The Silent Pandemic

How many times have we casually popped a pill for a common cold, a mild fever, or a routine headache? How often have we prescribed ourselves a cocktail of antibiotics for what is often just a harmless sore throat? Each of these seemingly innocent actions contributes to a far deadlier crisis than most people realise: Antimicrobial Resistance (AMR).

AMR occurs when bacteria, viruses, fungi, or parasites evolve to withstand the very medicines designed to kill them, rendering infections increasingly difficult—or in some cases, impossible—to treat. The result is a health threat so severe that it is already killing more people than cancer in some parts of the world.

The O’Neill Report (2016), commissioned by the UK government, warned that if left unchecked, AMR could cause up to 10 million deaths annually by 2050 and inflict an economic burden of USD 100 trillion. Already, in 2019 alone, over 1.3 million deaths worldwide were directly attributed to antibiotic-resistant infections.

India, unfortunately, sits at the eye of this storm. That same year, 297,000 deaths in India were directly caused by AMR, while another 1.04 million deaths were associated with it, making us one of the countries bearing the heaviest burden. A study funded by the Bill & Melinda Gates Foundation found that, on the eve of the COVID-19 pandemic, Sweden had the world’s lowest antibiotic resistance rates, while India topped the chart with a staggering 71.6% resistance rate.

The Deadly Six

Six particularly dangerous bacteria—E. coli, Klebsiella pneumoniae, Staphylococcus aureus, streptococcus pneumoniae, acintobacter baumannii and pseudomonas aeruginosa—account for the majority of AMR-related deaths worldwide. These pathogens are now categorised into escalating tiers of resistance: MDR (Multi-Drug Resistant): Resistant to at least three classes of antibiotics. XDR (Extensively Drug Resistant): Resistant to all but two antibiotic categories. PDR (Pan-Drug Resistant): Resistant to every commercially available antibiotic—a living nightmare for modern medicine.

The Big Bang of Antibiotics

Ancient civilisations like the Greeks, Romans, and Mayans used fungi, soil bacteria, and even moulds for medicinal purposes. Roman scholar Pliny the Elder wrote extensively about the healing properties of mushrooms in his Historia Naturalis. Hippocrates, the Greek physician, recognized the medicinal benefits of yeast to treat certain gynaecological issues.

The modern era of microbiology began in 1675, when Dutch scientist Antoni van Leeuwenhoek, peering through his handcrafted microscope, first observed living microorganisms. By the late 19th century, Robert Koch’s work on pathogens revolutionised medicine, paving the way for miracle drugs. The discovery of penicillin by Alexander Fleming in 1928 saved millions of lives and transformed healthcare. But just under a century later, that miracle is fast losing its magic.

Chaos is a Ladder

Bacteria reproduce with astonishing speed and can share resistance traits through horizontal gene transfer, accelerating their evolution. A recent ICMR (Indian Council of Medical Research) study revealed that resistance among E. coli is rising sharply: in 2017, 81% of strains could still be treated with Imipenem, an antibiotic,  but by 2022, effectiveness had plummeted to 65%.

Even Colistin—once hailed as the "last-resort antibiotic"—has fallen to misuse. While doctors restricted its use in humans due to toxicity, the agricultural sector used it liberally in livestock feed. By 2015, scientists in China confirmed Colistin-resistant strains of bacteria in animals—an ominous signal that agriculture-fuelled misuse could boomerang on human health.

The crisis is further compounded by environmental factors. A 2018 study in Nature Climate Change revealed that with every 10°C rise in temperature, resistance in E. coli increased by 4%, Klebsiella pneumoniae by 2%, and Staphylococcus aureus by 3%. Combine this with the WHO’s finding that 2 billion people worldwide consume water contaminated by faeces, and the result is a vicious cycle of resistant infections spreading silently across communities.

Way Forward

AMR is not a looming threat of the future—it is a clear and present danger, silently claiming lives each day. If cancer is the emperor of all maladies, antimicrobial resistance may well become the emperor’s more ruthless heir. The solution lies not in panic, but in swift, coordinated, and sustained action—by governments, doctors, farmers, and individuals alike.

The challenge of AMR is daunting but not insurmountable. India had attempted to take some steps, such as the 2011 H1 Rule, which restricted over-the-counter sales of certain antibiotics. Yet enforcement remains patchy, and a 2013 modification diluted its impact. As the “pharmacy of the world,” India produces over 20% of global generic drugs. Pharmaceutical companies must adopt wastewater treatment standards to prevent antibiotic discharge into rivers—a problem documented around Hyderabad’s bulk drug manufacturing hubs. A good step would be to mandate that all hospitals, including district and rural facilities, report AMR data to state health authorities. Currently, only NABH (National Accreditation Board for Hospitals & Healthcare) hospitals in India collect data on hospital-acquired infections every month and take measures to reduce such infections. It is essential to train healthcare staff in Antimicrobial Stewardship Programmes (ASPs), ensuring prescriptions are evidence-based, not profit-driven. Additionally, Kashmir’s economy is heavily agrarian, with livestock forming a key livelihood. Restricting indiscriminate antibiotic use in dairy and poultry, and promoting traditional methods of animal care, can make the region a model for antibiotic-smart farming.

If we fail, we risk entering a post-antibiotic era where a minor scrape or routine surgery could once again prove fatal. Humanity has fought and won against pandemics before—this time, the enemy is silent, but no less deadly.