Will Prime Minister Narendra Modi’s statement on antimicrobial resistance, in his last ‘Mann Ki Baat” broadcast for the year 2025 be the anagnorisis that we have been waiting for to galvanise action on Antimicrobial Resistance (AMR) in India? Doctors feel that it might well be the one fell swoop to stop in its tracks what could easily be the biggest emerging health crisis of India.
In his address (129th edition) on December 28, Mr. Modi mentioned antimicrobial resistance as a “matter of concern for us.” Quoting from the Indian Council for Medical Research’s (ICMR) dataset, he mentioned that antibiotics are proving to be less effective against pneumonia and urinary tract infections. He went on to hit at the heart of the AMR crisis in India — “thoughtless and indiscriminate use of antibiotics by people”. These were not medicines to be taken casually or without the advice of doctors, the Prime Minister stressed. “People have started believing that popping a pill will solve everything. But it is because of this that diseases and infections are overpowering antibiotics.” Appreciably, he ended with a piece of advice that his listeners and followers will do well to religiously practise: “Avoid taking medicines by yourself, particularly antibiotics.”
Mainstreaming the subject
It is, by now, common knowledge that while there are many prongs that contribute to the galloping AMR in the country, the biggest contributor is the irrational use of antibiotics. Commonly known as the ‘misuse and overuse’ problem, AMR however, has remained in the preserve of the infectious diseases experts and the corridors of hospitals, and in policy circles. Until now. That is where Mr. Modi’s remarks will make a difference, coaxing AMR out of the rarefied domain into the mainstream, where there is awareness of the public risk it poses, along with the links to everyday behaviour.
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By invoking national data and appealing directly to citizens to avoid over-the-counter antibiotics, the speech translates lab-based warnings into a public call to action, from the pulpit by the head of the government. This is why it is reasonable to expect it to have an impact on the population in a manner that no other intervention in the past in the sector — the first National Action Plan on Antimicrobial Resistance or the ban on colistin use as a growth factor, for instance — has managed. Striking at the broadest base is where the success of this appeal lies, and public awareness will be absolutely key in deciding whether the AMR numbers see an upper trajectory or whether they go down south in the future.
But, merely at hitting the base will no longer be sufficient, at this stage of the AMR pathway in India. It has grown like a hydra-headed beast and it is a One Health approach that can behead the monster effectively. The need for a One Health approach has become current by force of circumstances where cognition of the interconnectedness of human, animal and environmental health now actively shapes solutions.
Most non-urban centres left out
At this juncture, enhancing the number of surveillance sites is a critical aspect to marking and following the trail of AMR in India, experts point out. They contend, that currently, while the network is steadily expanding, there is still no exhaustive dataset for India as a whole, representative of the wide variance in the country.
Surveillance sites are located largely in urban centres and tertiary care centres, and may drive up the average as the bulk of the non-urban centres are not even accounted for. The urgent need now is to expand the surveillance network in a manner that will provide a reasonably accurate position of community prevalence of AMR in India.
India’s National AMR surveillance network (NARS-Net), which provides data to the World Health Organization’s Global Antimicrobial Resistance and Use Surveillance System (GLASS), currently stands at 60 sentinel medical college laboratories.
However, for the recent GLASS report (reporting period January to December 2023), information was gathered from 41 sites in 31 States/Union Territories. NARS-Net was established in 2013 to determine the magnitude and trends of AMR in different geographical regions of the country, and laboratories under this network include government medical colleges. These labs are required to submit AMR surveillance data on nine priority bacterial pathogens of ‘public health importance’ and some fungal pathogens as well.
‘Include private hospitals’
Recently, in a letter to the Director of the National Centre for Disease Control, Professor, (Dr.) Ranjan Das, the nodal agency for AMR surveillance in the country, Dr. Abdul Ghafur, of the Chennai Declaration on AMR and an infectious diseases specialist, said, “… the only credible approach is to present true national data — data not limited to tertiary care hospitals, but inclusive of secondary and primary care centres across the country. If such data are included, the national resistance picture will naturally be more balanced and representative.” He also makes the case for including private hospitals in the network too.
The 2015 WHO Global Plan on AMR recommended a blueprint addressing five objectives: raising awareness, strengthening surveillance and research, reducing infections, optimising antimicrobial use, and ensuring sustainable investment in new medicines, diagnostics and vaccines. Mr. Modi’s speech will increase awareness, something that is essential, but expanding the surveillance network for AMR is a critical function that will require investments, strategies, monitoring and enforcement and as much political will.
