India’s Red Line campaign to curb over-the-counter use of antibiotics is finding recognition, and could be adopted on a world scale

India’s idea of putting a red line on antibiotic packages to curb their over-the-counter sale is now being cited as a model that can be used globally to counter the rising threat of superbugs.

In its final report on tackling drug resistant infection released on May 19, the global Review on Antimicrobial Resistance — commissioned by UK Prime Minister David Cameron in 2014 and chaired by economist Jim O’Neill — , says India has led the way so far with its idea of a ‘Red Line Campaign’ for antibiotics packaging, launched earlier this year and should be considered as a starting point. It recommends that the labelling and symbols used can be improved if needed and then expanded globally.

“Common labelling standards of this type could become a condition of sale of antibiotics around the world,” the report notes, while stressing that convincing people to stop using antibiotics would not be effective unless people recognise antibiotics. “Labelling of antimicrobials, especially antibiotics, is crucial. We call on governments and international health organisations to agree on global labelling standards,” it adds.

The Red Line campaign

India’s Red Line campaign, launched in February this year, began marking prescription-only antibiotics with a red line to curb their irrational use and create awareness on the dangers of taking antibiotics without being prescribed them.

The report says laws prevent sale of antibiotics and other antimicrobials over-the-counter, but these may be weakly enforced in some countries and non-existent in many. It says 20-30 per cent of antibiotics are consumed without prescription in south and east Europe, and up to 100 per cent in parts of Africa.

It is still early in India to map the impact of the Red Line initiative, but experts see better awareness. “The government has backed it up with a communication campaign that says a Red Line medicine should not be taken without prescription,” Dr Kamini Walia, who heads the Indian Council of Medical Research’s (ICMR) antibiotic stewardship programme and antimicrobials, said. She added the campaign must continue and have hard-hitting messages like those used for tobacco, and side-effects of over-prescribing should also be highlighted.

Dr Camilla Rodrigues, consultant microbiologist at Hinduja Hospital, said while there is better awareness among doctors, people too are curious enough to ask. She added that while doctors in most countries don’t prescribe antibiotics, in India patients go directly to the chemist or use an old prescription to buy antibiotics.

It predicts by 2050, unless action is taken, deaths due to AMR could balloon to 10 million each year and cost the global economy $100 trillion. “On this basis, by 2050, the death toll could be a staggering one person every three seconds and each person in the world today will be more than $10,000 worse off,” the report states.

Modi endorses campaign

In a press release issued by the Review on Antimicrobial Resistance, Prime Minister Narendra Modi was quoted as saying that India recognises AMR as one of the major global threats to public health. “We have placed restrictions on the sale of antibiotics by making necessary statutory changes. A campaign has been launched to increase awareness regarding AMR along with national treatment guidelines for antibiotic use.”

By 2050, unless action is taken, deaths due to AMR could balloon to 10 million each year