Medical research is once again pointing to India as a dangerous crucible of bacterial strains that resist many forms of antibiotic treatment. Cheap, under-regulated antibiotics and a severe shortfall of sanitation infrastructure fuel the problem.
Medical experts warn India remains at the forefront of what the World Health Organization calls “the post-antibiotic era,” in which a wide range of infectious bacteria evolve past the ability of even potent medicines to treat them.
So-called “superbugs” contain a gene named NDM-1, which boosts the ability of bacteria to resist even powerful antibiotics. The ND stands for New Delhi, where it was found in a difficult-to-treat Swedish patient hospitalized in 2007 in the Indian capital. Four years later, a study in the British medical journal Lancet warned bacteria containing NDM was widespread not only in New Delhi hospitals, but also in the Indian capital's drinking supply and sewer systems.
K. Kumarasamy is a microbiologist in the Indian city of Chennai who specializes in drug-resistant pathogens. He says superbugs are coming to be found not only in hospitals but in outpatient clinics, and warns his country is becoming a breeding ground for drug-resistant germs.
"There are lot of evidences that it is one of the epicenters," said Kumarasamy.
When bacteria evolve to become drug resistant, even simple illnesses like dysentery can become nearly impossible to treat. Advanced procedures like surgery, which rely on antibiotics to control infection, become much more dangerous.
The problem here in India stems mainly from the fact that the market is flooded with cheap, mass-produced, and under-regulated antibiotics. Dr. Mark Toleman is a molecular geneticist at Britain's Cardiff University.
"Very powerful antibiotics are freely available by anybody off the street wanting to purchase [them]," said Toleman. "In many other nations in the world they are quite tight[ly] controlled. I think that's the main problem as regards the overuse of antibiotics."
Last year's Lancet study, co-authored by Toleman, came under sharp criticism over its methodology. Some Indian leaders accused Toleman and other researchers of deliberately trying to discredit India's emerging medical tourism industry. Toleman describes India as being in a state of denial.
"Even to be seen to be doing something constructive about the problem is obviously in India's best financial interest as well as just the general interest of her own population," he said. "So, it's very difficult for me to understand why the Indian government [is] trying to brush it, as it were, under the carpet."
Unsanitary conditions in India are blamed for creating an environment for superbugs - both in emerging megacities, and in rural locations where toilet infrastructure is nearly nonexistent.
Nitya Jacob, head of water issues at New Delhi's Center for Science and Environment, co-authored a recent study called “Excreta Matters.”
"India has a capacity to treat only about a fifth of its sewage and I think about 40 percent of that capacity is concentrated in just two cities of Delhi and Bombay," said Jacob.
Superbug researcher Kumarasamy says the Indian government needs to act urgently to prevent the spread of drug-resistant diseases.
"First of all, the banning of self-medication," said Kumarasamy. "Proper antibiotic control. Next, they have to initiate [an] antibiotic surveillance network all over India."
The World Health Organization describes antibiotic resistance as “one of the biggest health scares to the world”. The United Nations agency estimates about 150,000 people die annually from drug resistant tuberculosis alone.