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India demonstrates high political leadership for preventing antimicrobial resistance

Ufulu

SHOBHA SHUKLA – CNS

Antimicrobial resistance (AMR) is among the top 10 global health threats – and is also a threat to food safety and security and environment. AMR warrants more robust action to stop misuse and overuse of antimicrobial medicines in all sectors with One Health approach. World leaders have come together twice earlier in 2016 and 2024 at United Nations General Assembly High Level Meetings, and adopted Political Declarations with important time-bound commitments that have spurred stronger global response. But we need more country-level leadership at highest levels of echelons of power and sub-national levels to spark lasting change for health security.

AMR concerns all of us, says Indian PM

“Medicines require guidance, and antibiotics require doctors.” Indian Prime Minister Narendra Modi on 28th December 2025 gave a clear message to the people to not take antibiotics at their own discretion – rather take them only when prescribed by medical experts.

The government of India’s apex and prestigious medical research body – Indian Council of Medical Research (ICMR) released an important report recently which states that antibiotics are proving ineffective against many diseases like pneumonia and urinary tract infections. According to ICMR report, a major reason for this is people’s indiscriminate use of antibiotics. Antibiotics are not medicines that should be taken mindlessly. They should be used only upon medical advice.

“In the final #MannKiBaat of 2025, our PM has cautioned the country on increasing trends of antibiotic resistance. For this, he referred to ICMR’s recently published AMR Research and Surveillance Network Report. As per that report, we are seeing increasing levels of resistance to commonly used antibiotics in patients from 25 hospitals across the country. This paints a very grim scenario because patients having drug-resistant infections have to spend more money on treatment, stay longer in the hospitals, and sometimes are not able to recover from these infections leading to their untimely death. AMR is driven by misuse and overuse of antimicrobial medicines. Patients should not consume antibiotics without prescription from the treating doctors,” said Dr Kamini Walia who heads ICMR AMR Surveillance Network and is among the senior-most ICMR scientists (Scientist-G).

When simple infections become difficult to treat…

When simple infections become difficult (or impossible) to treat, then it is a completely preventable catastrophe for the people and communities. This is also undoing the historic gains made in modern science as no one wants to slide back to pre-antibiotic era, says Global AMR Media Alliance (GAMA).

Former WHO Chief Scientist and former ICMR Director General Dr Soumya Swaminathan shared: “This is an important message and warning from the Indian PM. Over the counter use of medicines, unnecessary use of antibiotics, rampant use (of antimicrobial medicines) in agricultural and livestock sectors, improper disposal from pharmaceutical factories and hospitals, and ability of bacteria to develop resistant mutations all contribute to AMR.”

We have to stop misuse and overuse of medicines – be it antibiotics (which work against bacterial infections like TB), anti-fungal medicines (which work against fungal diseases), anti-viral medicines (which work against viral infections like HIV) or anti-parasitic medicines (which work against diseases like malaria). We also have to stop misuse and overuse of antimicrobial medicines in all sectors, because the problem of misuse and overuse of medicines is rampant in them – such as human health, animal health or livestock, food and agriculture and our environment, says GAMA.

WHO AMR Director commends India’s political commitment

“We have been very happy to note that the Prime Minister of India Narendra Modi has made explicit reference to the importance of mitigating the emerging threat of antimicrobial resistance at the national level – and by doing so he made a specific reference to the importance of addressing over-the-counter use of antibiotics,” said Dr Yvan JF Hutin, Director, WHO Antimicrobial Resistance Department in Geneva.

Dr Hutin stressed on importance of ensuring that we use antimicrobial medicines responsibly (and stop their misuse and overuse) while we accelerate the development of new medicines – and improve access to healthcare services where no one is left behind.

Hope from India

Dr Hutin commended India which “..has a lot to offer… Whether it is on the capacity for research and development, production capacity, or antimicrobial stewardship, we know that the country has a lot of potential to improve the situation nationally – and – to assist other countries in the world.”

Dr Hutin commended ICMR’s ongoing nationwide efforts on AMR surveillance in India and offered WHO’s continued support to strengthen it. “There could even be some national representative survey that could help us quantify the problems and make sure we have an adopted response,” said Dr Hutin.

“AMR is invisible. But I am not”

AMR survivor Bhakti Chavan, who is also a member of the WHO Task Force of AMR Survivors, thanked the Indian PM for bringing AMR to national attention. “I am an AMR survivor. Despite having no previous history of TB, I was diagnosed with extensively drug-resistant TB or XDR-TB (one of the severest forms of drug-resistant TB). This means that these drug-resistant strains are already circulating in the environment. Timely diagnosis, access to the novel medicines and completion of two years treatment as prescribed by my doctor, were critical for my recovery. Along with a responsible use of antibiotics, strengthening early diagnosis, access to the novel treatments, having a robust AMR surveillance system, R&D for new medicines, and creating awareness remain essential to fight against AMR. It is time to act now.”

Pledge to prevent AMR

“Let us make a simple pledge today that we will use antibiotics only on medical advice, complete the full treatment course when and as prescribed, and help stop antimicrobial resistance before it stops us,” said Dr Sangeeta Sharma, Professor and Head of the Department of NeuroPsycho-Pharmacology at the government-run Institute of Human Behaviour and Allied Sciences (IHBAS) and President of Delhi Society for Promotion of Rational Use of Drugs (DSPRUD). Dr Sangeeta Sharma is also part of the Steering Committee of WHO Civil Society Task Force on AMR.

Drug-resistant infections like TB are entirely preventable

Dr Rajesh Kumar Sood, District Health Officer and District TB Officer, Kangra, Himachal Pradesh, India, who has played a pivotal role in shaping sub-national health responses especially TB, said: “We welcome the AMR statement by Indian PM. Even TB response is challenged by drug-resistant TB. We call upon everyone to join the clarion call to prevent AMR.”

Although tremendous efforts have happened, drug-resistant TB rates have almost remained plateaued around 400,000 every year worldwide since last two decades. There is no excuse for inaction, says GlobaL AMR Media Alliance (GAMA). We have to ensure that:

* No one gets infected with TB bacteria or drug-resistant TB bacteria in the first place. So, optimal infection prevention and control in all settings like healthcare, communities and homes is vital, and

* Everyone with TB or drug-resistant TB, gets right and timely diagnosis, right treatment, care and support without any delay. Currently, we barely diagnose and treat one-third of the (under)-estimated people with drug-resistant TB globally – this is so unacceptable.

Urgency must drive AMR response

“The words of Prime Minister of India underscore an urgent reality: antibiotics, once life-saving, are losing their effectiveness against common infections like pneumonia and urinary tract infections, as highlighted in the recent ICMR report. PM’s call to action is timely and vital. AMR is a pandemic which is threatening global health security,” said Dr Tikesh Bisen of PATH. “Visionary leadership that advocates for such critical issues will undoubtedly help generate awareness at scale and inspire responsible action across communities. This is how we can build a healthier, safer future together.”

Let us hope that in 2026 and beyond, no one gets infected from a preventable disease, and all those with infections are able to access right and timely diagnosis, correct treatment, care and support in person-centred and rights-based manner. Right to health is a fundamental human right and it is high time for governments to walk the talk and deliver on #HealthForAll.

Shobha Shukla – CNS (Citizen News Service)

(Shobha Shukla is a feminist, health and development justice advocate, and an award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service). She was also the Lead Discussant for SDG-3 at United Nations inter-governmental High Level Political Forum (HLPF 2025). She is a former senior Physics faculty of prestigious Loreto Convent College; current President of Asia Pacific Regional Media Alliance for Health, Gender and Development Justice (APCAT Media); Chairperson of Global AMR Media Alliance (GAMA received the inter-ministerial AMR One Health Emerging Leaders and Outstanding Talents Award 2024); and Host of SHE & Rights (Sexual Health with Equity & Rights). Follow her on Twitter/X @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)

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Health

Beyond the shadow of stigma: Internal stigma is out of the shadows at AIDS 2024

Maravi Post Reporter

DEIRDRE NI CHEALLAIGH – CNS

“Stigma can be so insidious. It cuts deep and affects all of us,” said Shaun Mellors, Director, Community Stakeholder Engagement, ViiV Healthcare who was speaking on Zero HIV Stigma Day during the opening plenary of LIVING2024. “Every day should be Zero HIV Stigma day,” rightly said Shaun.

Shaun celebrated the inspiring legacy of Prudence Nobantu Mabele who was a force for change for a socially just world, and a noted South African activist. Shaun said that lessons from Prudence’s legacy are to “speak your truth”, “be brave”, “sing, even if you are a terrible singer, sing”, and “laugh and make others laugh.”

All forms of HIV-related stigma and discrimination must end so that all people can access full spectrum of health and social services in a rights-based, people-centred and gender transformative manner.

People living with HIV who anticipate stigma are 2.4 times more likely to delay care until very ill.

Stigma – from the inside out?

“It is important to tackle stigma and discrimination at all levels of the socio-ecological level – individual, family and peers, community and structural level, to affect sustainable and transformative change. We need evidence-based multi-level interventions (to tackle all forms of stigma and discrimination – including internal stigma) for lasting change,” said Nadine Ferris France, CEO of Beyond Stigma and Certified Facilitator of Inquiry-based Stress Reduction (IBSR).

Internal stigma is a mindset of negative beliefs, thoughts, and behaviours about HIV, which manifests as shame, guilt, feelings of contamination, reduced self-efficacy, self-loathing, low self-esteem and self-rejection. “Internal stigma happens when we internalise external stigma and judgements and believe that they are true. Internal stigma also happens in the absence of external stigma and discrimination”, explained Nadine.

“84.5% of people living with HIV report internalised stigma or internal stigma or shame, according to the People Living with HIV (PLHIV) Stigma Index (December 2023)”, she added. The PLHIV Stigma Index is supported by the Global Fund to fight AIDS, TB and Malaria (The Global Fund) and US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Partnership to Eliminate all Forms of HIV-Stigma and Discrimination. The PLHIV Stigma Index indicates that addressing internalised stigma is crucial for implementing community-led initiatives, improving treatment adherence, and accessing prevention services in focus countries.

Internal stigma results in a host of negative impacts on HIV programme outcomes, shares Nadine. For example, people tend not to seek care, treatment adherence goes down, depression increases, fears of disclosure increases, quality of life and self-esteem dips, self-efficacy is reduced, and people likely to feel more isolation, anger or resentment.

Through evidence-based interventions such as as the Wakakosha: I am Worth It peer-led intervention to support young people living with HIV improve wellbeing and improve self-worth, Wakakosha is layered within the existing Zvandiri CATS model and uses a cognitive-awareness approach called Inquiry-based stress reduction together with creativity such as music, poetry, writing and drawing. Currently being implemented in Zimbabwe and starting now in Rwanda, Ghana and elsewhere, results are promising.

“Addressing internal stigma helps improve treatment adherence; boosts self-confidence, self-agency, and sense of purpose/ meaning; reduces fears around disclosure, and body positivity; increases communication and personal/family relationships and forgiveness,” said Nicola Willis, Executive Director of Zvandiri.

“For us to conquer stigma in the community, we have to first tackle internal stigma. When you know who you are, and know your worth, you can stand up to the community. When you have accepted yourself and seen yourself worthy, you can go and impact that to the community” said Vimbinashe Jazi, Zvandiri CATS and a Wakakosha Programme Coach at 25th International AIDS Conference (AIDS 2024).

Journey from internal stigma to self-love and self-worth

Targets of 10-10-10 refers to the promise that by 2025 less than 10% of countries should have punitive legal and policy environments that deny or limit access to services, less than 10% of people living with HIV and key populations will experience stigma and discrimination, and less than 10% of women, girls, people living with HIV, and key populations will experience gender inequality and violence.

The Global Partnership to Eliminate All Forms of HIV-related Stigma and Discrimination has identified six settings where stigma and discrimination are still posing significant barriers to HIV. “Addressing stigma and discrimination is central to the Global AIDS Strategy and its 10-10-10 targets on societal enablers,” said Simone Salome, Human Rights Advisor for UNAIDS and Global Partnership Lead.

The Global Partnership has prioritised and is supporting efforts to reduce internal stigma over the next few years.

“It is time to see beyond stigma, to see what is possible in a world of self-love, self-worth – let’s stop using deficit-based language and reframe our efforts” said Nadine.

Deirdre Ní Cheallaigh – CNS (Citizen News Service)

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Health

Think twice: Can we deliver on #HealthForAll without saving lives from viral hepatitis?

Maravi Post Reporter
Can we deliver on #HealthForAll without saving lives from viral hepatitis?

Despite over 350 million people living with hepatitis B and C virus globally, and 3 persons dying every minute, much-needed efforts are yet to be on-track to end viral hepatitis in next 108 months (by 2030) as promised by heads of all countries in UN General Assembly (by adopting the Sustainable Development Goals). More importantly, during the Covid pandemic, efforts to prevent and save lives from viral hepatitis had taken a backseat – which is risking losing the gains made earlier in addressing viral hepatitis across the world.

“Elimination of viral hepatitis should be part of any sound public health agenda. With a strong political will and collective leadership we can achieve the regional goal of eliminating viral hepatitis by 2030” said Wangsheng Li, cofounder and founding President of The Hepatitis Fund (endHep2030.org).

He was speaking at the 6th Asia Pacific Summit of Mayors (APCAT Summit) which brought together subnational leaders of almost 80 cities across the region. Addressing viral hepatitis was an important part of the integrated health and development agenda of this summit. The Mayors and other subnational leaders and delegates of APCAT Summit adopted an APCAT Declaration 2021 which includes the promise for “addressing the challenge of viral hepatitis as a major public health threat in the Asia Pacific region through elimination of mother to child transmission by raising public awareness and strengthening health systems through public and private partnerships.”

The Declaration endorsed by 6th APCAT Summit further underlines: “We commit to doing everything to harness the power of our city governments to ensure that tobacco control, prevention of non-communicable diseases, TB control, elimination of viral hepatitis, routine immunization and scaling up Covid vaccination are effectively implemented and measured, along with other health and development initiatives, and the recovery from Covid is healthy, equitable and sustainable.”

“We are very excited on the recently formed partnership between EndHep2030 and APCAT” said Wangsheng Li. Rightly so, given how critical is political leadership to advancing ending hepatitis agenda.

“Health is a political choice that should ensure leadership, accountability and sustainability for the effective implementation of public health policies and programmes and prevent current and future pandemics. Viral hepatitis is an essential part of the #HealthForAll agenda”, said Dr Tara Singh Bam, Asia Pacific Director of the International Union Against Tuberculosis and Lung Disease (The Union), and Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT) in Singapore.

How will we end hepatitis by 2030?

Dr Po-Lin Chan from Manila-based World Health Organization (WHO)’s Western Pacific regional office said that “Elimination of viral hepatitis as a public health threat by 2030 is a combination of existing interventions at scale. These include ensuring universal free childhood vaccinations of 3 doses of hepatitis B vaccines, prevention of mother to child transmission of hepatitis during antenatal care, ensuring safe blood and blood products (so that transfusions are safe), making sure universal precautions is the norm in healthcare settings, ensuring safer sex programmes are in place, ensuring harm reduction interventions and efforts to prevent new infections among people who inject drugs are in place and accessible, and making sure that tests and affordable drugs are available in healthcare facilities nearer to where people live.”

Along with Singapore, other countries like Bangladesh, Bhutan, Thailand, Malaysia, and Nepal have also successfully met the WHO target for 2020 of achieving 90% prevention of hepatitis B through vaccination (by providing birth dose of hepatitis B vaccine to newborn children).

“Vaccination is the foundation of prevention of hepatitis B virus (HBV)” said Dr Po-Lin Chan.

Asia Pacific is home to more than half of world’s people with hepatitis B and C

Asia and the Pacific has more than half of world’s total number of people with hepatitis B and C virus. About 200 million people are chronically infected with hepatitis (180 million with hepatitis B and 20 million with hepatitis C) and most people are not even aware that they are infected, said Dr Po-Lin Chan of WHO. These are the people who are also at high risk of developing liver cancer. Chronic infection of hepatitis B and C affects the liver overtime and causes cirrhosis and eventually liver cancer. All these premature deaths are untimely and so preventable, because we have prevention tools, as well as good tests and drugs that can treat hepatitis B and C, and hepatitis C can be cured.

Globally, 296 million people are estimated to be infected with Hepatitis B Virus (HBV), and 58 million with Hepatitis C Virus (HCV).

African region has 82 million people with hepatitis B virus (HBV) and 9 million with hepatitis C virus (HCV). Pan-American region has 5 million people each with HBV and HCV. Southeast Asian region has 60 million people with HBV and 10 million with HCV, and accounts for around 15% of global HBV and HCV cases, as well as 30% deaths due to HBV and HCV. European region has 14 million people with HBV and 12 million with HCV. Eastern Mediterranean region has 18 million people with HBV and 12 million people with HCV. Western Pacific region has 116 million people with HBV and 10 million with HCV.

Dr Po-Lin Chan shared that latest scientific evidence shows that there is a group of pregnant women who are more at risk of passing the hepatitis B virus to their babies. These are pregnant women who are themselves hepatitis B infected. WHO guidelines provide recommendations that we can further prevent hepatitis B transmission from an infected pregnant woman to her baby. Universal testing during antenatal care for HIV, HBV and syphilis, is the entry point to get infected woman timely into the care she needs. WHO’s framework for triple elimination of mother to child transmission of HIV, syphilis and HBV brings together integrated mother to child care so that next new generation of babies can be free of infectious diseases such as HIV, syphilis and hepatitis B.

Act today to prevent liver cancer tomorrow

“If we take action today, we can prevent liver cancer tomorrow. To reduce liver cancer and to reduce advanced liver disease such as cirrhosis, an effective way is to provide testing services so that people can know their own hepatitis status, can get linked to health services and get drugs to treat hepatitis. Even during the pandemic we must intensify our efforts to prevent our babies from getting infected with viral hepatitis B. This means investing in childhood vaccination (against HBV), and prevention of mother to child transmission to get to elimination” said Dr Po-Lin Chan.

People living with hepatitis B and C are at high risk of developing liver cancer. Most are not aware. But liver cancer can be prevented by ensuring testing and treatment for those who need it. Because cancer once developed will cost all of us even more.

“Hepatitis C can be cured. Hepatitis B can be effectively treated. We need to work towards strengthening health systems, towards universal health coverage which includes hepatitis, optimising primary care service delivery nearer to places where people live, including public private partnership, equitable access including hard to reach groups and engaging communities, and data based decision making” said Dr Po-Lin Chan.

Almost all countries in southeast Asia have now developed and are implementing national strategic plans that provide key guidance on hepatitis testing and treatment and blood and injection safety. All southeast Asian countries have at least 3 doses of hepatitis B vaccine in their national immunization schedule with the region achieving more than 90% coverage rate in 8 countries.

We have to scale up genuine and effective hepatitis-interventions for supporting key populations through community outreach and by implementing opioid substitution therapy and safe injection programmes.

For eliminating mother to child transmission of hepatitis B, it is essential to ensure that all pregnant women are tested for the virus and where necessary treated and for every newborn to receive the hepatitis B birth dose.

Shobha Shukla, Bobby Ramakant – CNS (Citizen News Service)

(Shobha Shukla and Bobby Ramakant both are part of editorial team of CNS (Citizen News Service), and founding board members of Asia Pacific Media Alliance for Health and Development. Follow them on Twitter @Shobha1Shukla, @BobbyRamakant)

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