Why is this in news?
- WHO released its Global Antimicrobial Resistance Surveillance System (GLASS) 2025 report in mid-October 2025.
- India identified as one of the worst AMR hotspots globally.
- Highlights a severe rise in antibiotic-resistant infections, especially in ICUs.
- Kerala’s progress and India’s slow national AMR implementation reignited policy debates.
- Published just ahead of World AMR Awareness Week (18–24 November).
Relevance
- GS 3 – Science & Technology / Biotechnology
Antimicrobial resistance, global surveillance systems (GLASS) - GS 3 – Health & Disease Burden
AMR as a major public health threat; ICU infections; One Health approach - GS 3 – Environment
Pharma effluent regulation, environmental determinants of AMR
Basics
- Antimicrobial resistance (AMR) occurs when microbes evolve to resist antibiotics → infections become harder or impossible to treat.
- AMR is driven by human, animal, agriculture, and environmental pathways → a One Health problem.
- GLASS is WHO’s global AMR monitoring system, operational in 100+ countries; India joined in 2017.
Key global findings (GLASS 2025)
- 1 in 6 infections globally resistant to commonly used antibiotics.
- South-East Asia shows the steepest rise; India is disproportionately affected.
- High resistance among critical pathogens: E. coli, Klebsiella pneumoniae, Staphylococcus aureus.
- WHO flags a modest but insufficient improvement in the global antibiotic development pipeline.
India-specific findings
- 1 in 3 infections in India in 2023 were antibiotic-resistant.
- Highest resistance burden in ICUs for E. coli, Klebsiella, and MRSA.
- Strong AMR drivers in India:
- Over-the-counter antibiotics
- Self-medication and incomplete courses
- Contaminated pharma effluents and hospital waste
- Weak enforcement of antibiotic regulations
- GLASS notes progress but flags underfunding, uneven surveillance, and weak coordination.
Current efforts in India
- National Programme on AMR Containment.
- ICMR’s AMRSN / i-AMRSS network.
- NCDC’s NARS-Net.
- 2019 ban on colistin in animal feed (significant but long-term impact).
Major weaknesses identified
- Surveillance bias:
- Overdependence on tertiary hospitals → overestimation of AMR; weak data from rural/primary-care settings.
- Underfunding:
- No long-term investment in AMR research, stewardship, or diagnostics.
- Poor One Health coordination.
- NAP-AMR implementation slow:
- 2017 plan remains mostly unexecuted in many States.
- Public awareness extremely low → AMR remains an abstract concept for most Indians.
Expert assessments
Abdul Ghafur
- India’s AMR levels are among the highest globally.
- True national estimates require integrating 500+ NABL labs + primary/secondary hospital microbiology.
V. Ramasubramanian
- Surveillance centres must be geographically spread; without regional representation, conclusions are distorted.
Ella Balasa
- Public needs relatable narratives; humanising AMR is essential for behavioural change.
Antibiotic development pipeline (critical analysis)
Global pipeline trends
- WHO 2024 pipeline report:
- 97 candidates in clinical & preclinical stages (up from 80 in 2021).
- Only 12 of 32 traditional antibiotics are innovative (new class or new mechanism).
- Just 4 candidates target WHO priority MDR Gram-negative pathogens.
India’s status
- CDSCO has approved four new antibiotic candidates in the last two years.
- Six more have global approval.
Limitations
- Pipeline is still too small to address global AMR.
- Limited innovation; low access in LMICs.
- Most new drugs do not target carbapenem-resistant Gram-negatives.
Features needed in next-generation antibiotics
- New mechanisms bypassing current resistance.
- Dual formulations (IV + oral).
- Activity against highest-priority MDR pathogens.
- Safe, affordable, and aligned with stewardship guidelines.
- Low likelihood of inducing further resistance.
Global and industry-side initiatives
AMR Industry Alliance
- Promotes development of new antibiotics and diagnostics.
- Supports responsible antibiotic manufacturing.
- Works on equitable access, especially in LMICs.
Funding gaps
- Surveillance and innovation receive intermittent and inadequate funding.
- Need sustained national investment in AMR research, stewardship, and public awareness.
Kerala model
- Only State with a fully operational AMR State Action Plan.
- Kerala AMR Strategic Action Plan (2018) adopts a strong One Health model.
- AMRITH (2024) stops over-the-counter antibiotic sales.
- State antibiogram shows a slight reduction in AMR levels.
- Goal: antibiotic-literate Kerala by December 2025.
Other significant interventions
- 2019 colistin ban in poultry/livestock → expected long-term benefits.
- Need uniform enforcement across all States.
What India must do (priority recommendations)
Surveillance
- Build a representative national network using NABL labs.
- Strengthen microbiology capacity in district and primary-care hospitals.
Stewardship
- Nationwide ban on OTC antibiotic sales.
- Standardised antibiotic guidelines across hospitals.
- Functional stewardship committees in all tertiary and secondary facilities.
Environment
- Regulate pharma effluents and medical waste.
- Mandatory antimicrobial pollutant monitoring.
Awareness
- Large-scale community orientation on AMR.
- Humanised public campaigns (schools, digital media).
Innovation
- Incentives for new antibiotic classes.
- Academia-industry collaborations.
- Public funding for early-stage R&D.
Governance
- Accelerate implementation of NAP-AMR (2017).
- Strong State-level monitoring and coordination.
Conclusion
- India’s AMR crisis is severe, escalating, and under-monitored.GLASS 2025 reinforces that resistance is rising faster than countermeasures, and progress remains fragmented.
Kerala demonstrates that structured One Health interventions, regulatory enforcement, and public literacy can reduce resistance trends. - India now needs integrated surveillance, strict stewardship, environmental control, innovation incentives, and long-term funding to prevent a future where routine infections again become untreatable.
