Can a single health vision remedy AMR crisis?

After a week of illness, a rural doctor changed a 6-year-old's antibiotic for the third time. Two days later, the child lay in Dhaka Shishu Hospital with sepsis. Nearby in Gazipur, a farmer watched 3,000 broiler chickens die from a gut infection no longer controlled by the "growth promoter" mix in their feed. That same week, University of Dhaka students found alarming levels of ciprofloxacin in the Buriganga River, downstream from a major pharmaceutical plant-where people still collect water.
These are faces of one crisis: Antimicrobial Resistance (AMR), the "silent pandemic" turning Bangladesh's hospitals, farms, and rivers into a giant petri dish. AMR has been identified by the World Health Organization (WHO) as one of the major threats to public health in the present and near future. COVID-19 proved an invisible virus can halt economies; AMR is quietly undermining surgery, cancer care, transplants, even simple wound treatment. The World Bank warns low-income countries may lose 5 per cent of GDP yearly by 2050, weakening Bangladesh's garments sector, health, and aquaculture. It stems from many small, separate choices, not one culprit.
THE HUMAN PILL: If we walk into any local pharmacy and ask for "something strong" for a sore throat, we'll likely be given a strip of azithromycin without needing a prescription. According to a study, an overwhelming majority of participants (78.3 per cent) who self-medicated without a prescription procured their medicines directly from pharmacies or drug shops during their last illness. Even in Bangladesh's flagship public hospitals, antibiotics are handed out like cough drops: A 2024 review of 21,500 hospitalised Severe Acute Respiratory Infection (SARI) patients found that 91 per cent received antibiotics-four times the WHO benchmark for uncomplicated chest infections.
THE ANIMAL PILL: Bangladesh's fastest-growing protein sectors-poultry, aquaculture and dairy-are also the biggest antimicrobial users. Small commercial poultry farms depend on dealer credit for chicks and feed; these dealers also sell and promote antibiotics. This trust-based credit system raises major public health risks by building reservoirs of resistant bacteria and genes that can move to humans.
A 2024 study found high resistance in bacterial isolates: penicillin (100 per cent), ampicillin (85 per cent), amoxicillin (75 per cent), tetracycline (66 per cent), chlortetracycline (64 per cent), azithromycin (57 per cent), kanamycin (54 per cent) and gentamicin (50 per cent); 36 of 56 isolates (64 per cent) are multidrug resistant. Routine prophylactic use drives resistance to vital human drugs like ciprofloxacin, colistin and tylosin. Resistant bacteria spread via manure: farms using colistin shed mcr-1-positive faeces, with the same genes in nearby canals and in farmers' stools. Farm and family now share the same microbes.
THE ENVIRONMENTAL PILL: Antibiotic Resistance Genes (ARGs) are a new pollutant, driven by heavy antibiotic use in farming, human and veterinary medicine. Resistant bacteria now contaminate soil, animal waste, livestock buildings, nearby land, manure sites and farm animal guts. Rivers act as drains for drug waste. In the Buriganga River, seven antibiotics were found above resistance selection levels. Untreated hospital wastewater adds broader spectrum drugs. Once ARGs take hold in aquatic microbes, they spread via fish, irrigated crops and storm aerosols, turning the environment into a long lasting, circulating reservoir of resistance
CONNECTING THE DOTS: The only viable response is the coordinated system already proposed: a National One Health Coordination Council with legal authority to set and enforce cross-sectoral limits.
What would unified action look like?
The Council should issue a single "Bangladesh Antibiotic Use & Resistance Standard" that caps prophylactic use in poultry, aquaculture and livestock, aligns with national human treatment guidelines, and mandates annual benchmarking. Import licenses for veterinary antimicrobials should depend on compliance audits, not just customs paperwork.
The government should consolidate AMR interoperability data from hospital microbiology labs, veterinary/animal health labs, and environmental monitoring sites (water bodies, effluent, food and live-bird markets, farms) into a single, interoperable, near-real-time dashboard, hosted and governed by IEDCR. The platform should offer role-based access for clinicians, veterinarians, and regulators (DGHS, DLS, DoF, DoE etc.) to support timely clinical decisions, outbreak detection, and enforcement. AMR surveillance should be the flagship component.
Medical colleges should teach that many human pathogens originate in animals; veterinary schools should treat antibiotic stewardship as a core obligation. Joint field practicums-vet students collecting litter samples while medical students map household diarrhea-could start next academic year if universities align their syllabi.
The government should gradually remove the 10 per cent import duty on animal probiotics and vaccines while introducing a tiered excise on bulk antibiotic active ingredients. A clear price gap will push feed mills towards preventive measures instead of routine antibiotic use. Export incentives for "antibiotic-free" shrimp and poultry should match those for ready-made garments, turning stewardship into an economic asset.
The Parliament's Standing Committee on Health should hold an annual "AMR Week" hearing where the secretaries of health, livestock, environment and commerce jointly present quantified progress-with no sector allowed to opt out.
The draft One Health Strategic Framework 2025-2030 already includes these mechanisms; what is missing is the political will to finalise and fund them before the next budget cycle. The cost of delay is measured in lives and livelihoods. Every month we wait, we condemn thousands of vulnerable newborns to sepsis that our best drugs can no longer treat. At the same time, thousands of tons of poultry waste continue to pollute our soil, spreading drug-resistant genes across our farms. This is both a public health and environmental emergency, and inaction is steadily making it worse.
Bangladesh has beaten the odds before-eradicating smallpox without vaccine plants, ending polio with door-to-door volunteers, and turning cholera into a treatable illness with oral saline. It can again overcome AMR through commitment, coordination and cooperation among all stakeholders.

Dr Md. Abdul Latif is Additional Director, Bangladesh Institute of Governance and Management (BIGM); bdul.latif@bigm.edu.bd;
Afsana Akter is Research Associate, BIGM