Waterborne antimicrobial resistance in India: strategies to address the key challenges and gaps through a One Health approach

Antimicrobial Resistance (AMR) has become a “silent pandemic,” projected to surpass cancer as the leading cause of global deaths by 2050. India faces one of the world’s highest AMR-related mortality rates, driven by the overuse of antibiotics across human health, livestock, agriculture, and aquaculture, leading to widespread contamination of surface water and groundwater. Although India has launched several initiatives—including the National Action Plan on AMR (NAP-AMR) and the National One Health Mission (NOHM)—water, a major carrier of AMR, remains insufficiently addressed in national and state strategies.

This report assesses the status and challenges of waterborne AMR in India and recommends strengthening the One Health approach by integrating water-sector stakeholders, enhancing AMR surveillance and research, promoting sustainable pollution control technologies, and increasing awareness and policy action to curb the spread of waterborne AMR.