With AMR linked to millions of deaths worldwide each year, the international community has agreed on targets and actions to reduce this burden.
Published Jul 17, 2025 | 7:33 PM ⚊ Updated Jul 17, 2025 | 7:33 PM
Antimicrobial resistance or AMR, is a growing global concern. Kerala has plans to combat it. (Representational image/Creative Commons)
Synopsis: Kerala became the first state in India to release a sub‑national antimicrobial resistance action plan, known as the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP), designed to tackle AMR through a One‑Health approach and coordinated action across multiple sectors.
Antimicrobial Resistance, commonly known as AMR, has been recognised by the World Health Organization as one of the biggest public health challenges.
It happens when microorganisms such as bacteria and viruses stop responding to medicines that once killed them. This makes infections harder to treat and increases the risk of disease spreading, severe illness and death.
On a global level, the United Nations General Assembly has also discussed AMR and called for strong national action plans, as this issue matters far beyond one region. With AMR linked to millions of deaths worldwide each year, the international community has agreed on targets and actions to reduce this burden. A strong political will and a whole-of-society approach are essential to achieve these targets, with local, context-specific solutions playing a crucial role.
From India, the southern state Kerala has stepped into this global effort with a distinct contribution. It became the first state in India to release a sub‑national antimicrobial resistance action plan, known as the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP), designed to tackle AMR through a One‑Health approach and coordinated action across multiple sectors.
Kerala’s One Health Programme is a state-led, multi-sectoral initiative that strengthens disease surveillance, prediction, response, and long-term planning to build a resilient health system.
A new study titled “When policy‑makers have your back: the Kerala experience with state‑wide antimicrobial resistance mitigation efforts”, published in Antimicrobial Stewardship & Healthcare Epidemiology (ASHE) in 2025, explains in detail how Kerala planned, developed and carried out its own state‑wide steps to tackle antimicrobial resistance, and highlights the different measures and approaches used in the state.
The study reiterates that AMR is a serious problem where medicines stop working against bacteria and other microorganisms.
The study says KARSAP was “conceptualized and implemented on the One Health platform” and was jointly drafted by departments such as health, animal husbandry, fisheries and agriculture. It notes that KARSAP was the first action plan of this kind in India at the state level.
One main part of the study talks about awareness and understanding. To aid the same, Kerala started a campaign called The Antibiotic Literate Kerala Campaign (ALKC).
This campaign, in the words of the study, “puts people and their needs at the centre of the AMR response.” It focuses on teaching people to use antibiotics only when a doctor prescribes them and to safely throw away expired medicines.
They also created online learning materials in Malayalam, the regional language, for farmers, students and the public. The study explains that “the broad objectives envisaged under ALKC are universal awareness about the importance of having access to antibiotic‑free food and water, consuming antibiotics only on a doctor’s prescription, and safely disposing of unused or expired antibiotics.”
The study also emphasized how Kerala used a decentralized approach, meaning work was shared across different local levels. District and block‑level committees were formed, and they monitor activities and share progress. The study says that “the AMR committees at the district and block levels are truly One Health‑based.”
These committees have been running education sessions, and some family health centres, called FHCs, have been named as antibiotic‑smart hospitals because of their good practices.
Another important part is knowledge and evidence. Kerala built a network called KARS‑NET, which is a surveillance system to collect data on infections and resistance patterns.
This system helps doctors choose better medicines. The study notes that “In 2023, Kerala published the first district antibiogram for Ernakulam district, which reflected the susceptibility trends in secondary care institutions.”
Further, the Antibiotic Smart Hospital Initiative, gives public and private hospitals a chance to earn recognition when they meet certain safety and stewardship standards.
These steps, along with other efforts like Operation AMRITH that checks if antibiotics are sold only with prescriptions, have built a strong base for Kerala’s response. These combined efforts mark Kerala’s early progress in creating a structured and coordinated response to antimicrobial resistance.
The study highlighted that Kerala will work on tracking antibiotic use by pin code and on creating tier‑based guidelines for antibiotics in hospitals.
It mentioned plans “to incorporate AWaRe color coding matrix into e‑health with visual cues to guide prescription” within three years. The study also pointed out plans to expand the Antibiotic Smart Hospital model to more private hospitals with the involvement of different medical associations.
While these steps have laid a strong foundation, the study also detailed the challenges that remain in the path of antimicrobial resistance control.
The study described how KARSAP was built mainly around process indicators, which measure actions rather than final results.
It noted that there has been “a 30 percent reduction in antibiotic sales in Kerala (unpublished data),” but added that “it is too early to determine whether this decrease in sales will translate to a reduction in AMR trends.”
The study stated that AMR challenges vary across regions, and “a one‑size‑fits‑all model for AMR mitigation efforts will be suboptimal.” It also observed that it took the state four years to map multi‑sectoral AMR challenges and draft a time‑specific monitoring and evaluation framework.
The study however, described the Antibiotic Smart Hospital Initiative and participatory stewardship as “a transformative approach to combating antibiotic resistance.”
It noted that through government‑led programs, strong policies and community participation, Kerala has developed a model that can handle AMR challenges at different levels of healthcare. The study stated that these steps show that when policy‑makers treat AMR as a priority, technical experts can successfully design and implement measures that protect public health.
(Edited by Sumavarsha)
