Assa Doronis is professor of anthropology and South Asia at the Australian National University in Canberra. Alex Broomis is academic director for Social, Behavioural and Economic Sciences at the Australian Research Council. Doronis & Broomis have authored a book titled ‘A World of Resistance: India and the Global Antibiotic Crisis’ (2026). This long essay in Aeon is based on that book.
Doronis & Broomis central point is that extensive use of antibiotics in India has created a medical crisis because bacteria has mutated to become impervious to these meds:
“Across India, antibiotics are regarded as ‘strong medicine’: a fast and familiar solution when there is neither time nor money for a proper diagnosis and medically supervised treatment. Decades of routine use by millions of Indians – rich and poor alike – have reinforced the sense that antibiotics work and are just part of day-to-day life. They are cheap, widely available through thousands of streetside pharmacies and, for most people, seemingly free of immediate side effects…
The costs, however, accumulate elsewhere. The side effects are not immediate, overt or dramatic, but delayed, concealed and pervasive. Bacteria adapt. Previously potent drugs lose their power. What once seemed like the perfect answer to human vulnerability to bacterial infection is now revealing its limits in the form of antimicrobial resistance: a slow-moving consequence of antibiotic overuse.”
In a tightly connected global economy, it is easy for these superbugs to spread first within India and then globally. Doronis & Broomis provide tangible examples of this as they write:
“In a connected world, those microbes and resistant genes will not remain local.
They may travel in the gut of an unwitting tourist or circulate through the body of a worker in India. But resistance is not contained within individual bodies. It moves through wider systems, from sewage and waste to farms, food chains and global trade. Superbugs emerge in densely packed farms outside India’s megacities and in shrimp ponds supplying supermarkets in the United States. There, antibiotics do more than treat disease. They help sustain intensive production, deliver cheap protein, protect farmers’ incomes and secure corporate profit…
Antibiotics have become a routine tool of intensive farming. By volume, around two-thirds of antimicrobials sold worldwide are used in animals rather than humans. In India, their use is especially common in shrimp farming and poultry, where they are used to promote growth, ward off disease in crowded conditions and protect yields. What looks like efficiency is often a form of pharmaceutical dependence…
Resistant bacteria also gather around pharmaceutical manufacturing plants in South India. Wastewater from some of these facilities has repeatedly been found to contain antibiotic residues and resistance genes. At the same time, some manufacturers produce substandard or spurious antibiotics for both foreign and domestic markets. These are two distinct routes into the same problem. Environmental contamination exposes bacteria to a mixture of chemicals and low levels of antibiotic residues, helping the hardiest survive and multiply. Poor-quality drugs allow bacteria to persist, making treatment less effective next time. Either way, the phenomenon is the fuel behind MRSA bacteria, drug-resistant tuberculosis, and the highly resistant strains of E coli, Klebsiella and Acinetobacter. Then, such microbes and their resistance genes cross borders through travel, trade, food system…”
So, what is to be done? What is the way forward? The article is silent with regards to practical solutions to this crisis in our meds and in the processed non-veg that we eat. Doronis & Broomis write:
“India’s crisis is our collective crisis. Offshored production, export markets and cost-driven procurement shape what enters global supply chains and what then circulates through waterways, food systems, hospitals and bodies far beyond India….Civil society has long called for effective wastewater treatment and transparent disclosure of antibiotic use and discharge. What’s needed now is a global response with enforceable supply chain rules, alongside technology transfer that builds regional capacity and fits local realities…
The costs will be paid not only in lives, but in higher treatment expenses, lost productivity, and major hits to livestock production and wider welfare…Unless the global community assumes shared responsibility for the rise of resistance in India – and the Global South more broadly – it will end up paying for the consequences everywhere.
Superbugs care little for national borders or bodily boundaries. They move through healthcare systems, infrastructures and industries that reward short-term gain while dispersing long-term harm. India is not the source of this crisis, but one of the places where those pressures converge most intensely and at scale.”
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