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Can clinics, pharmacies and farms get on the same page to tackle AMR?
This article is authored by Dr K Madan Gopal and Dr KS Uplabdh Gopal.
On 28 December 28, 2025, in the year’s final Mann Ki Baat, Prime Minister (PM) Narendra Modi put a public face on a problem that is usually filed away as “clinical” or “technical”: Antibiotics are increasingly failing against everyday infections such as pneumonia and urinary tract infections, in part because they are treated as a quick fix rather than a medicine that demands precision. The importance of that moment lies less in the warning and more in what it does to the politics of antimicrobial resistance (AMR). AMR is a classic collective-action failure. The benefit of misuse is immediate, the harm is deferred, and accountability is spread across prescribers, dispensers, patients, farms, manufacturers and regulators. Political attention does not solve coordination failures by itself, but it can legitimise enforcement, financing and hard choices that otherwise remain politically awkward.
In 2019, bacterial AMR directly caused about 1.27 million deaths worldwide and was associated with roughly 4.95 million. It is not driven by a single dramatic failure so much as by everyday clinical and retail shortcuts, where antibiotics are used to compensate for thin diagnostics, hurried care, and inconsistent infection control, and microbes treat that exposure as selection pressure. India concentrates these conditions, which is why 2021 estimates (from Global Burden of Disease analyses cited in recent reporting) place AMR-attributable deaths at around 2.6 lakh, with roughly 9.8 lakh deaths occurring alongside resistant infections.
The PM’s warning comes at a moment when AMR is no longer being managed through broad statements alone. In 2024, the UN General Assembly’s Political Declaration set a concrete goal: Cut deaths associated with bacterial AMR by 10% by 2030, relative to 2019. Targets matter because they force choices. They compel governments to decide what will be counted, paid for, and enforced, and they expose the limits of pilots that look good on paper but do not change controls at scale. India has responded by updating its roadmap. On November 18, 2025, the Union health minister launched NAP-AMR 2.0 (2025–2029), framed explicitly through One Health, linking human health, animals, food systems, and the environment. Its importance is not the language of alignment, but the attempt to build governance for a problem that slips between sectors and jurisdictions.
If AMR is a collective-action failure, “public action” cannot stop at awareness weeks and a handful of model hospitals. It has to change the everyday incentives of care so that the quickest option is not also the most resistance-producing one. Three pillars do that work: durable governance and financing, One Health infrastructure that treats resistance as a shared signal, and diagnostics that shrink the uncertainty driving defensive prescribing.
AMR cannot be managed as a string of short projects that flare up with external funding and fade when attention moves on. It behaves like a public utility problem as surveillance, infection prevention, and laboratory capacity are the basic infrastructure that makes rational prescribing possible. NAP-AMR 2.0 can coordinate, but coordination does not implement itself. The test is whether AMR is given predictable budget lines at Union and state levels, and whether responsibility is assigned tightly enough for performance to be judged. Measurement is the hinge and requires routine tracking of antibiotic consumption, cultures taken before antibiotics, compliance with surgical prophylaxis, infection-control audits, and whether antibiograms shape prescribing rather than gathering dust.
Microbes move through people, animals, food chains, and water. Treating AMR as a hospital-only problem misunderstands how resistance is produced and sustained. That starts with surveillance that does not end at the hospital gate. Antimicrobial use and resistance patterns in animal husbandry, aquaculture, and food production belong on the same map as hospital antibiograms. The environmental front is where governance is most uncomfortable and most necessary. Residues and resistant organisms exist in pharmaceutical manufacturing clusters, dense livestock belts, and wastewater discharge points. If stewardship is demanded from clinicians while resistant organisms are continually seeded and amplified outside the clinic, the system is fighting uphill. What is needed is outbreak-grade discipline applied to a slower threat like sentinel sites, standardised testing, and credible data.
Most irrational antibiotic use begins as risk management. When diagnostics are slow, unavailable, or unaffordable, a broad-spectrum antibiotic becomes an insurance policy. If India wants rational antibiotic use at scale, it must make diagnostic certainty easier to obtain than presumptive prescribing. That means moving from symptom-led treatment to diagnostic-informed care through a dependable pathway which includes affordable point-of-care tests where appropriate, functioning microbiology at least at district level, reliable sample transport, faster turnaround, and antibiograms that are used in decision-making.
The PM’s line that antibiotics should be taken only on medical advice is hard to contest and harder to implement. India’s antibiotic economy runs on speed: Brief consultations, rapid dispensing, and a public system that does not reliably deliver diagnostics. In that setting, AMR is less a failure of awareness than a failure of alignment between incentives and safeguards.
Over the counter (OTC) antibiotic use is not a fringe behaviour. When the medicine shop becomes the first point of care, the pharmacy counter begins to perform a clinical function without the clinical infrastructure that makes prescribing safe. Schedule H1 restricts specified antimicrobials to prescription-only sale and requires records for inspection; the Red Line Campaign attempted to turn that rule into a social cue. The gap is inspection capacity and the realities of access. The workable approach is smarter regulation, not softer regulation. Treat pharmacies as regulated partners in access, have predictable audits for H1 compliance, ensure targeted deterrence for repeat violators, and digital traceability for where infrastructure allows. At the same time, reduce the demand that drives OTC sales by making credible advice and essential medicines easier to obtain through public facilities.
There is comfort in believing science will deliver a new generation of antibiotics in time. The global pipeline does not justify that comfort. Innovation remains limited for serious infections and priority pathogens, while resistance continues to evolve faster than the incentives that drive new drug development. For India, this reframes health security. The highest-leverage strategy is to preserve what still works such as tighter stewardship, stronger infection prevention, and diagnostics that reduce blind prescribing. R&D for new antimicrobials matters, but so does the quieter work of ensuring manufacturing quality and responsible marketing.
AMR policy reads tidy until it reaches farms and food systems. The UN’s 2024 Political Declaration explicitly pulls the agri-food sector into AMR commitments, and India cannot treat that as a formality when livestock and aquaculture are both livelihood engines and potential reservoirs of resistant organisms. A credible transition lowers the need for antibiotics in animals through vaccination, biosecurity, and husbandry improvements, backed by veterinary extension capacity that reaches beyond urban centres. Without a transition plan, pressure to reduce antimicrobial use will be ignored or complied with on paper while informal channels will continue to supply the same drugs.
India is not starting from zero. NAP-AMR 2.0 (2025–2029) has been launched with a One Health frame; NCDC’s AMR containment programme and surveillance structures exist; ICMR’s surveillance network continues to publish evidence; and states such as Kerala have documented action plans. The gap is not the absence of initiatives but the failure to make them routine. Containment will be visible when everyday OPD care changes. Cultures are taken more often before antibiotics, antibiograms are used rather than filed, infection control is treated as a performance metric, Schedule H1 compliance is inspected predictably, and One Health surveillance produces signals that trigger action rather than reports.
The PM’s message is correct. The global target has been quantified. The national plan has been refreshed. India’s health security will be settled in the small choices: Whether a prescription is written to manage uncertainty, whether a pharmacy sale respects the rule or the queue, whether a hospital treats infection control as a checklist or as performance, and whether farms prevent disease well enough to stop leaning on antibiotics. Those decisions, repeated daily across clinics, pharmacies, and farms, will decide whether political attention becomes durable protection or a brief flare before business returns to usual.
This article is authored by Dr K Madan Gopal, senior health sector expert and advisor, public health administration, NHSRC and Dr KS Uplabdh Gopal, associate fellow, health initiative, Observer Research Foundation (ORF), New Delhi.
