The National Centre for Disease Control,in a survey of three Delhi hospitals,has confirmed the presence of New Delhi metallo-beta-lactamase-1,or NDM-1,in intensive care units. Delhis health minister,A.K. Walia,insisted that the mutated enzyme NDM-1 is a gene variety resistant to many common antibiotics is within safe levels,and is not in the citys water,sewers,or environment,though that assertion would presumably require a larger-scale survey to confirm,especially as previous surveys have suggested the opposite. Neither the tone in which NDM-1s presence was confirmed nor the actions that have accompanied the confirmation,are particularly reassuring. Even though it has accepted the actual presence of the superbug,it does not appear that the government has gotten over its first reaction: to stonewall queries,and downplay the problem.
Our public health authorities should take this issue far more seriously than they have. Even a small amount of bacteria so thoroughly resistant to antibiotics will make many surgical interventions,in particular,difficult: organ and bone marrow transplantation and chemotherapy will be particularly badly hit,according to the Journal of the Association of Physicians of India. The confirmation from government agencies has taken a long time to arrive,and it is hard to point to a single action that has been lined up in preparation for this bad news. Indeed,in its hypersensitive response to the original discovery (and naming) of NDM-1,the government has limited the sort of cross-border investigation and control mechanisms for antibiotic resistance that the World Health Organisation has said are essential to control the spread of the problem.
It is necessary for the government to acknowledge,at the highest level,that India has a problem with antibiotics. They are too easily prescribed,and basic norms for their use are not followed. Correcting that will not be easy,and will need the health ministry at the Centre to cooperate with the states to rework how India manages,regulates and thinks about antibiotics. Yet,a comprehensive antibiotics policy,the first necessary step,remains undrafted; while the Drugs Controller General of India has reported its intention to alter the Drugs and Cosmetics Act to better regulate antibiotics,that proposal remains on the drafting board,and may indeed given how lax the government has been about this problem be forgotten altogether. That cannot be allowed to happen. The health ministry must take the lead in ensuring that Indias negligent attitude to antibiotics is not allowed to poison modern medicine.