Victor Mallet is a journalist and author who has reported on Asia, Africa, the Middle East and Europe for Reuters and the Financial Times. Visit his website at victormallet.org

Few people are surprised to hear that Indian waterways, including the holy Ganges River that sweeps across north India and Bangladesh, are a common source of stomach bugs and illnesses. Sanitation is notoriously poor in this country of 1.3 billion people; about half the inhabitants do not even have access to a toilet; and hundreds of children die each day from easily preventable ailments such as diarrhoea.

What is less well known is that the waters of the Ganges can also carry so-called ‘superbugs’: bacteria with antibiotic resistance genes to fortify the bugs against any medicines that might be taken to cure disease.

Sadhus washing dishes and cleaning teeth in the water of Ganges (Image: Yavuz Sariyildiz/Shutterstock)

In rich countries, the threat of drug-resistant superbugs is much discussed, particularly when there are lethal outbreaks of MRSA (Methicillin-Resistant Staphylococcus aureus) in hospitals. Dame Sally Davies, England’s chief medical officer, said in October that without immediate action we would soon be facing ‘a dreadful post-antibiotic apocalypse’. Already about 700,000 people worldwide die each year from infections that can no longer be treated by antibiotics, and the number of fatalities is predicted to rise to ten million a year – more than the number of people now killed annually by cancer – without the development of new drugs.

In India, however, the topic is barely mentioned by policymakers even though thousands of newborns – over 58,000 a year according to a study in The Lancet – die from infections by antibiotic-resistant bacteria. The number of adult victims can barely be guessed at.

India, furthermore, is one of the epicentres of the superbug phenomenon. It is therefore essential that the country plays a bigger role in the international campaign to find a solution to the spread of antibiotic resistance, however inconvenient it may be to admit that India itself is part of the problem.

A pilgrim in Varanasi taking a holy bath in the Ganges (Image: Yavuz Sariyildiz/Shutterstock)

It was back in 2009 that a 59-year-old man caught a urinary tract infection during a trip to India, where he was being treated for another ailment. Later, in a Swedish hospital, he was found to be infected with bacteria that resisted antibiotics with the help of a previously unreported bacterial gene known for short as NDM-1 (for New Delhi metallo-beta-lactamase).

The global spread of NDM-1 and its many variants has been startlingly quick, and in India scientists have found that the antibiotic-resistance genes are spread through the river water by pilgrims in places holy to Hindus such as Haridwar on the Ganges. Devout Hindus are unwittingly spreading diseases, and resistance to diseases, in the very river to which they have come to pay homage.

One problem (poor basic sanitation and the resulting disease) combines with another (the overuse and misuse of antibiotics) to lead to a third and even graver problem in the form of spreading resistance to antibiotics. Ramanan Laxminarayan, a medical expert on the topic, says India has created a ‘perfect storm’ to produce dangerous strains of bacteria because of its high levels of infectious diseases, its large pharmaceutical industry, and the poor handling of antibiotics.

Cleaning the Ganges will have benefits for both health and infrastructure (Image: Marcos del Mazo Valentin/Shutterstock)

Fortunately, solutions can beget other solutions, just as problems can spawn other problems. Narendra Modi, the Indian prime minister and a devout Hindu, has personally championed a $3billion clean-up campaign to save the Ganges since he won his own seat in Varanasi on the river in 2014 – and at the same time achieved an overwhelming general election victory for his Bharatiya Janata Party.  Foreign and Indian donors and lenders, including the World Bank and Japan, stand ready to help with both money and expertise.

By improving sanitation and cleaning the river – and emulating the rescue of other polluted rivers such as the Thames in England, the Rhine in continental Europe and the Chicago in the US – India will not only provide thousands of municipal and construction jobs for the millions of unemployed who leave school each year. It will also benefit wildlife and the beleaguered riverine environment, and provide safe water for drinking and ceremonial bathing. Above all, it will save the lives of thousands of children who die unnecessarily from infections, and start to make progress in what will be a long struggle against the spread of superbugs across India and the world.

Victor Mallet is the author of River of Life, River of Death: The Ganges and India’s Future (£20 hardback/eBook • Oxford University Press). Click here to order via Amazon.

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