Model Answer

Introduction

Antimicrobial resistance (AMR) — the ability of microbes to withstand antibiotics — is an escalating public-health threat. WHO's GLASS 2025 report shows India has one of the highest burdens of resistant bacterial infections in South-East Asia, with roughly one in three bacterial infections in 2023 showing resistance to commonly used antibiotics. This lends urgency to assessing drivers of AMR and recent policy responses.

Body

Factors driving AMR in India

• Inappropriate antibiotic use: Over-the-counter sales, easy access to antibiotics and self-medication lead to widespread misuse and incomplete courses.
• Weak stewardship in healthcare: Many facilities lack antibiotic stewardship programmes; prescription practices are often empirical and poorly regulated.
• Surveillance gaps: Existing surveillance is heavily weighted toward tertiary hospitals, so national estimates may be biased and primary-care/community resistance is under-reported.
• One-Health factors: Use of antibiotics in animal husbandry, environmental contamination from pharmaceutical effluent and inadequate waste management amplify resistance transmission across humans, animals and environment.
• Resource & implementation constraints: Slow roll-out of India's NAP-AMR at state level, financing shortfalls and limited industry engagement hinder coordinated action.

Evaluation of government initiatives — Kerala's AMRITH and other measures

Kerala's AMRITH (launched January 2024) exemplifies a targeted state-level response: it adopts a One-Health, intersectoral model focused on curbing OTC sales, strengthening stewardship and improving public awareness (with an antibiotic-literacy target). Strengths include political commitment, cross-department coordination and public education. However, challenges remain: scaling successful pilots to other states, ensuring sustained funding, integrating private sector clinical practices and measuring impact beyond tertiary centres.

The 2019 ban on colistin as a growth promoter in animal husbandry is a significant regulatory step that reduces selection pressure for resistance to a last-resort antibiotic. Yet enforcement, monitoring and alternatives for livestock producers must be improved. India's NAP-AMR provides the right strategic framework, but its slow operationalization at state and district levels limits effectiveness.

Way forward — actionable recommendations

• Scale surveillance by linking the 500+ NABL-accredited labs into a national network to capture community and primary-care data for representative estimates.
• Strengthen antibiotic stewardship across public and private sectors (guidelines, audit and feedback, diagnostic stewardship).
• Enforce regulations on OTC sales and pharmaceutical effluents; provide alternatives and incentives for livestock producers.
• Fund and incentivize R&D & industry engagement for novel antibiotics and rapid diagnostics, and create public-private partnerships.
• Promote One-Health implementation with measurable targets, capacity building and state-level operational plans.
• Public education to achieve antibiotic literacy and behaviour change at the community level.

Conclusion/Way Forward

AMR in India is a multifactorial problem requiring coordinated policy, regulatory enforcement, strengthened surveillance and sustained investment. State models like Kerala's AMRITH offer practical lessons, but nationwide success will depend on scaling these approaches, closing implementation gaps in NAP-AMR and treating AMR as a sustained, multisectoral priority.