NAP-AMR 2.0: India's New Antimicrobial Strategy

Context

Recently, India released the National Action Plan on Antimicrobial Resistance (NAP-AMR 2.0), designed for the period 2025–29. This plan comes at a time when antimicrobial resistance (AMR) is affecting human health, animal health, agriculture, fisheries, the food chain, and the environment.

Background

• India launched the first NAP-AMR in 2017. That plan:
  • Increased national awareness of AMR
  • Improved multi-sectoral partnerships
  • Strengthened lab networks
  • Promoted surveillance and antimicrobial stewardship
  • Gained official recognition of the One Health approach
• However, implementation at the state level remained very limited.
• Only a few states—Kerala, Madhya Pradesh, Delhi, Andhra Pradesh, Gujarat, Sikkim, and Punjab—developed and partially implemented state-level AMR action plans.
• All key determinants, such as health services, veterinary care, pharmacy regulation, antibiotic use in agriculture, and waste management, fall under state jurisdiction, so national guidelines alone were not sufficient.

About NAP-AMR 2.0

• NAP-AMR 2.0 is a more mature and implementation-oriented national plan, with clear timelines, clear responsibilities, resource planning, a greater focus on scientific innovation, and a deeper expansion of the 'One Health' system.
• This plan views AMR not just as a health problem but as a national development priority.

Key Features

• Expanding the 'One Health' approach
  • Integrates human health, animal health, agriculture, aquaculture, the food chain, and the environment.
• Focus on innovation
  • Rapid diagnostics
  • Antibiotic alternatives
  • Point-of-care tools
  • Environmental monitoring
• Private sector participation
  • Because a large portion of health and veterinary services are in the private sector.
• Integrated surveillance
  • Integrated data system between the human, animal, agriculture, and environmental sectors.
• Strong national governance framework
  • Collaborative and Monitoring Committee under NITI Aayog
  • Establishment of State AMR Cells in the States
  • Monitoring through a national dashboard
• Clear division of responsibilities
  • Clarified roles between the Centre and the States.

Significance

• AMR is a major threat to the increasing mortality and disease burden in India.
• AMR spreads rapidly through the food chain, water, human-animal contact, and environmental pollution.
• AMR has spread widely outside hospitals.
• This plan provides a framework for integrated action at the national level.
• By involving all sectors, private and public, the likelihood of effective control at the national level increases.

Concerns

• There is no binding mechanism for implementing the plan at the state level.
• States are not mandated to develop an AMR Action Plan.
• No joint review mechanism.
• No financial incentive or penalty structure like the NHM.
• No concrete legal or administrative pressure to create an AMR cell and state plan.
• Without state-level engagement, the national plan risks becoming a mere "document."

Challenges

• Large variations in capacity and resources across states
• Poor monitoring of antibiotic use in the agricultural and veterinary sectors
• Minimal data reporting in the private sector
• Weak monitoring of environmental and waste management
• Lack of multi-departmental coordination
• One Health framework still lacks administrative strength
• Safe disposal of AMR-related biological waste is a major challenge

Way Forward

• Establishment of a Central-State Joint AMR Council
• Chaired by the Union Health Minister
• Regular review, joint decision-making, and problem-solving
• Formal directives to states
• Preparation and implementation of State AMR Action Plans within stipulated timeframes
• Mandatory annual review
• Financial incentive system
• Conditional grants under the NHM
• Additional funding to strengthen lab networks, surveillance, and stewardship
• Regular monitoring and reporting by the private sector
• Data collection from hospitals, pharmacies, veterinary, and food businesses
• Public awareness and behavior change campaigns
• Support for both human and animal sectors For
• Strengthening environmental monitoring
• Testing for antibiotic residues in rivers, wastewater drains, and sewage systems
• Multi-sectoral training and capacity building
• Skill development across all departments, including health, animal husbandry, agriculture, and municipalities

Conclusion

NAP-AMR 2.0 offers a scientifically, strategically, and administratively robust framework for India. However, its success lies in the shared commitment and coordination between the Centre and the states. If active state participation is ensured, financial and administrative incentives are provided, and the multi-sectoral 'One Health' framework is effectively implemented, NAP-AMR 2.0 could provide a decisive turning point in India's AMR fight. Otherwise, this plan risks remaining merely a document.