How India presents a unique antimicrobial resistance innovation opportunity

AMR is a one health problem 

AMR is one of the most severe global threats to health and food safety and is often referred to as the silent pandemic. The global impact of AMR is clear, with economic projections indicating a 3.8% decrease in annual GDP by 2050 and with an annual cost of $1 trillion after 2030. According to recent estimates, there were 4.95 million deaths related to bacterial AMR in 2019, with 1.27 million deaths attributable to bacterial resistance.

A closer look at these figures show AMR to be a more complex multi-faceted problem arising from a number of factors including consumer behaviour and misuse, animal health and the environment. The One-Health concept aims to address this by highlighting the interconnection between humans, animals and their shared environment.  

The challenge in India 

India’s burden of AMR is staggering, in 2019 alone 297,000 deaths were attributed to AMR and a further 1M deaths associated with drug resistant bacteria. With its unique combination of a dense population, diverse healthcare practices and a significant disease burden, it places the country at a critical stage in the global fight against AMR.

The country faces a number of challenges with the most pressing of these being the prevalence of infectious diseases which makes it difficult to combat AMR. There is also the improvident use of antibiotics and with an unregulated antibiotic market operating in India it becomes increasingly difficult to fight against antibiotic overuse, misuse and self-prescription. Poor farming practices also contribute greatly to the problem with downstream exposure to fish, livestock and humans. The AMR challenge in India cannot be trivialised with recent data suggesting by 2050 India will account for 20% of the global AMR related deaths.

Aquaculture a hotbed for AMR 

While India is one of the largest exporters of shrimp, many of the aquaculture farms belong to small local businesses. Biosecurity measures that are needed to mitigate the spread of AMR can often be costly to install for these small businesses with antibiotics being the cheaper option. There is also a tendency to estimate dosage, leading to accumulation in waterways and contributing the likelihood of resistance developing.

Transition to antibiotic stewardship and responsible use will require a cultural shift. Vaccination or other preventative measures need to be relatively inexpensive compared to antibiotics to make them the treatment of choice. In reality, for many aquaculture farms in India the cost of not using antibiotics can lead to a 20-30% loss in shrimps costing billions for the industry. 

India’s response to AMR 

There is a vibrant innovation ecosystem in India with hubs in Delhi, Bengaluru and Hyderabad developing innovative new products and services in diagnostics and therapeutics. Investment in AMR is a high priority for the Government of India demonstrated by the Delhi declaration at the 2023 G20 presidency. In addition to the national action plan for AMR, state-level action plans have also been introduced to engage with the community and address local challenges.  

India has launched a number of national and state level programmes to drive innovation and support, for example through some of their innovation hubs such as the Bangalore Bioinnovation Centre (BBC) and the Centre for Cellular and Molecular Platforms (C-CAMP) where start-ups are provided the resources to develop their products from conception to commercialisation. In addition, the IKP knowledge park in Hyderabad is home to the International One Health Centre (IOHI) with a collaborative and multi-sectorial focus on addressing One Health global challenges.

Innovation opportunities 

India with its complex innovation landscape with national and state level challenges presents an enormous opportunity for UK organisations to work with Indian innovators. Innovate UK’s Global Expert Mission identified four innovation pillars across human and animal health to address AMR.  

• Diagnostics: Point of Care (PoC) diagnostic is critical for the timely identification of bacterial or viral infection which can mitigate inappropriate use of antibiotics. The use of rapid PoC has enormous potential in India to identify resistant bacteria and if required to prescribe the appropriate antibiotic.  
• Vaccines: The rapid rise in resistance bacteria to new antimicrobials makes it challenging to produce new and effective drugs. Vaccines have played a critical role in human health and is an effective approach to mitigating AMR. Human and veterinary vaccines can drastically reduce bacterial infection, reducing antibiotic use and incidence of AMR. Vaccines play a pivotal role in India where secondary infection and symptoms from existing diseases drive antibiotic use.  
• Alternative Therapeutics: Phage technology is increasingly being explored in India as credible alternatives to traditional antibiotics and with similar interests in the UK it presents an opportunity for joint UK-India collaboration. The challenge however is in the quality and cost of large-scale manufacturing of bacteriophages.  
• Environment: Environmental spread of resistant genes results from the discharge of antibiotics (and other antimicrobials) by pharmaceutical manufacturers and hospitals, for example, into wastewater. These antibiotics can lead to the emergence of resistant micro-organisms, both of which spread further through sewage and surface water. There is an opportunity to develop and implement IoT and real time monitoring system leveraging national AMR surveillance data.  

How Innovate UK can support your business 

Successful engagement with key AMR stakeholders requires navigating and understanding the cultural differences, state-level priorities, start-up ecosystem, and the regulatory and innovation landscape. Reach out to our team below to find out how Innovate UK can support your business:

• Syed Ahmed – UK-India AMR Mission Lead: syed.ahmed@iukbc.org.uk 
• Charlie Fraser – India Partnership Manager: charlotte.fraser@iuk.ukri.org 
• Phil Packer – AMR and Vaccines Innovation Lead: phil.packer@iuk.ukri.org