WHO GLASS 2025 and India’s Antimicrobial Resistance Crisis
Introduction
In mid-October 2025, the World Health Organization (WHO) released the Global Antimicrobial Resistance Surveillance System (GLASS) Report 2025.
It reconfirmed that Antimicrobial Resistance (AMR) in India is “a serious and escalating threat”, with resistance levels among the highest in the world.
In 2015, WHO Member States unanimously approved a Global Action Plan to tackle AMR (GAP-AMR).
GLASS works across all three levels of WHO – headquarters and regional and country offices – and is supported by the WHO AMR Surveillance and Quality Assessment Collaborating Centres Network (WHO AMR Surveillance CC Network).
Key Findings of WHO GLASS 2025
Global Situation
1 in 6 confirmed infections globally is resistant to commonly used antibiotics.
Severe trends observed across South-East Asia.
India-Specific Findings
In 2023, 1 in 3 bacterial infections in India was resistant to commonly used antibiotics.
India disproportionately affected due to:
High infectious disease burden
Overuse and misuse of antibiotics
Weak regulatory enforcement
Poor surveillance coverage
Environmental contamination (pharma effluents, hospital waste)
High Resistance in Critical Pathogens
Escherichia coli (E. coli)
Klebsiella pneumoniae
Staphylococcus aureus
Most alarming in ICUs, with high antibiotic pressure.
National Surveillance Gaps
India’s Surveillance Systems
ICMR-AMRSN
Indian Council of Medical Research – Antimicrobial Resistance Surveillance Network
i-AMRSS
Indian Antimicrobial Resistance Surveillance System
NCDC’s NARS-Net
National Centre for Disease Control – National Antimicrobial Resistance Surveillance Netw
Participation in GLASS since 2017
Key Issues
Data mainly from tertiary hospitals (medical colleges/referral centres).
Primary and secondary care hospitals poorly represented, leading to:
Biased overestimates of national resistance
Poor understanding of rural/community AMR patterns
WHO urges complete nationwide surveillance, rational antibiotic use, and stronger regulation.
Implementation Failures: National Action Plan on AMR (NAP-AMR)
Status
India’s NAP-AMR (2017) created an ambitious One Health framework.
Very slow implementation; few States operationalised State Action Plans.
Most remain in early stages of execution.
Kerala Model – India’s Standout Success
Key Interventions
Kerala Antimicrobial Resistance Strategic Action Plan (2018)
Strong One Health operationalisation
Launched AMRITH (Antimicrobial Resistance Intervention for Total Health) in 2024:
Cracked down on OTC sale of antibiotics
Strengthened surveillance and awareness campaigns
Outcomes
State’s latest antibiogram shows a slight but measurable dip in AMR levels.
Kerala aims to become antibiotic-literate by December 2025.
Structural Drivers of AMR in India
Healthcare Factors
OTC antibiotic availability
Self-medication
Incomplete antibiotic courses
Poor Infection Prevention and Control (IPC)
Unregulated antibiotic use in private sector
Environmental Drivers
Contamination from pharmaceutical manufacturing effluents
Hospital sewage
Antibiotic residues in water, soil
Regulatory Issues
Weak enforcement of Schedule H and Schedule H1
Uneven regulation across States
Lack of integrated One Health coordination
Key National Interventions
Colistin Ban (2019)
India banned colistin as a growth promoter in animal husbandry.
Intuitively beneficial, but quantification needs long-term data.
Need for Wider Surveillance
Experts urge including:
500+ NABL-accredited labs
Peripheral/primary care hospitals
Veterinary and environmental labs
Full-network model essential for representative national estimates.
Antibiotic Pipeline and Innovation
Global Pipeline (WHO 2024 Report)
Increase from 80 candidates (2021) to 97 candidates (2023).
However, pipeline remains thin and insufficient:
Only 12 of 32 traditional antibiotics meet WHO innovation criteria
Only 4 target WHO Priority 1 Critical MDR pathogens
India’s Progress
CDSCO approved four new antibiotic candidates recently.
Several Indian biotech firms participating in trials (e.g., Bugworks Research Inc.).
Ideal New Antibiotics Should:
Be from new classes or have new mechanisms of action
Target critical priority MDR pathogens (e.g., CRE, Acinetobacter baumannii)
Provide both oral and IV formulations
Be affordable, especially in Low and Middle Income Countries (LMICs)
Align with antimicrobial stewardship principles
Global Initiatives: AMR Industry Alliance
The AMR Industry Alliance, formed in 2017, includes 100 life science companies and trade associations, committed to tackling antimicrobial resistance.
Multi-stakeholder alliance of pharmaceutical, biotech, and diagnostic companies.
Roles include:
Accelerating development of new antibiotics
Ensuring equitable global access
Promoting responsible antibiotic manufacturing standards
Strengthening global diagnostics and stewardship
Funding and Governance Gaps in India
Limited, inconsistent funding for:
Surveillance
Research and innovation
Public awareness
Industry engagement sporadic and small-scale.
AMR stewardship programmes weak or absent in many States.
AMR in India is a full-fledged public health emergency, with resistance levels among the highest globally, weak surveillance, poor stewardship, and slow implementation of the NAP-AMR.
The Kerala model demonstrates that:
Strong inter-sectoral collaboration
Strict enforcement against OTC sales
Public literacy
One Health approach
can produce measurable impact.
India must adopt a multi-pronged, nationwide strategy combining surveillance expansion, regulatory enforcement, new antibiotic development, public awareness, and One Health integration to prevent common infections from becoming untreatable.
Prelims Practice MCQs
Q. With reference to the WHO GLASS 2025 report, consider the following statements:
India recorded approximately one in three bacterial infections resistant to commonly used antibiotics in 2023.
Globally, one in three bacterial infections was resistant.
India’s AMR burden is primarily due to a combination of high infectious disease load and overuse of antibiotics.
Which of the statements given above is/are correct?
A. 1 and 3 only
B. 2 and 3 only
C. 1 only
D. 1, 2 and 3
Answer: A
Explanation:
Statement 1 is correct: India had 1 in 3 resistant infections.
Statement 2 is incorrect: Globally, it was 1 in 6, not 1 in 3.
Statement 3 is correct: High disease burden + overuse/misuse + regulatory gaps drive AMR.
Q. Consider the following pathogens, which are highlighted by WHO GLASS as showing high resistance in hospital ICUs in India:
Escherichia coli
Klebsiella pneumoniae
Staphylococcus aureus
Vibrio cholerae
How many of the above are correctly included?
A. Only one
B. Two
C. Three
D. All four
Answer: C
Explanation:
E. coli, K. pneumoniae, and S. aureus show high resistance.
Vibrio cholerae is not listed as a major ICU-resistant pathogen.
Q. Which of the following correctly describes the recommended characteristics of next-generation antibiotics for tackling AMR?
New class or new mechanism of action
Dual (oral + IV) formulations
Low potential for resistance development
Targeting WHO Priority 1 Critical MDR pathogens
Select the correct answer:
A. 1, 3 and 4 only
B. 1 and 2 only
C. 2 and 4 only
D. 1, 2, 3 and 4
Answer: D
Explanation:
All listed characteristics represent ideal features for future antibiotics.