The Spectre of Superbugs: Waste, Structural Violence and Antimicrobial Resistance in India

The crisis in antimicrobial viability interplays with the viability of everyday practices (open defecation), particular forms of labour (risky occupations), geographies of vulnerability (urban slums), India as a pharmaceutical global producer and the salve of unfettered access to drugs (in the absence of state-provided healthcare and regulations). Put differently, behaviour in one realm—around production, consumption and discarding of goods—can actually be tracked to another, seemingly discrete, problem of AMR and diminishing antimicrobial viability.

MROs have become an entrenched global health and security issue, and India represents a hotbed for MROs. The stage has been set for political and cultural contestations around issues of responsibility and bacterial relations. Many of these dynamics require far more research. We need more studies to clearly establish how such environmental contamination intersects with infectious disease epidemiology among humans and farm animals. Studies are required to identify which infectious agents persist in the environment and when and how they come into contact with pharma waste. We also need to know more about what makes it likely for AMR to evolve in an environment contaminated by active pharmaceutical ingredients, which is not necessarily analogous to the human (or mammalian) body, where much of AMR evolution occurs.

In establishing the extent of MROs in India’s healthcare facilities, rural and urban environments, or even within different populations, political will and tightened regulations are urgently required. Density of population, poor sanitation, the magnitude of waste and scarcity of clean water mean that bacterial risk, and accompanying use of microbials, will grow. This provides an ideal laboratory in which MROs will flourish. To understand the development and potential of MROs, the study of Indian conditions should be a priority.