It’s the gravest healthcare threat facing humanity. The World Health Organization has estimated that antibiotic resistance, or ‘superbugs’ as these bacteria have come to be known, may kill 10 million people per year by 2050, and cost the global economy an estimated $100 trillion to address. In India the situation is very alarming and the country is already seeing the deadly impact of these invisible bacteria. Mandakini Gahlot and Alban Alvarez report.
We began filming this report shortly after the historic high-level meeting at the United Nations General Assembly in September 2016. The UN had painted a bleak picture, urging the world to formulate a response. In India, alarm bells about superbugs had been set off way back in 2009, when doctors in Sweden discovered a patient - who had recently travelled to India - was not responding to any known antibiotic. They published their findings in the medical journal The Lancet - in it, they named the bacteria New Delhi Metallo-beta-lactamase-1 or NDM1.
India was outraged; lawmakers in parliament were furious that the bacteria had been named after the country’s capital. They saw it as a deliberate attempt to malign the country.
So vehement was the outrage that two years later, in 2011, The Lancet was compelled to make a public apology to the Indian government. By then, NDM-1 and its various mutations had spread to over 70 countries including France. India had lost precious time arguing over nomenclature instead of addressing the problem.
By the time we began filming, a slew of scientific reports had confirmed that India was losing nearly 52,000 newborn infants to antibiotic resistance each year. We filmed with the chief of pediatrics at a large public hospital in central India, and he told us what he was seeing in his ward - patients not responding to any drugs - was a “nightmare.”
Antibiotics had made many common infections curable, and made it possible to perform complex surgeries. The doctor, however, like millions of others across the world, was worried that what he was seeing in his ward was the end of the antibiotic era -- a truly frightening scenario.
Elsewhere, we filmed how easily one can walk into an Indian pharmacy and buy strong antibiotics without a prescription. Overuse of antibiotics and indeed misuse - not taking the entire dosage in a timely manner - is one factor that is responsible for the virulent spread of superbugs. For India, one of the gravest challenges is educating its citizens about these dangers. As such, the country has launched many awareness campaigns urging people not to use antibiotics without a prescription. All antibiotics sold in pharmacies now carry a red band indicating that they cannot be sold without a prescription. But the reality on the ground can be quite different, as we show in the report.
Restricting overuse and misuse
In New Delhi, we filmed at the High Court with the father of an 18-year-old girl who had developed drug-resistant tuberculosis. The only medicine that could save her life - Bedaquiline - was being controlled by the government. The understanding is (and this was backed by the scientific community) that if this medicine was made easily available, it could be inadvertently misused by people who could develop resistance to it as well.
Another factor responsible for the spread of superbugs is the use of antibiotics in cattle and poultry. In Haryana, barely 50 km from the capital New Delhi, we visited a large chicken farm where the farmer admitted that antibiotics act as a growth agent, helping him to get his chickens ready for the market much faster. Finally, in search of solutions, we met a team of scientists in Bangalore who are racing against time to develop a new class of antibiotics.
The United Nations recognised in 2016 that combatting antibiotic resistance will require the kind of global response that we see around climate change today. The battle is under way on several fronts - the need right now is for a simple diagnostic tool that can detect resistance easily. In countries like India, a lot of attention is being paid to effective infection control policies within hospitals. Researchers across the world are struggling with the conundrum of making antibiotics easily accessible to the millions who need them urgently, while restricting overuse and misuse.