Fighting back against antimicrobial resistance: Partnerships and Innovations
By Dr Navin Dang, Ashwajit Singh, and Vinaina Suri
The global threat of antimicrobial resistance (AMR) is one of the most pressing public health challenges of our time. In India, this silent pandemic threatens to undermine decades of medical progress as previously treatable bacterial infections increasingly defy conventional antibiotic interventions. From compromising the safety of routine surgical procedures to rendering common infections potentially lethal, AMR poses an unprecedented risk to modern medicine’s fundamental capabilities.
The magnitude of this crisis is staggering. Recent estimates show that AMR directly caused 1.27 million deaths globally in 2019 and contributed to an additional 4.95 million deaths, making it a bigger killer than HIV/AIDS or malaria. India faces a particularly acute challenge, with one of the world’s highest antimicrobial resistance rates and projections of two million AMR-related deaths by 2050. The country’s high AMR burden and substantial out-of-pocket healthcare expenditure are expected to significantly contribute to the projected cumulative global Gross Domestic Product (GDP) loss of $100-210 trillion by 2050.
India’s AMR challenge is multifaceted. The country, being the world’s major antibiotic producer and largest consumer among the BRICS nations, faces a complex regulatory framework where state-level authorities can approve medications independently of national standards, creating significant quality control challenges. One concerning outcome of this fragmented regulation is the widespread availability of combination products that mix multiple antibiotics into a single dose. These combinations are problematic as they might not provide the correct dose for individual patients and often expose them to unnecessary antibiotics, accelerating drug resistance. This is further exacerbated by the easy over-the-counter availability of antibiotics – a practice that essentially puts these powerful drugs within reach of anyone who wishes to buy them.
At the core of this crisis lies a struggling health care infrastructure. The system faces critical gaps, particularly in small cities and rural areas. Limited laboratory facilities for rapid and accurate diagnosis and insufficient surveillance systems to track resistance patterns leave health care providers with few options for correct disease diagnosis and prescription of the most appropriate drugs. Without access to proper diagnostic testing, they often resort to prescribing broad-spectrum antibiotics as a precautionary measure, perpetuating the cycle of resistance.
Several factors complicate the path to addressing these challenges. A fundamental issue is the significant capital investment required for upgrading laboratory infrastructure, which faces commercial viability concerns, especially in rural areas where public health facilities struggle to balance affordability with accessibility. Private companies are hesitant to invest in diagnostic development, particularly rapid diagnostic tests and point-of-care solutions crucial for resource-limited settings, due to limited financial returns, market uncertainties, and complex regulatory requirements. The antibiotics market faces similar challenges–unlike drugs for chronic conditions, antibiotics are prescribed for short durations and in limited quantities to prevent resistance, making it difficult to achieve economies of scale. These commercial constraints, combined with stringent regulatory bottlenecks in development and approval processes, have severely impacted innovation in this space. Evidence indicates that no new class of antibiotics has been discovered since 1987, with the last novel antibiotic receiving FDA approval in 2003.
This complex landscape deters much-needed investments and expertise from entering the sector, limiting the development and scale-up of innovative solutions. These hurdles particularly affect the rural and semi-urban areas, where the need for accessible diagnostics and robust health care infrastructure is often greatest.
Amidst these multifaceted challenges, public-private partnerships (PPPs) emerge as a crucial pathway forward. These partnerships create a framework where diverse stakeholders can combine their unique strengths to address different aspects of the AMR crisis.
The public sector’s role extends beyond policy leadership. Government agencies can strengthen surveillance systems to track resistance patterns, upgrade public health laboratories, and implement standardized testing protocols. India’s National Action Plan for AMR, launched in 2017, provides a comprehensive framework for these initiatives while states develop their respective State Action Plans to address region-specific challenges. Through strategic reforms like tax incentives and market entry bonuses, the government plays a pivotal role in creating an enabling environment for private sector participation in healthcare. Government-supported initiatives like the Centre for Cellular and Molecular Platforms (C-CAMP) that offer incubation space, funding opportunities, and mentorship to budding entrepreneurs further strengthen this ecosystem by fostering innovation and entrepreneurship. Equally important is their role in establishing and enforcing regulatory standards that ensure quality control across health care settings.
Private sector expertise is vital for technological innovation. Enterprises are revolutionising AMR diagnostics through transformative point-of-care solutions that deliver on both speed and accessibility. Innovations like Rapidddx Technologies’ r-PASA, an automated microfluidics-based platform, and Ramja Genosensor’s Prathamasense, a paper-based diagnostic tool, deliver results within five to six hours and 90 minutes, respectively, making rapid, affordable testing feasible even in resource-limited settings. Furthermore, initiatives in bacteriophage sensitivity testing demonstrate the private sector’s push toward innovative diagnostic approaches. Beyond diagnostics, companies are advancing efforts to establish quality-assured laboratory networks and create digital platforms for tracking antimicrobial use patterns. Their operational efficiency can help scale solutions across India’s diverse health care landscape.
NGOs and civil society organisations play a crucial role in grassroots implementation. Their understanding of local contexts helps adapt solutions for different settings, and their networks facilitate targeted programs that educate health care professionals about responsible antibiotic use and raise public awareness about AMR risks.
Financial institutions complete this collaborative framework through innovative financing mechanisms. Development financial institutions (DFIs), philanthropic organisations, and commercial banks each bring unique strengths to the table. Through innovative financing structures, philanthropic capital helps de-risk initial investments, while DFIs provide strategic guarantees encouraging commercial bank participation.
Multi-stakeholder initiatives are crucial for India’s diverse health care landscape, enabling comprehensive solutions from strengthening diagnostic infrastructure and surveillance systems to promoting responsible antibiotic use–ultimately laying the foundation for sustainable AMR management.
Several global partnerships demonstrate the potential of such collaborative approaches. The AMR Action Fund, the world’s largest public-private partnership in this space, is working to bring new antimicrobial therapies to market by 2030. The Global Antibiotic Research & Development Partnership (GARDP) has been instrumental in developing and distributing new treatments in resource-constrained settings. The Global Antibiotic Resistance Partnership (GARP) also focuses on developing actionable policy recommendations tailored to low- and middle-income countries. Within India, organisations like the Welcome Trust and CARB-X drive innovation through targeted funding for AMR research, rapid diagnostics, and antibiotic stewardship programmes.
The complexity of antimicrobial resistance demands more than isolated interventions–it requires sustained collaboration across sectors. India’s experience shows that transformative change is possible when diverse stakeholders align their efforts, supported by innovative financing and clear governance frameworks. While the challenges are formidable, they are not insurmountable. By fostering partnerships that leverage each sector’s strengths, we can build a future where quality diagnostics are accessible to all, surveillance systems provide timely insights, and antimicrobials retain their effectiveness for generations to come. The time for coordinated action is now.
This article is authored by Dr Navin Dang, founder & chairman, Dr Dangs Lab, Ashwajit Singh, founder & managing director, IPE Global and Vinaina Suri, lead, communications and advocacy, SAMRIDH Blended Finance Facility.
