Nayan Chanda, For The Straits Times

Superbugs in an incredibly unwell India

Indian women holding latrines as they participate in the opening ceremony of the three-day International Toilet Festival in New Delhi last month. Open-air defaecation and poor public hygiene have allowed superbugs to contaminate the rivers, waterways
Indian women holding latrines as they participate in the opening ceremony of the three-day International Toilet Festival in New Delhi last month. Open-air defaecation and poor public hygiene have allowed superbugs to contaminate the rivers, waterways and even drinking water. -- PHOTO: AFP

India has recently launched an online visa programme in the hope of doubling the inflow of tourist dollars, which has been well below the country's potential.

Quick delivery of visas is, however, only the first and easiest step. It is much harder to provide the facilities for a safe and enjoyable visit for millions wishing to taste what the country's tourist promotion has billed as "Incredible India".

It is high time the country redoubled its efforts to tackle the emergent threat of superbugs that has increasingly come to be associated with India.

In recent years, the so-called superbugs - the catch-all for pathogens resistant to known antibiotics - have caused thousands of deaths around the world.

Even developed countries like the United States and those in Western Europe see nearly 50,000 deaths each year from infections caused by antibiotic-resistant bacteria.

In 2010, a British scientist named a superbug NDM-1 - after New Delhi where it was found - and it caused an uproar. Some even spoke of a plot to harm India's rising medical tourism. Now, a research paper published by the US National Institutes of Health has named India as the likely home of superbugs. The paper warned that health-care providers should be aware of the increased risk of superbug infection "among returned travellers, especially those from India".

Shortly thereafter, in September, US President Barack Obama concluded that superbugs pose a serious public health risk and appointed a commission to prepare a five-year plan to confront the potential spread of the disease.

The seriousness and international nature of the problem were highlighted by the fact that in addition to the relevant health authorities, the commission included the state and defence departments.

In a way, those afflicted with the superbugs are victims of India's success. The rise of the country's US$12.4 billion (S$16.3 billion) pharmaceutical industry, producer of nearly one-third of the world's antibiotics, has seen the proliferation of powerful generic drugs to every corner of India. Until recently, local chemists in any small town would hand strips of antibiotics, without a prescription, to customers complaining of common ailments like diarrhoea, fever or cough.

The indiscriminate use of such magic drugs has provoked an inevitable response: These "bugs" have gradually developed a resistance to antibiotics.

According to Yale University's Associate Professor Manisha Juthani-Mehta, a specialist in infectious diseases, between 70 and 90 per cent of Indians have drug-resistant varieties residing harmlessly in their intestines.

The problem is that open-air defaecation and poor public hygiene have allowed the superbugs to contaminate the rivers, waterways and even drinking water. If such bacteria infect other organs or enter the bloodstream, they can be lethal. There have been incidents in India's private hospitals where international patients have died of an infection from a superbug after undergoing routine bypass surgery.

Global concern led India to set up a task force in 2011 to address the issue of the superbug. After initially blaming unnamed foreigners for plotting to damage India's medical tourism industry (which brought in US$872 million in revenues in 2010), the government has taken some long-overdue measures.

A decision earlier this year requiring chemists to insist on a doctor's prescription before selling common antibiotics should help in reducing the overuse of antibiotics. However, the efficacy of the rule will depend on its enforcement.

The Modi government's cleanliness campaign and the drive to build toilets in the countryside, where millions relieve themselves in the open, are a good start.

Along with measures to provide toilets and clean drinking water and build sanitation infrastructure, India needs to launch mass education campaigns about public hygiene and preventive health care.

The country certainly needs more international visitors, but the easy availability of tourist visas should not merely open the door to an incredibly unwell India.

stopinion@sph.com.sg

The writer is editor-in-chief of YaleGlobal Online, published by the MacMillan Centre, Yale University.