A One Health approach to fight waterborne antimicrobial resistance in India

Water is a major but often overlooked driver of antimicrobial resistance (AMR) in India, acting as a reservoir and transmission route for antibiotic residues, resistant bacteria and resistance genes from hospitals, households, farms and pharmaceutical industries. Because only a small share of wastewater is treated, rivers and groundwater become contaminated, accelerating the spread of resistance across human, animal and environmental systems. The article argues that tackling AMR in India requires a dedicated One Health water-focused approach, including integrating water-sector actors into national AMR governance, enhancing environmental and wastewater surveillance, upgrading wastewater treatment (including cost-effective and nature-based solutions), and strengthening research, data systems and public awareness to address waterborne AMR as a core pathway of resistance spread.