Context:

India has released the second National Action Plan on Antimicrobial Resistance (NAP-AMR 2.0) for 2025–29 at a time when antimicrobial resistance is rapidly emerging as one of the gravest public health threats of the century. Launched by the Union Minister of Health and Family Welfare, the new plan builds on India’s earlier efforts from 2010 onwards and aims to translate national intent into coordinated action across human health, animal health, agriculture, aquaculture, food systems and the environment.

• • AMR today is not confined to hospitals. Resistant organisms travel through soil, water, livestock, food chains and waste systems, making containment possible only through a strong One Health approach. The updated national plan reflects this reality and attempts to create a far more structured, multi-sectoral framework than before.

Why AMR Matters:

• • Antimicrobial resistance develops when microorganisms such as bacteria, viruses or fungi stop responding to medicines designed to kill them. It leads to delayed treatment, prolonged illness, higher medical costs and greater risk of death. More importantly, it threatens the safety of life-saving medical procedures.
  • Routine surgeries, cancer chemotherapy, organ transplantation, intensive care and neonatal treatment all depend on effective antibiotics. If medicines fail, these procedures become dangerous or impossible. AMR therefore has direct consequences for health systems, economic productivity and national development.
  • India faces a particularly serious challenge due to high infectious disease burden, widespread antibiotic misuse, inadequate regulatory oversight and environmental contamination from pharmaceutical waste, agriculture and aquaculture. Without coordinated action from all sectors, AMR could reverse years of medical progress.

India’s Journey So Far:

India began addressing AMR in a structured manner in 2010 with the creation of a National Task Force. This led to:

• • National Policy on AMR Containment (2011)
  • First National Action Plan on AMR (2017–21) aligned with the WHO Global Action Plan
  • Strengthening of laboratory networks and national surveillance
  • Early adoption of the One Health approach linking human, animal and environmental health
  • State-level initiatives such as those in Kerala, Delhi, Madhya Pradesh, Andhra Pradesh, Gujarat, Sikkim and Punjab
  • Regulatory steps like banning over-the-counter antibiotic sales in Kerala and Gujarat
  • Environmental and agricultural safeguards such as banning certain antimicrobials and pesticides in crops
  • Establishment of the India AMR Innovation Hub involving international and national partners to drive research, develop novel technologies and encourage collaboration

Why the First Plan Fell Short:

• • The earlier plan provided strategic direction, but implementation depended heavily on States. Health administration, hospital functioning, pharmacy regulation, veterinary services, agricultural antibiotic practices and waste governance are primarily State subjects.
  • Without clear mechanisms to ensure State-level compliance or shared accountability, implementation became fragmented. Only a few States built formal One Health structures. Most relied on isolated initiatives within individual departments.
  • India’s experience in other national programmes shows that large public health goals succeed only when Centre and States work within a common framework. The progress made in tuberculosis elimination and NHM reforms is rooted in joint reviews, shared planning missions and dedicated funding pathways. The absence of similar structures for AMR meant that the first NAP did not achieve uniform national impact.

Key Features of NAP-AMR 2.0 (2025–29):

1. Stronger One Health Integration

The plan recognises that AMR spreads through hospitals, farms, fisheries, food systems and environmental pathways. It therefore strengthens coordination between human health, veterinary services, agriculture, aquaculture and environmental agencies. Waste management, food-chain monitoring and environmental discharge receive greater attention.

2. Clearer Targets, Roles and Timelines

Each stakeholder ministry and department has prepared a sector-specific action plan with defined goals and budgets. This allows better monitoring and makes implementation more accountable.

3. Enhanced Surveillance Across Sectors

Human, veterinary, agricultural and environmental surveillance systems will now follow more harmonised protocols. This will enable India to generate more reliable national data on resistant organisms, antibiotic use patterns and environmental contamination.

4. Greater Focus on Innovation

The plan highlights the need for rapid diagnostics, point-of-care tools, alternatives to antibiotics, and better environmental monitoring technologies. The India AMR Innovation Hub will play a central role in supporting research and building new technology platforms.

5. Private Sector Engagement

Recognising that a major share of healthcare and veterinary services in India is delivered privately, NAP-AMR 2.0 stresses stronger partnerships with private hospitals, laboratories, pharma companies, professional groups and industry bodies.

6. Capacity Building and Awareness

The plan calls for extensive training programmes, public awareness campaigns and infection control strengthening across healthcare facilities. Laboratory networks will be upgraded to improve diagnostic capacity.

7. Stronger National Oversight

Inter-sectoral supervision will now be led by NITI Aayog through a dedicated Coordination and Monitoring Committee. A national dashboard will track implementation across States and ministries.

Centre–State Mechanisms:

Despite these improvements, the new plan inherits a major weakness from the earlier one: it does not establish a formal mechanism to ensure State-level commitment.

There is:

• • No statutory requirement for States to notify AMR Action Plans
  • No joint Centre–State review platform
  • No defined system of administrative accountability
  • No incentive or funding mechanism linked to progress

Given that the determinants of AMR - hospital practices, veterinary oversight, pharmacy regulation, agricultural antibiotics, food safety and waste management—rest with States, this gap is significant.

Building an Effective Coordination Framework:

1. National–State AMR Council

A permanent body chaired by the Union Health Minister, with representation from NITI Aayog, key ministries and all States.

Such a forum can:

• • • Review progress regularly
    • Enable joint problem-solving
    • Ensure multi-sectoral decisions
    • Elevate AMR as a political and administrative priority

2. Formal State-Level Directions

The Union Government can formally request each Chief Secretary to prepare, notify and operationalise a State AMR Action Plan with annual review cycles. This would give AMR much-needed administrative visibility.

3. Funding Pathways Through NHM

Even modest conditional incentives—similar to those used in TB and maternal health programmes—can motivate States to strengthen surveillance, laboratory capacity, stewardship and infection control.

4. Common Monitoring and Dashboards

A national digital platform can help track indicators across human health, animal health, agriculture and environment, ensuring more transparent performance assessment.

Way Forward:

• • NAP-AMR 2.0 provides a solid scientific foundation, clearer timelines and stronger multi-sectoral collaboration. India has shown leadership in global AMR discourse, especially through innovation hubs, State-level regulations and early adoption of One Health principles.
  • However, national progress ultimately depends on State-level ownership. AMR is fought not in committees but in hospitals, pharmacies, farms, markets, laboratories and wastewater systems. Unless States build functional AMR Cells, enforce regulations, strengthen infection control and monitor antibiotic use, the plan will struggle to deliver measurable outcomes.
  • With the right political attention, administrative coordination and funding signals, India can build a national model that ensures collective action across all sectors.

Conclusion:

Antimicrobial resistance is no longer a distant scientific issue - it is shaping healthcare outcomes, environmental health and national development. India’s NAP-AMR 2.0 offers a more mature, detailed and implementation-oriented framework than before. The challenge now is to ensure that national strategy translates into State-level action. If India succeeds in creating a coordinated Centre–State architecture, it can not only safeguard its own population but also emerge as a global leader in AMR response. The next five years will therefore be crucial in shaping India’s long-term battle against antimicrobial resistance.