[Answered] Examine the reasons for the resistance faced by India’s National Action Plan on AMR. Justify the necessity of a fresh commitment to implement its second version effectively.

Introduction

According to WHO’s Global Antibiotic Resistance Surveillance Report (2023), one in three bacterial infections in India is resistant to commonly used antibiotics, highlighting the urgent need for robust AMR policy implementation.

AMR as Public Health Trust

1. Antimicrobial Resistance (AMR) is considered by UNEP (2023) as one of the top global public health threats, causing nearly 5 million deaths annually (Lancet, 2022).
2. India, being the world’s largest consumer of antibiotics (OECD, 2020) and having a high communicable disease load, faces heightened vulnerability.
3. The National Action Plan on AMR (NAP-AMR 2017-21) aimed to establish antibiotic stewardship, strengthen laboratory surveillance, and promote the One Health approach, but faced substantial resistance and implementation challenges.

Reasons for resistance faced by NAP-AMR

1. Weak inter-governmental coordination: Health is a State subject; implementation required strong cooperation. Only Kerala adopted and executed a State AMR policy, showing measurable reduction in resistance levels. Most States lacked institutional mechanisms.
2. Overuse and misuse of antibiotics: Easy over-the-counter access, aggressive pharmaceutical marketing, and irrational prescription patterns impede stewardship. CDDEP study (2022) reported 60% antibiotic prescriptions in India were inappropriate.
3. Limited surveillance and laboratory capacity: Although NCDC expanded its surveillance network during COVID-19, monitoring remains fragmented, especially in Tier-2/3 regions and rural areas.
4. Influence of livestock and agriculture sectors: Use of antibiotics as growth promoters in poultry and aquaculture worsened resistance. Although colistin was banned in 2019, enforcement remains weak.
5. Lack of awareness and behavioural resistance: Public demand for quick cures, limited education on microbial threats, and poor infection prevention and control (IPC) standards hinder adoption.
6. Fragmented One Health implementation: Cross-sector collaboration among health, veterinary, food safety and environment ministries remains minimal, despite the multidisciplinary nature of AMR transmission.

Why a fresh commitment for NAP-AMR 2025–29 is necessary

1. Escalating health crisis: Rising resistance in pathogens like E.coli and Klebsiella pneumoniae has made last-line antibiotics ineffective, leading to unmanageable hospital infections.
2. Economic burden: World Bank estimates AMR could push 28 million people into poverty by 2050 and cause about 3.8% GDP loss in low-income nations, including India.
3. Strengthening global leadership: As a G20 member, India must demonstrate global stewardship and align with the Global AMR Action Plan (WHO, FAO, OIE).
4. Need for enforceable regulation: Stronger prescription rules, clinical audit systems, and environmental discharge standards for pharma industries are required to curb antimicrobial pollution.
5. Integrating One Health: Holistic AMR control must cover hospitals, farms, wastewater, and community behaviour simultaneously—not isolated silos.

Conclusion

As Amartya Sen argues in The Idea of Justice, institutional intent without implementation is inadequate. A strengthened NAP-AMR 2.0 must transform commitments into actionable, enforceable, accountable public health reforms.