A World of Resistance: India and the Global Antibiotic Crisis

This alarming and deeply perceptive study from anthropologist Doron (Waste of a Nation) and sociologist Broom (Survivorship) examines why India has become ground zero for the global explosion in antibiotic resistance. The authors begin with the “haunting statistic” that an estimated 58,000 Indian newborns die each year from antibiotic-resistant sepsis (not to mention the half million Indians who died in 2021 from drug-resistant tuberculosis, or the country’s horrifying new drug-resistance strains of cholera and typhoid). From there, they emphasize that an urgent solution is needed for India’s crisis but that “oversimplified” explanations of Indians as overusing antibiotics, in both medical and agricultural contexts, due to poverty, inadequate sanitation, and overburdened healthcare systems don’t paint a full picture. The real issue, they explain, is the country’s massive, and growing, pharmaceutical industry. India, they argue, is “saturated” with antibiotics, and like any drug, its very presence creates an epidemic of usage. Indeed, reminiscent of the American opioid epidemic, the authors find that “assertive medical representatives... promote new antibiotics to [Indian] doctors and play a key role in creating incentives for overprescription.” The influence of pharmaceutical sales reps, plus the complex machinations of the country’s “hybrid public-private health-care system,” have created “a cycle of antibiotic dependence,” as the authors astutely put it. Incisively argued and genuinely terrifying, this is a must-read for those whose work touches on epidemiology and public health. (Mar.)