Written on November 14, 2025
India’s first national action plan on antimicrobial resistance (NAP-AMR 1.0) ended in 2021. It should have been followed, ideally immediately, by a renewed strategy, new targets, and a clear mandate for states and ministries. Instead, four years have passed without a publicly released successor. Consultations were held in the last four years, expert reports have been produced, and ministries have met, but no national blueprint has been released so far. In AMR governance, and for a threat that grows silently and relentlessly, this gap is not a bureaucratic footnote. It is a structural gap with tangible consequences, and a potential sign that India’s AMR governance could be losing the continuity that the problem demands.
NAP-AMR 1.0 was built on six pillars: awareness, surveillance, infection prevention and control (IPC), antimicrobial stewardship, research, and leadership. It helped expand laboratory networks, mainstream AMR in policy conversations, and nudge multiple ministries into cooperation. Educational materials were created, surveillance partnerships with hospitals widened, and the One Health concept formally entered India’s institutional vocabulary.
Yet several core components in responding to a complex problem like AMR, in a setting where the burden is so high, remained incomplete. State Action Plans were slow to materialise, with only a handful of states operationalising them. Environmental pathways (wastewater discharge, agricultural run-off, effluent controls) remained the weakest link in the One Health chain. Antimicrobial stewardship struggled to take root in secondary hospitals, where misuse is often highest. Rural and informal markets, where over-the-counter antibiotic sales flourish, remained largely untouched.
These were not failures; they were tasks awaiting a strengthened successor plan. And that successor has still not been made public.
AMR is not a five-year problem. Bacteria continue to accumulate resistance, surveillance systems need annual reinforcement, stewardship requires stable mandates, and coordination across human, animal and environmental sectors cannot be switched on and off.
When a national plan expires and no new one replaces it, predictable risks follow. For instance, institutional momentum weakens as committees meet less frequently, funding streams lose their anchor, and stewardship pilots stall. States risk losing direction without new national targets, and state plans risk drifting or stagnating. Surveillance and IPC falter as laboratories plateau, data flows slow, and quality assurance weakens without a national framework in place. One Health integration recedes with environmental and veterinary components, which are already stretched, lose further priority. And finally, equity gaps widen: well-resourced states (or indeed states with a strong health systems infrastructure) may continue improving, but poorer states (and the facilities where misuse is highest) fall behind.
In a country where carbapenem-resistant Klebsiella, Acinetobacter, and Pseudomonas are rising steadily in hospitals, and where rural health systems depend heavily on national directives for stewardship and diagnostics, policy pauses are not neutral. They create space for the problem to deepen.
The scale of India’s AMR crisis makes this policy vacuum even harder to justify. India is widely described as one of the world’s AMR “hotspots”, combining very high infectious disease burden with intense antibiotic use, weak regulation and deep social inequalities. Analyses of global consumption data show that India had become the world’s largest consumer of antibiotics in human health in absolute terms, with roughly a doubling of antibiotic use between 2000 and 2015. Recent Indian hospital data from the ICMR AMR Surveillance Network show that around half of Klebsiella spp. isolates (54%) and 40% of E. coli isolates from blood and other sterile sites are already resistant to at least one carbapenem, drugs that are supposed to be last-resort options. Non-susceptibility to broad-spectrum agents such as third-generation cephalosporins and fluoroquinolones in E. coli has reached around 75–80% in some Indian surveillance datasets, and reviews of urinary E. coli in India consistently report fluoroquinolone resistance above 60%.
The human cost is stark: estimates suggest that tens of thousands of Indian newborns die every year from sepsis caused by resistant bacteria, with one analysis putting this figure above 58,000 deaths annually, and another suggesting that roughly a third of an estimated 190,000 neonatal sepsis deaths may be attributable to antibiotic resistance. At the same time, India has a vast and complex antibiotic market, with over-the-counter sales, informal providers and under-regulated prescribing repeatedly documented as major drivers of misuse, while surveillance of antibiotic consumption remains patchy. The pressures extend beyond hospitals: antimicrobial use in food-producing animals is estimated at over 2,000 tonnes per year and projected to rise further, and multiple studies have detected antibiotic residues and resistant bacteria in Indian rivers and water bodies downstream of pharmaceutical, hospital and urban effluents.
In a country with this combination of high burden, intense antimicrobial use and documented environmental contamination, the absence of an updated national action plan is not just a minor policy delay, it is a systemic risk.
COVID-19 undoubtedly disrupted health systems worldwide. But the pandemic did not halt AMR governance across other countries. In fact, many nations released or updated their national AMR plans during the pandemic years: