Type: Prelims Only

INTRODUCTION

AMR in India is now labelled a “serious and escalating threat”, with the latest WHO GLASS report (2025) confirming extraordinarily high resistance levels across commonly used antibiotics. Nearly one in five severe infections in India mirrored or exceeded South and East Asian trends, and one in six confirmed infections was resistant. India’s high infectious disease burden, misuse of antibiotics, weak surveillance, and gaps in healthcare infrastructure continue to aggravate the problem. The article highlights incomplete data, insufficient funding, fragmented stewardship, and the urgent need for rational antibiotic use, surveillance strengthening, and affordable new-generation antibiotics.

WHY IN THE NEWS? 

India features prominently in the WHO’s October 2025 GLASS report, which confirms that the country now records some of the highest antibiotic resistance rates globally, particularly for gram-negative pathogens. For the first time, GLASS shows significant data gaps, reflected in India uploading surveillance results from only tertiary hospitals, leaving rural and peripheral areas undocumented. The report highlights a sharp contrast with global progress, exposing India’s limited surveillance expansion, weak stewardship, and slow adoption of newer effective antibiotics, despite AMR being among the country’s gravest public-health threats.

Understanding the Scale of AMR in India

1. High Resistance Rates: India shows disproportionately high resistance to commonly used antibiotics, especially in infections caused by E. coli, Klebsiella pneumoniae, Staphylococcus aureus, and pathogens causing sepsis in ICUs.
2. Escalating Threat Category: WHO labels AMR in India as a “serious and escalating threat,” placing India among the highest global burden countries.
3. Gram-Negative Pathogens: Severe risks emanate from resistance trends in gram-negative bacteria which limit treatment options in hospitals.
4. Community-Hospital Gap: Surveillance primarily reflects tertiary hospital data, leaving a large rural and primary-care void, producing incomplete national estimates.

Why Current Surveillance is Insufficient

1. Incomplete Data Representation: GLASS data reflects only a segment of India’s population; peripheral, rural, and primary-care levels remain unrepresented, leading to erroneous conclusions.
2. Fragmented Networks: Laboratories under NCDC’s AMR and AMRRSN networks provide data, but coverage is inadequate for a country of India’s scale.
3. Operational Challenges: Shortage of trained microbiologists, inconsistent reporting, and infrastructure deficits weaken surveillance reliability.
4. Underestimation of Burden: Without wider surveillance, actual AMR spread across different geographies or demographic groups remains unknown.

Kerala’s State-Led Model of AMR Management

1. State Action Plan Success: Kerala’s progress stems from early adoption of the State Action Plan aligned with India’s National Action Plan (NAP-AMR).
2. Whole-of-System Approach: Kerala integrates veterinary, human health, and environmental data, demonstrating One Health operationalisation.
3. Institutional Leadership: Dedicated stewardship committees and infection-control protocols ensure sustained monitoring and policy continuity.

Antibiotic Stewardship and Public Awareness Challenges

1. Unregulated Antibiotic Use: Easy over-the-counter access, self-medication, and incomplete courses contribute to rising resistance.
2. Hospital Overuse: Lack of stewardship committees and infection-control practices deepen resistance in ICUs and emergency departments.
3. Limited Community Awareness: Behavioural change campaigns remain inadequate, leading to misconceptions about antibiotic effectiveness.
4. Inappropriate Prescriptions: Physicians often prescribe broad-spectrum antibiotics without culture sensitivity results due to delays or lack of labs.

Innovation, R&D Pipelines and the Crisis of New Antibiotics

1. Weak Domestic Innovation: Only 2 of the 32 antibiotics under global development meet WHO innovation criteria.
2. Positive Trend: India’s CDSCO approved two new antibiotic candidates recently, while six others received global approval.
3. Global Gap: Out of 97 candidates in preclinical pipelines (2022), few target WHO’s priority pathogens.
4. High Barriers: Costly R&D, limited incentives, and delayed regulatory approvals weaken India’s innovation environment.

Global and National Funding Gaps

1. Insufficient Domestic Funding: India’s AMR response suffers from limited financial allocations, affecting surveillance expansion and lab capacity building.
2. Gaps in Multilateral Support: Despite WHO’s Global AMR Challenge, LMICs like India lack sustained funding for new antibiotics and diagnostics.
3. Need for Collaborative Platforms: Strengthened partnerships with bodies like the AMR Industry Alliance and CARB-X can accelerate innovation pipelines.

Why Solutions Must Prioritise Stewardship, Surveillance, and Affordability

1. Urgency of Behaviour Change: Stewardship requires both medical and community engagement to reduce irresponsible antibiotic use.
2. Strengthening Peripheral Health Systems: Decentralised surveillance networks are essential to capture India’s actual AMR burden.
3. Making New Antibiotics Accessible: India must prioritise affordability and availability given rising MDR (multi-drug resistant) infections in LMICs.
4. Integrating One Health: Coordinated animal-human-environmental monitoring is indispensable for durable AMR containment.

CONCLUSION

India stands at a critical juncture where AMR has outpaced existing stewardship, surveillance, and innovation capabilities. The GLASS 2025 report acts as a mirror reflecting the country’s systemic gaps, from incomplete data and misuse of antibiotics to insufficient funding and slow R&D advancement. A robust national response must integrate strong stewardship, affordable innovation, decentralised surveillance, and a One Health framework to prevent AMR from becoming an unmanageable public-health catastrophe.

PYQ Relevance

[UPSC 2014] Can overuse and free availability of antibiotics without Doctor’s prescription be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

Linkage: Because AMR is a recurring public-health crisis with direct links to governance, regulation, and science-tech, making it a favourite UPSC theme. The article shows rampant antibiotic misuse and OTC access driving India’s high resistance rates. This exactly reflects the PYQ’s focus on irrational use, weak monitoring, and stewardship gaps.

Why in the News?

Health authorities are debating whether Hepatitis A vaccine should have higher priority for inclusion in Universal Immunisation Programme (UIP) compared to Typhoid Conjugate Vaccine (TCV).

About Hepatitis A:

• Overview: Viral infection caused by Hepatitis A Virus (HAV), spreading through contaminated food, water, or close contact with an infected person.
• Nature of Disease: Leads to acute liver inflammation with fever, jaundice, nausea, abdominal pain, and fatigue.
• Treatment: No antiviral therapy; illness is self-limiting and recovery occurs within six months with supportive care.
• Vaccine: Highly effective (90 to 95 percent), long-lasting immunity for 15 to 20 years or lifelong; prevents symptomatic infection.
• Current Trend: Improved sanitation lowers childhood exposure, but adult susceptibility is rising, increasing disease severity.

What is Universal Immunisation Programme (UIP)?

• Launch and Evolution: Started in 1985; later integrated with Child Survival and Safe Motherhood Programme (1992) and National Rural Health Mission (2005).
• Coverage: Provides free vaccines against 12 diseases–  9 nationally (Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, Tuberculosis, Hepatitis B, Hib) and 3 in selected states (Rotavirus, Pneumococcal Pneumonia, Japanese Encephalitis).
• Achievements: Played a central role in polio eradication, reducing measles deaths, and improving child survival indicators.

Why Hepatitis A deserves priority?

• Greater Adult Severity: Shift from childhood to adult infections results in higher rates of acute liver failure.
• Recent Outbreaks: Reported surges in Kerala, Maharashtra, Delhi, and Uttar Pradesh signal a widening public-health risk.
• Falling Immunity: Seroprevalence has declined from around 90 percent to under 60 percent in many cities, leaving millions unprotected.
• Indigenous Vaccine: Biovac-A (Biological E Ltd.) is safe, affordable, and effective, with single-dose protection simplifying rollout.
• No Resistance Concerns: Viral disease with no antibiotic use eliminates resistance challenges.
• Cost Advantage: More economical and operationally easier than multi-dose vaccines like typhoid conjugate vaccine.
• Policy Relevance: Inclusion in the national programme could curb outbreaks and reduce adult liver-failure cases.

Back2Basics: Hepatitis What is it: Liver inflammation from viruses, alcohol, toxins, drugs, autoimmune disorders, or metabolic issues. Viral Types: A – Fecal-oral; acute; vaccine available. B – Blood/body fluids; chronic risk; vaccine available. C – Blood-to-blood; often chronic; no vaccine; treatable with antivirals. D – Discussed above. E – Fecal-oral; usually acute. Chronic B, C, D: Major drivers of cirrhosis and liver cancer. Prevention: Vaccination (A, B), safe injections, screened blood, safe sex, good hygiene.

 

[UPSC 2019] Which one of the following statements is not correct? (a) Hepatitis B virus is transmitted much like HIV. (b) Hepatitis B, unlike Hepatitis C, does not have a vaccine. * (c) Globally, the number of people infected with Hepatitis B and C viruses are several times more than those infected with HIV. (d) Some of those infected with Hepatitis B and C viruses do not show the symptoms for many years.

 

Why in the News?

Recent investigations after the Delhi Bomb Blast revealed a plot to use ricin, a deadly biological toxin, for large-scale terror attacks.

About Ricin:

• Origin: Ricin is a highly toxic protein derived from the mash left after processing castor beans (Ricinus communis) for castor oil.
• Discovery: First isolated in 1888 by German scientist Peter Hermann Stillmark, who documented its lethal, cell-destroying properties.
• Mechanism of Action: Ricin enters human cells and blocks protein synthesis, causing rapid cell death, tissue damage, and multi-organ failure. Even a few micrograms can be fatal.
• Routes of Exposure: Can cause poisoning through inhalation, ingestion, or injection, each producing sudden symptoms like respiratory collapse, gastrointestinal bleeding, seizures, and circulatory failure.
• Treatment: No antidote exists; medical management involves supportive care such as oxygen therapy, IV fluids, activated charcoal (if ingested early), and mechanical ventilation.
• Weaponisation Risk: Due to easy availability from an agricultural by-product and high lethality, ricin is classified globally as a potential bioterrorism agent.

Legal Classification and Security Implications:

• International Status: Listed under Schedule 1 of the Chemical Weapons Convention (CWC) and controlled under the Biological Weapons Convention (BWC).
• Indian Legal Framework: Criminalised under the Chemical Weapons Convention Act, 2000, and the Unlawful Activities (Prevention) Act (UAPA), with offences being non-bailable.
• Penalties: Violations involving ricin can result in life imprisonment under Indian law.
• WMD Classification: Covered under the Weapons of Mass Destruction and Delivery Systems Act, 2005, placing it within the legal category of weapons of mass destruction.
• Dual-Use Concern: Castor is an industrial crop, making ricin a dual-use substance requiring strict monitoring of castor by-products.