Final of the year on 28 December 2025 mind matterPrime Minister (PM) Narendra Modi put a public face to a problem that is usually recorded as “clinical” or “technical”: Antibiotics are increasingly failing against everyday infections like pneumonia and urinary tract infections, partly because they are perceived as a quick fix rather than a medicine that demands precision. The significance 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. Benefits of abuse are immediate, harms are avoided, and accountability extends to prescribers, dispensers, patients, pharmacies, manufacturers, and regulators. Political attention does not solve coordination failures themselves, but it can legitimize enforcement, financing, and difficult choices that otherwise remain politically awkward.
In 2019, bacterial AMR directly caused approximately 1.27 million deaths worldwide and was linked to approximately 4.95 million. It’s driven not so much by any one dramatic failure as by everyday clinical and retail shortcuts, where antibiotics are used to compensate for poor diagnosis, rushed care, and inconsistent infection control, and germs perceive that risk as selection pressure. India focuses on these conditions, which is why a 2021 estimate (from a Global Burden of Disease analysis cited in recent reporting) puts AMR-attributable deaths at around 2.6 lakh, with around 9.8 lakh deaths occurring with resistant infections.
The Prime Minister’s warning comes at a time when AMR is not being managed through blanket statements alone. In 2024, the UN General Assembly’s political declaration set a concrete target: reduce deaths from the bacteria AMR by 10% by 2030 compared to 2019. Goals matter because they force choices. They force governments to decide what will be counted, paid for, and enforced, and they highlight the limitations of pilots that look good on paper but don’t change control at scale. India has responded by updating its roadmap. On November 18, 2025, the Union Health Minister launched NAP-AMR 2.0 (2025-2029), clearly built through One Health, which links human health, animals, food systems and the environment. The importance of this is not the language of alignment, but the effort to create governance for the problem of slipping between regions and jurisdictions.
If AMR is a collective action failure, “public action” awareness may not last for weeks and a few model hospitals. It must change the everyday incentives for care so that even the fastest option is not the one that generates the most resistance. Three pillars underpin that work: sustainable governance and financing, a health infrastructure that treats resistance as a shared signal, and diagnostics that reduce uncertainty, driving defensive prescriptions.
AMR cannot be managed as a series of small projects that shine with external funding and fade when attention wanes. It behaves like a public utility problem because surveillance, infection prevention, and laboratory capacity are the infrastructure that makes rational determination possible. NAP-AMR 2.0 can coordinate, but the coordination itself is not implemented. The test is whether the AMR is given projected budget lines at the Central and State levels, and whether responsibility for judging performance is adequately devolved. Measurement is key and requires regular tracking of antibiotic consumption, cultures taken before antibiotics, compliance with surgical prophylaxis, infection-control audits, and whether antibiograms are prescribed rather than collected.
Microorganisms move through people, animals, food chains, and water. Treating AMR as only a hospital problem misunderstands how resistance arises and is sustained. It starts with surveillance and doesn’t end at the hospital gate. Antimicrobial use and resistance patterns in animal husbandry, aquaculture, and food production are on the same map as hospital antibiograms. The environmental front is where governance is most inconvenient and most necessary. Residues and resistant organisms are present in pharmaceutical manufacturing clusters, dense livestock belts and waste water discharge points. If management is demanded from physicians while resistant organisms are continually sown and propagated outside the clinic, the system is struggling hard. What is needed is outbreak-grade discipline applied to slow threats like sentinel sites, standardized testing and reliable data.
Most irrational antibiotic use begins as a form of risk management. When diagnosis is slow, unavailable, or unobtainable, a broad-spectrum antibiotic becomes an insurance policy. If India wants rational antibiotic use on a large scale, it will have to make it easier to achieve clinical certainty than speculative prescribing. This means moving from symptom-based treatment to diagnosis-informed care through a reliable pathway that includes affordable point-of-care testing where appropriate, working microbiology at least at the district level, reliable sample transport, rapid turnaround, and antibiograms used in decision making.
The Prime Minister’s statement that antibiotics should be taken only on medical advice is difficult to oppose and even more difficult to implement. India’s antibiotic economy runs on speed: brief consultations, quick delivery, and a public system that does not reliably provide diagnosis. In that setting, AMR is less a failure of awareness than a failure of alignment between incentives and protection measures.
Using over the counter (OTC) antibiotics is not a trivial practice. When the drugstore becomes the first point of care, the pharmacy counter begins to perform clinical functions without the clinical infrastructure that makes prescriptions secure. Schedule H1 limits specified antimicrobials to sale only by prescription and requires records of inspection; The Red Line campaign attempted to turn that rule into a social signal. The difference is the realities of observability and access. The practical approach is better regulation, not softer regulation. Treat pharmacies as regulated partners in accessibility, conduct predictive audits for H1 compliance, ensure targeted redress for repeat violators, and ensure digital traceability where infrastructure allows. Also, reduce the demand that drives OTC sales by making it easier to get reliable advice and needed medicines through public facilities.
There is relief in believing that science will provide a new generation of antibiotics in time. The global pipeline does not justify that facility. Innovation is limited for serious infections and priority pathogens, while resistance is developing faster than the incentives driving new drug development. For India, this redefines health security. The highest-leverage strategy is to preserve the things that still work such as strict management, strong infection prevention, and diagnostics that reduce indiscriminate prescribing. R&D for new antimicrobials matters, but the quieter work of ensuring manufacturing quality and responsible marketing also matters.
AMR policy looks neat until it reaches farms and food systems. The UN Political Declaration for 2024 clearly draws the agri-food sector into AMR commitments, and India cannot treat this as a formality when livestock and aquaculture are both livelihood engines and potential reservoirs of resistant organisms. A credible transformation reduces the need for antibiotics in animals through vaccination, biosecurity and husbandry improvements, supported by veterinary extension capacity reaching beyond urban centres. Without a transition plan, pressure to reduce antimicrobial use will be ignored or complied with on paper while informal channels continue to supply the same drugs.
India is not starting from zero. NAP-AMR 2.0 (2025-2029) has been launched with the One Health Framework; NCDC has an AMR prevention program and surveillance structures in place; ICMR’s surveillance network continues to publish evidence; And states like Kerala have documented action plans. The difference is not the absence of initiatives but the failure to regularize them. Prevention will be visible when there is change in daily OPD care. Cultures are taken more frequently before antibiotics, antibioticograms are used instead of filing, infection control is treated as a performance metric, Schedule H1 compliance is monitored predictively, and One Health Surveillance generates signals that trigger actions rather than reports.
PM’s message is correct. Global targets have been set. The national plan has been refreshed. India’s health security will be determined by small choices: whether a prescription is written to manage uncertainty, whether a pharmacy respects sales rules or queues, whether a hospital treats infection control as a checklist or as a performance, and whether pharmacies prevent disease well enough to stop relying on antibiotics. Those decisions, repeated daily in clinics, pharmacies and farms, will determine whether political attention becomes durable protection or a brief flare-up before business returns to normal.
This article is written by Dr K Madan Gopal, Senior Health Sector Expert and Consultant, Public Health Administration, NHSRC and Dr KS Available Gopal, Associate Fellow, Health Initiative, Observer Research Foundation (ORF), New Delhi.
