project of eliminating filariasis, he says. All associations were amassed under the umbrella of the Filariasis control movement or ‘Filco‘ movement. The project targeted removing floating vegetation where mosquitoes that cause the disease breed. The mosquitoes lay eggs on leaves and the larvae absorb oxygen from the air sacs in the roots of the plants. Understanding the breeding pattern of the mosquitoes helped remove the floating vegetation, which was then placed as manure in coconut groves.

To control mosquitoes the State Health Department also targeted Kerala’s large resource of ponds and water bodies to develop aquaculture, using fish from dams. The fish would feed on the larvae, curtailing mosquito breeding.

Interdepartmental support

Support also came from Kerala’s Agriculture Department which saw the potential of improving livelihoods in rural areas. Shramdhan workers cleaned temple tanks, canals and water bodies, and NABARD pitched in with financial support to remove the plants, and establish aquaculture.

In two years, inland fisheries had been developed. To add value to the removed water vegetation, hemp was cultivated. This improved the quality of fertilisers that coconut groves received. Ultimately, the Health Department roped in the Education Department to raise an army of schoolchildren who could spread awareness to help improve adherence to treatment of the disease. 

The Health Department also used the knowledge of how village residents checked the feet of eligible young women to check if they harboured the disease before offering a marriage proposal. The Department made a young woman with lymphatic oedema, in whose family many women had been rejected owing to the disease, their mascot. The young woman recovered from filariasis after treatment and this boosted people’s confidence. Her story was made into a short film, Yudham (war) and exhibited, giving further fillip to treating the disease. Alongside, the Department trained Filco workers to detect the disease and bring in patients for treatment.

Free clinics were opened to offer treatment. The next step was checking for hidden disease, which involved mass drug administration. Soon, the number of cases fell drastically indicating that the disease was in the elimination stage.

The Kerala Health Department’s approach included collaborating with the Agriculture Department to develop aquaculture, engaging schoolchildren for awareness, and using a recovered patient as a mascot. Mass drug administration and training workers to detect and treat the disease led to a significant reduction in cases, pushing filariasis towards elimination. Picture shows an awareness campaign on filariasis held in Tamil Nadu (Photo taken on August 21, 1987)
PHOTO: THE HINDU ARCHIVES

A win, and a mass strategy

The success of the experiment was shared at the WHO’s meeting in 1996 in Kuala Lampur and the World Health Assembly decided on a strategy of administering a single dose of diethylcarbamazine citrate (DEC).

In India, the annual single dose mass therapy was introduced in 2002, but the nation-wide the scheme did not help in eliminating the disease, for want of follow-up care.

In 2006, the Union Health Ministry introduced the drug Albandazole that can have an effect on adult worms of the parasite. But there was a lack of compliance, even though the drugs were distributed. The Health Ministry found that despite distributing the drug there, was no reduction in the number of cases.

Meanwhile in Kerala another development took place.

The salt story

Through a project, salt-infused with a low dose of the drug DEC was introduced in Kerala. This project was launched with the support of the salt corporation in Thoothukudi in Tamil Nadu. Within a year, the number of filariasis cases fell significantly. The project’s success was expanded in Tamil Nadu’s Kanyakumari district in 2003. 

By 2020, the Indian Council of Medical Research launched DEC salt in Andaman and Nicobar and successfully eliminated another variety of filariasis. This salt therapy could be used as an adjunct therapy across the country Dr. Sabesan has said in the white paper he has published on the subject: Not only is it odourless, but it also doesn’t change the colour of food and is safe for pregnant women and children as well. 

For the success to be sustained it is imperative that we achieve the target of elimination, he says. “Tamil Nadu is doing well. But filariasis is found in Karnataka, Andhra Pradesh, Bihar and Uttar Pradesh as well. There are areas where filariasis is a challenge. If uncontrolled, filariasis will be reintroduced, as the vector is already present in the atmosphere. The low density carriers will build up gradually. So it is necessary to continue surveillance even after elimination is declared. Vector entomologists must focus on the mosquitoes and the vector,” he emphasises.

Telangana State AIDS Control Society (TSACS) presented data on the number of HIV cases detected in Telangana in 2024. The image is used for representative purposes only.
| Photo Credit: RAMAKRISHNA G

As many as 9,415 people in Telangana tested positive for HIV in 2024, according to data presented by the Telangana State AIDS Control Society (TSACS). The figures emerged during a high-level review meeting chaired by Minister for Health C. Damodar Raja Narasimha on Monday.

A total of 19.02 lakh individuals were tested for HIV in the State during the year. Officials informed the Minister that approximately 1.24 lakh people living with HIV were currently receiving free treatment through the network of Antiretroviral Therapy (ART) centres across Telangana.

TSACS officials said that more than 5,000 HIV patients were concentrated in 13 districts, while another 13 districts had between 2,000 to 5,000 patients. The Minister instructed health officials to scale up testing in all districts, especially targeting high-risk groups, and to intensify awareness programmes to curb the spread of the virus.

He stressed the need to regularly assess the performance of NGOs working in collaboration with TSACS. “The State government is committed to the goal of eliminating HIV AIDS by 2030. All our efforts should be directed toward this objective,” he said.