India needs to strengthen and implement regulations on antibiotic misuse
Even as antibiotics lose their efficacy against deadly infectious diseases worldwide, it seems to be business as usual for governments, private corporations and individuals who have the power to stall a post-antibiotic apocalypse. In a recent investigation, it was found that the world’s largest veterinary drug-maker, Zoetis, was selling antibiotics as growth promoters to poultry farmers in India, even though it had stopped the practice in the U.S. India is yet to regulate antibiotic-use in poultry, while the U.S. banned the use of antibiotics as growth-promoters in early 2017. So, technically, the drug-maker was doing nothing illegal and complying with local regulations in both countries. But such reasoning is self-defeating, because antibiotic-resistance does not respect political boundaries. Of course, the country that stands to lose the most from antibiotic resistance is India, given that its burden of infectious disease is among the world’s highest. According to a 2016PLOS Medicinepaper, 416 of every 100,000 Indians die of infectious diseases each year. This is more than twice the U.S.’s crude infectious-disease mortality-rate in the 1940s, when antibiotics were first used there. If these miracle drugs stop working, no one will be hit harder than India.This is why the country’s progress towards a tighter regulatory regime must pick up pace. Consider the three major sources of resistance: overuse of antibiotics by human beings; overuse in the veterinary sector; and environmental antibiotic contamination due to pharmaceutical and hospital discharge. To tackle the first source, India classified important antibiotics under Schedule H1 of the Drugs and Cosmetics Rules 1945, so that they couldn’t be sold without prescriptions. Still, Schedule H1 drugs are freely available in pharmacies, with state drug-controllers unable to enforce the law widely. As far as veterinary use goes, India’s 2017 National Action Plan on Antimicrobial Resistance did talk about restricting antibiotic use as growth promoters. Sadly, no progress has been made on this front yet, allowing companies to sell last-resort drugs to farmers over the counter. The 2017 document also spoke about regulating antibiotics levels in discharge from pharmaceutical firms. For instance, Hyderabad’s pharmaceutical industry has been pumping massive amounts of antibiotics into local lakes, rivers and sewers. This has led to an explosion in resistance genes in these waterbodies. Still, India is yet to introduce standards for antibiotics in waste water, which means antibiotic discharge in sewage is not even being monitored regularly. As the country takes its time to formulate regulations, the toll from antibiotic-misuse is growing at an alarming rate. According to a 2013 estimate, around 58,000 newborns die in India each year due to sepsis from resistant bacteria. When these numbers mount, India will have no one to blame but itself.