In 2014, India achieved what many had deemed impossible: it eliminated wild poliovirus. Not long before, it was home to nearly half the world’s unvaccinated children. Yet within a few years, the country mobilised its public-health machinery—door-to-door immunisation, relentless surveillance, rapid outbreak response, and logistics—on a scale and with a level of precision that left no stone unturned. The result was not fleeting but lasting: India became polio-free and has remained so ever since.
Today, it is well placed to replicate that success against a different—and in many ways more insidious—public health threat that is currently sweeping its way across the country: Drug-resistant infections. India has already become the generic drugmaker of the world, but to tackle antimicrobial resistant (AMR) it now needs to innovate.
As with polio, India now faces a formidable challenge in drug resistance, with a recent small study showing that up to 83% of patients entering hospitals in India were carriers of drug-resistant bacteria. Such high resistance rates, combined with India’s large population and high infectious disease burden, makes it a hotspot for antimicrobial resistance (AMR).
With nearly five million AMR-associated deaths globally each year—of which India accounts for one fifth—this toll is now projected to rise by 70% globally by 2050. Yet at the same time, India also has the scientific expertise, clinical resources, pharmaceutical manufacturing capacity and regulatory standards to not only turn the tide at home, but to lead the global fight against AMR. That effort is already underway.
Since the launch of its National Action Plan (NAP) on AMR in 2017, India has ramped up efforts to improve how antibiotics are used across the country. Antibiotic stewardship matters because their unnecessary or inappropriate use gives bacteria the opportunity to develop resistance; without restraint, even the most powerful drugs will become less effective. Under its NAP, and through the work of the Indian Council of Medical Research (ICMR), India has been strengthening stewardship programmes, building capacity, expanding surveillance to track resistance patterns, and tightening controls on over-the-counter sales. These are essential foundations for slowing the spread of resistance and preserving the effectiveness of existing treatments.
But as the challenge evolves, so too must the response. In the years ahead, it will become increasingly important to complement these efforts with two critical priorities: The development of innovative new antibiotics, and improved access to them.
This is particularly urgent for the development of antibiotics that target difficult-to-treat gram-negative infections, which are expected to account for a growing share of the global burden and for which treatment options are rapidly diminishing. Of the 90 antimicrobials currently in development globally, just five are innovative and target at least one of the World Health Organization (WHO) critical priority pathogens, most of which are multidrug-resistant gram-negative infections that pose the greatest threat to people.
At the same time, given that most people in the world do not have access to the antibiotics they need, it is equally critical that the right treatments reach the people who need them. This lack of access doesn’t just cost lives, it is also driving AMR. Because if the right antibiotics aren’t made available and infections are not treated correctly, it gives bacteria the opportunity to spread and develop resistance, making infections more difficult to treat in the long-run.
The problem is that the way antibiotics are currently developed is not necessarily geared towards innovation or access. Pharmaceutical development and market forces tend to favour products designed for high-income settings, rather than for the countries bearing the greatest burden of drug-resistant infections. The result is a mismatch between need and innovation—one of the key reasons why AMR has now begun to outpace antibiotic development.
A radically different approach is required: one that aligns research and development with public health priorities and ensures that antibiotics are designed, tested and made accessible for the populations most at risk. Here, India is in a unique position. Its high burden of drug-resistant infections means that clinical trials can be conducted in large, relevant populations, generating robust data and ensuring that new treatments are suited to real-world needs—including for groups often excluded from trials, such as newborns, women and people with co-morbidities.
This is reinforced by India’s strong clinical research networks, coordinated through the ICMR, which are helping to close critical data gaps and support the development and introduction of new antibiotics. Equally important is its innovative biotech and pharmaceutical sector, which provides a clear path from drug discovery to large-scale, affordable manufacturing.
This is why the organisation I lead, the Global Antibiotic Research & Development Partnership (GARDP), is working so closely with partners across India. We are collaborating with innovative companies like Bugworks Research, to develop a novel broad-spectrum antibiotic, BWC-0977. Similarly, our partnerships with companies, such as Aurigene Pharmaceutical Services and Dr Reddy’s, will enable the manufacture and commercialisation of zoliflodacin, a new first-in-class antibiotic for the treatment of multidrug-resistant gonorrhoea. We have also partnered with Orchid Pharma to manufacture and supply cefiderocol, a critical antibiotic for treating carbapenem-resistant gram-negative infections, with a focus on affordable access in India and other countries.
To be clear, India can, and is, already doing so much to tackle AMR. Cefepime-zidebactam, a new combination antibiotic that is close to approval, both discovered and developed in India, is just one example. But our partnerships in India, including those with other organizations like the Biotechnology Industry Research Assistance Council (BIRAC), the Indian AMR Innovation Hub and the Centre for Cellular and Molecular Platforms (C-CAMP), can help further by building a new model—one that connects research, development, manufacturing and access from the outset. This represents a fundamental shift in how antibiotics are developed and delivered—moving away from fragmented, market-driven systems towards a coordinated, public health–focused model. If India could once defy expectations to eliminate polio, it now has the opportunity to do so again by becoming the antibiotic innovator of the world. In doing so it can also help to reshape the global response to AMR.
(The views expressed are personal)
This article is authored by Dr Manica Balasegaram, executive director, Global Antibiotic Research & Development Partnership (GARDP).
