COVID-19, AMR and India

Maybe it’s not a coincidence that India is today the site of the world’s largest COVID-19 outbreak and the world’s most prominent source of antimicrobial resistant (AMR) pathogens, a.k.a. ‘superbugs’. The former fiasco is the product of failures on multiple fronts – including policy, infrastructure, logistics, politics and even ideology, before we need to consider faster-spreading variants of the novel coronavirus. I’m not sure of all the factors that have contributed to AMR’s burgeoning in India; some of them are irrational use of broad-spectrum antibiotics, poor public hygiene, laws that disprivilege ecological health and subpar regulation of hospital practices.

But all this said, both the second COVID-19 wave and the rise of AMR have benefited from being able to linger in the national population for longer. The longer the novel coronavirus keeps circulating in the population, the more opportunities there are for new variants to appear; the longer pathogens are exposed repeatedly to antimicrobial agents in different environments, the more opportunities they have to develop resistance. And once these things happen, their effects on their respective crises are exacerbated by the less-than-ideal social, political and economic contexts in which they manifest.

Again, I should emphasise that if these afflictions have been assailing India for such a long time and in increasingly stronger ways, it’s because of many distinct, and some overlapping, forces – but I think it’s also true that the resulting permission for pathogens to persist, at scale to boot, makes India more vulnerable than other countries might be to problems of the emergent variety. And given the failures that give rise to this vulnerability, this can be one hell of a vicious cycle.