Water Contaminants Blue

Opportunities in creating robust wastewater treatment regime in India with co-benefits of restricting antimicrobial resistance

By Anjali Parasnis, Ajith Radhakrishnan and Mahesh Patankar (2030 WRG India team)

Emerging standards in wastewater treatment and monitoring:

Globally, wastewater treatment is now perceived to be at par with the imperative to treat freshwater for human consumption. However, levels of contamination and treatment of water bodies still significantly vary across regions. Among other countries in South Asia, the state of contamination and treatment of water bodies in India is still evolving. According to the 2018 report of the Government of India’s (GOI) think tank Niti Ayog, 70% of India’s water resources is contaminated.[1] Additionally, out of the 122 countries assessed for the water quality index, India is ranked number 120. This is mainly due to the raw sewage and unprocessed industrial effluent water flowing into the country’s major rivers and water bodies. Fortunately, the GOI’s initiatives are moving in the right direction as seen in recent efforts to assign economic value to treated wastewater. Progress is likewise reflected in the January 2018 tariff order of the Maharashtra Water Resources Regulatory Authority, as well as in the National Green Tribunal’s (NGT) recent order[2] insisting on stringent standards for wastewater treatment. The NGT order in particular marks the first time that standards related to key parameters (e.g. biological and chemical oxygen demand, suspended solids, nitrogen (ammonia and nitrates), phosphorus, and fecal coliform) were made strict. In summary, the GOI is poised to offer a substantial boost to efforts toward wastewater treatment and reuse.

AMR – an emerging global threat and its link with the water sector:

All around the world, a new threat to water bodies and human health has been identified. Specifically, the contamination of water bodies due to residual antibiotics found in sewage and industrial effluents, has been determined as the next priority area in need of immediate attention. Antibiotics used for human consumption and for applications in animal husbandry, as well as effluents disposed from drug manufacturing facilities enter into ecosystems, water sources, and food chains. In several emerging economies, the poultry industry uses high amounts of antibiotics in bird feed that is used to raise broilers. The presence of these residual antibiotics in turn develops antimicrobial resistance (AMR) among the microbial organisms present in wastewater and soil. This phenomenon poses a serious threat to human health. Meanwhile, recently published media reports warn that the world’s water bodies are contaminated with dangerous levels of antibiotics.

We attempt to evaluate what recent global studies inform us regarding the vulnerability of the Indian agriculture sector, which is a major consumer of water. The agricultural practices and irrigation in drought-prone areas mainly depend on water sourced from nearby rivers or streams, or else from groundwater. Due to the contamination of water bodies, toxins such as heavy metals, residual pesticides, organic chemicals, and antibiotics are carried, through water, onto agricultural areas and food chains, thus introducing serious threats to human health and to the environment. There is hence a need to sensitize stakeholders to the threats of using unprocessed wastewater for agricultural applications. Equally necessary is a call for action to define the problem in the Indian context. Monitoring of antibiotic and drug residues in wastewater as well as their further processing using modern technologies are essential to India’s development process.

Presence of drugs like antibiotics, pharmaceutically active compounds (PhACs), and endocrine disrupting compounds (EDCs) in the aquatic environment is a global concern. These compounds, reported to have adverse impacts on the health of humans, animals, aquatic life, and the wider environment, have been detected in various quantities from treated wastewater, surface water, and groundwater. More importantly, through exposure to antibiotics from wastewater, natural microorganisms have acquired resistance to many antibiotics, which occurrence is regarded as a threat to modern medicine (Box 1).

Global efforts to identify the extent of AMR
Given the growing global problem of drug-resistant infections and its implications, the UK Prime Minister commissioned the Review on Antimicrobial Resistance in 2015.[3] According to the WHO, 490,000 people around the world developed multi-drug resistant tuberculosis in the year 2016, and drug resistance is starting to complicate the fight against HIV and malaria, too.[4] Furthermore, the treatment failure of the drug of last resort (DoLR) for gonorrhea (i.e. third-generation cephalosporin antibiotics) has been confirmed over the last few years in at least 10 countries (Australia, Austria, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden, and the United Kingdom of Great Britain and Northern Ireland). It is estimated that AMR may reduce world gross domestic product by 2-3% per year, imposing trillions of dollars on the already crushing global economic burden.[5]

Global production and use of antibiotics is increasing considerably. Around 20 years ago, annual antibiotic usage was estimated to be between 100,000 and 200,000 tons globally.[6] An assessment conducted in 76 countries from 2000 to 2015 also indicated a 65% increase in trends in and drivers of antibiotic consumption, expressed in defined daily dosage (DDD). Assuming the Business As Usual (BAU) scenario, consumption of antibiotics in 2030 has been projected to be up to 200% higher than the 42 billion DDDs estimated in 2015.[7] Now besides human consumption, there are diverse applications of drugs in veterinary practices, animal husbandry, aquaculture, fisheries, agriculture, and medical research. The large quantities of used and unused drugs from all such applications are released into natural ecosystems in various forms, like parent compounds, derivatives, degradation intermediates, and/or a combination of all these forms. Only a few compounds are degraded in the ecosystem, but many are persistent and take a substantial amount of time to degrade completely.[8]

Policy imperatives / Key action points:

In several emerging economies such as India, sectors like food processing, pharmaceuticals, and animal husbandry are identified as contributors to high growth and profits. Still and all, relevant policy interventions that are implemented at an early stage would be highly beneficial to circumventing the risks of AMR, and to instilling best practices for the protection of ecosystems in the process of development. A shortlist of priority policy directions are:

  1. Stringent regulation of the production and usage of antibiotics, drugs, and their precursors
  2. Restriction of the sale and overuse of drugs in human as well as veterinary applications: A strategic transition of antibiotic usage from over-the-counter (OTC) marketing status to strictly prescription-based (Rx) availability would be required.
  3. Early detection through integration of (Internet of Things) IoT for monitoring of antibacterial/drug contents in natural ecosystems, as well as of components of potable water resources and food chains
  4. Treatment and stringent periodic assessment of sewage water, industrial effluents, and sludge for presence of residual drugs as well as microflorae
  5. Budgetary provisions for establishing anaerobic treatment reactors, constructed wetlands, settling tanks, and/or other relevant treatment techniques
  6. Awareness among stakeholders regarding the concept of AMR and its causes and implications



[1] https://niti.gov.in/writereaddata/files/document_publication/2018-05-18-Water-index-Report_vS6B.pdf

[2] http://www.indiaenvironmentportal.org.in/files/file/revised-standards-STPs-NGT-Order.pdf

[3] https://amr-review.org/sites/default/files/Antimicrobials%20in%20agriculture%20and%20the%20environment%20-%20Reducing%20unnecessary%20use%20and%20waste.pdf

[4] https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

[5] https://www.rand.org/content/dam/rand/pubs/research_reports/RR900/RR911/RAND_RR911.pdf

[6] Richard Wise, Antimicrobial resistance: priorities for action, Journal of Antimicrobial Chemotherapy, Volume 49, Issue 4, April 2002, Pages 585–586, https://doi.org/10.1093/jac/49.4.585

[7] Global increase and geographic convergence in antibiotic consumption between 2000 and 2015, Eili Y. Klein, Thomas P. Van Boeckel, Elena M. Martinez, Suraj Pant, SumanthGandra, Simon A. Levin, Herman Goossens, Ramanan Laxminarayan, Proceedings of the National Academy of Sciences Apr 2018, 115 (15) E3463-E3470; DOI:10.1073/pnas.1717295115

[8] U.S. Environmental Protection Agency (EPA). 2001. Handbook on Advanced NonPhotochemical Oxidation Processes. EPA/625/R-01/004. EPA Office of Research and Development, Washington, DC. https://nepis.epa.gov/Exe/ZyPDF.cgi/30004HSM.PDF?Dockey=30004HSM.PDF


Photo by Paweł Czerwiński on Unsplash