Assa Doron and Alex Broom, who have been working in India for about two decades, shared their views that the antibiotic crisis in the country is rooted in issues of inequality, rather than solely in misuse of medication.
Origins of the Research
Doron recounted that his initial research in Hyderabad, near the Musi River, revealed contamination by pharmaceutical companies. He discovered a high concentration of antibiotic-resistant bacteria in the river itself. Conversations with local residents highlighted problems with skin diseases and foul odors, leading him to connect the waste issue with antibiotic resistance. He decided to collaborate with Alex Broom, who had been working on this topic for over ten years.
Data Collection and Global Context
Broom noted that his involvement was partly personal, as he observed the tension between the need to purchase antibiotics and the awareness that they are a valuable resource. Doron emphasized that despite scientific data showing the rise of antimicrobial resistance in polluted areas like the Ganges or Musi, their goal was to tell a story. India draws global attention because it is one of the largest consumers and a major producer of generics, where antibiotics circulate intensively in hospitals, pharmacies, farms, and households.
The Need for a Holistic Approach
Broom stated that understanding the problem requires diverse data that goes beyond biological results. He suggested looking at factors driving resource use, such as working conditions. Doron agreed, asserting that people cannot be blamed, as the antibiotic crisis is primarily an inequality crisis manifesting through social lines like class, gender, or housing conditions. He cited the example of women suffering from urinary or reproductive tract infections whose condition is delayed because it is perceived as less urgent.
The Role of Growth and Systemic Issues
Broom linked the rise in resistance to challenges of economic development, whether in food production or market creation. He pointed out that rational antibiotic prescribing is impossible if the entire system is geared towards growth. While growth can improve lives, unsustainable growth leads to mutating effects, which is a global issue, not specific to India.
Call to Action and Local Initiatives
Doron warned that humanity is on the verge of a situation where antibiotics will cease to work even against the simplest illnesses. He argued against viewing the problem simplistically as 'misuse,' pointing out that such decisions are made under conditions, for instance, in an overcrowded hospital with limited diagnostic access, or when a poor patient can only afford a few pills. In response to the crisis in India, there are initiatives such as 'Operation AMRITH' in Kerala, aimed at banning the sale of antibiotics without a prescription, as well as awareness programs among ASHA workers.
