AMR Crisis: India’s Industrial Blind Spot

Antimicrobial resistance (AMR) is no longer a future threat – it is a slow-moving catastrophe unfolding in real time. Often termed as a “silent pandemic” – AMR’s consequences are accelerating faster, while policy responses remain fragmented and inadequate. Already responsible for over a million deaths annually worldwide, projections indicate that AMR could claim up to 10 million lives every year by 2050, if systemic action is not urgently taken.   

For decades, policy debates around AMR have focused largely on antibiotic prescription misuse in health facilities and livestock production. While these remain primary drivers, growing scientific evidence points toward a critical yet dangerously under-addressed factor – pharmaceutical manufacturing pollution.

India sits at the centre of this threat in a uniquely contradictory way. Often referred to as the AMR capital of the world, the country faces one of the world’s highest burdens of drug-resistant infection mortality and at the same time, it is also the third largest pharmaceutical manufacturer by volume and a major exporter of life-saving drugs. This places India in a deeply consequential position – supplies medicines to the world, yet its current manufacturing practices raise serious concern about antibiotic pollution, potentially contributing to drug resistance. 

Numerous scientific studies have documented this dangerous chain of events: when untreated or inadequately treated effluents from pharma factories enter nearby rivers, or lakes, they often contain active pharmaceutical ingredients or API – the chemical compounds used to produce medicines. In such polluted environments, microbes are exposed to sub-lethal concentrations of these compounds. Such continued exposure creates evolutionary pressure that allows resistant bacteria to emerge and multiply.

Over time these resistant strains contribute to the rise of “superbugs” and spread further through water systems, food chains, and ultimately reaching human populations – causing routine treatment increasingly ineffective, prolonging hospitalisation, forcing the use of more expensive second or third-line drugs – thereby placing a substantial economic burden on both communities and the healthcare system.

Ground-level reports at several pharmaceutical manufacturing facilities highlight the enormity of the problem. Multiple studies around Patancheru-Bollaram industrial belt near Hyderabad have detected antibiotic concentrations in the Musi River thousands of times higher than safe levels, often reaching milligrams per litre. In some cases, these concentrations are even higher than the antibiotic levels found in the blood of patients undergoing antibiotic treatment!

Similar findings have emerged from river systems, such as Yamuna, Gomti to manufacturing hubs of Baddi in Himachal Pradesh to Rangpo in Sikkim where industrial discharge has introduced antibiotic residues into surrounding water ecosystems – in some instances, estimated total volume of several kilograms of antibiotics being released every day!

Given the vast geographical spread of pharmaceutical manufacturing units across India, these existing reports likely capture only a fraction of the true scale of contamination. Yet, instead of strengthening regulation, the government has repeatedly looked the other way, effectively allowing pharmaceutical corporations to treat rivers and groundwater as dumping grounds.

The gravity of the situation becomes even more alarming when viewed alongside the rapid expansion of India’s pharmaceutical industry. With over an estimated 10,500 drug manufacturing units currently in operation and projections estimating to a nearly $130 billion by 2030 from its current market value of $55 billion, the scale of antibiotic pollution is poised to rise in tandem.

This is where the crisis becomes unmistakably political. A development model that prioritises industrial output and export competitiveness, while weakening environmental safeguards, inevitably turns public health into collateral damage – rewards industrial expansion while externalising its health costs onto communities.

Globally, the warning signs are being taken more seriously. Recently, the World Health Organisation issued guidelines on antibiotic pollution from pharmaceutical manufacturing, aimed at limiting antibiotic residues in industrial effluents and reducing the risk of antimicrobial resistance.

Platforms such as the AMR Industry Alliance already have introduced the Antibiotic Manufacturing Framework, ensuring scientific guidance to adequate control of manufacturing effluent emissions. Additionally, there is also a growing shift in global medicine procurement, with European governments and multinational companies increasingly incorporating environmental sustainability criteria into pharmaceutical supply chains.

Contrary to this, India’s regulatory landscape continues to display a concerning degree of policy inertia. The Central Pollution Control Board has issued monitoring guidelines for antibiotic residues, but enforcement remains weak and largely confined to paperwork. The country neither has any comprehensive monitoring framework for antibiotic residues released from manufacturing facilities nor any proper fiscal or regulatory incentive mechanisms put in place that could accelerate investments in cleaner production technologies that become standardised across the industry.

This is not an administrative oversight. It reflects a deeper political orientation where corporate convenience is prioritised over long-term public health safeguards. The clearest example of this came in 2019, when the Ministry of Environment, Forest, and Climate Change proposed stringent antibiotic discharge standards for pharmaceutical effluents – potentially a historic move.

But industry resistance quickly stalled progress. Industry proponents citing compliance costs, competitiveness concerns, substantial upfront and operational investments required in installing advanced wastewater systems, which in turn could lead to a rise in medicine prices – narrative that ultimately diluted the momentum.

Eventually, the proposal was withdrawn, and pharmaceutical effluents were classified as hazardous waste, no antibiotic-specific discharge limits were implemented. This decision reflects a clear policy retreat dressed up as pragmatism – safeguarding industrial margins while leaving both ecological and public health risks unregulated.

Even the recently drafted National Action Plan on Antimicrobial Resistance last year, despite endorsing a “One Health” approach, the framework fails to seriously confront the environmental dimension of pharmaceutical pollution – leaving a persistent gap insufficiently addressed in addressing industrial sources of resistance.

This policy blindness is not only unjust – it exposes a deeper structural issue within India’s approach – the persistent prioritisation of industrial expansion over environmental accountability. India’s ambition to cement its position as a global pharmaceutical powerhouse cannot come at the cost of deepening a critical public health emergency.

Although sustaining the industry’s growth remains economically crucial and important for maintaining price affordability, it must be accompanied with proper environmental governance. The alignment is also critical, given India is a major pharmaceutical exporter, it may face declining competitiveness if the global markets increasingly prioritise green procurement practices.

But competitiveness cannot be the only argument for reform. The central issue is democratic accountability. Pharmaceutical manufacturing cannot be treated as a privileged sector exempt from environmental responsibility. Communities have the right to clean water and safe ecosystems. A public health emergency cannot be subordinated to corporate lobbying and market logic.

Addressing this policy blind spot requires more than incremental reform. It urgently demands a robust monitoring framework for antibiotic residues, enforceable discharge standards, and targeted incentive mechanisms to support the transition toward cleaner manufacturing practices. Most importantly, this requires political will to place public health and environmental protection at the centre of industrial policy.

Additionally, a well-rounded multisectoral approach, backed by stronger research, greater public awareness, and sustained cross-policy engagement across health, environment, and industrial departments can help address this policy gap and encourage industry’s transition – allowing India to expand its pharmaceutical leadership while ensuring that industrial progress does not inadvertently accelerate the very public health crisis.

India’s pharmaceutical industry is crucial for global affordable medicine access. But this leadership also brings a moral responsibility. Without stronger accountability and proper alignment between industrial growth and environmental safeguards, India risks deepening a crisis that not only threatens global health and undermines the very foundation of modern healthcare – worse, it risks normalising a dangerous policy consensus – that public health is negotiable as long as corporate profitability remains protected.

The writer, a Teaching Assistant and Research Fellow, currently based at IIT Bombay, focuses on energy transition, public health, waste management and South Asian policy issues.  The views are personal.