India, May 8 -- Every year, antibiotic resistance kills more people in India than in any other country. Drug-resistant infections were directly responsible for 267,000 deaths in India in 2021 and were associated with nearly a million more. Failing antibiotics are a catastrophe unfolding in hospital wards nationwide. The standard response to anti-microbial resistance (AMR) focuses on restricting antibiotic use, which includes better prescribing practices, tighter pharmacy regulations, reduced over-the-counter sales. These are necessary, particularly in India's cities, where antibiotics are dispensed with alarming frequency for viral fevers, coughs, and diarrhoea. But in rural India, people who genuinely need antibiotics often can't access or afford them. Overuse of antibiotics accelerates the selection of resistant strains while underuse leads to incomplete treatment and avoidable death and suffering. There is another strategy to tackle antibiotic resistance - vaccination. If you prevent the infection, you never need the antibiotic. And if you never prescribe the antibiotic, you never create the selection pressure that turns a treatable bacterium into an untreatable one. A report released this week in New Delhi by the Global Antibiotic Resistance Partnership (GARP), in collaboration with Christian Medical College Vellore and a national working group of infectious disease specialists, microbiologists, and public health experts, clarifies this opportunity. The WHO estimates that optimal use of vaccines against priority bacterial pathogens could avert up to 2.5 billion defined daily doses of antibiotics annually, which accounts for nearly 22% of global antibiotic consumption. India, as the country bearing the largest share of the global AMR burden, stands to gain the most from this focus on vaccination to tackle drug resistance, but has also done the least to capture it. India's vaccination record over the last decade has been largely positive. Mission Indradhanush, launched in 2014, raised full immunisation coverage from 62% in 2015-16 to 76% by 2019-21. However, vaccination coverage is below 60% in several northeastern states and nationally and the gains have been largely confined to childhood vaccines. India's immunisation programme must expand its vision to address drug-resistant infections, which requires vaccinating not just children but also adults. Consider typhoid. Active surveillance between 2017 and 2020 found typhoid incidence of up to 1,173 cases per 100,000 child-years in Vellore, 714 in Kolkata, and 576 in Delhi. The disease is now acquiring resistance at a pace that should alarm clinicians and policymakers alike: Salmonella typhi strains resistant to carbapenems - a class of antibiotics unaffordable for many patients - have already been detected in India. We have limited options to fall back on. But India has four licensed typhoid conjugate vaccines (TCVs), three of them WHO-prequalified and manufactured domestically. The delivery cost in Navi Mumbai was estimated at under 55 US cents per dose. The vaccine works and provides approximately 85% direct protection against blood culture-confirmed typhoid in children. This vaccine can be scaled up for high-risk populations immediately. Pakistan, Nepal, Zimbabwe, and Burkina Faso have all integrated TCV, a remarkable tool to address drug-resistant typhoid, into their national immunization programs. Unfortunately, India has yet to do so despite a recommendation for rollout by the National Technical Advisory Group on Immunization back in 2022. A similar situation prevails in the case of pneumonia. India introduced the pneumococcal conjugate vaccine (PCV) into childhood immunization in 2017, late by global standards, and lowering child deaths. Meanwhile, pneumonia is increasingly a cause of death in older adults - deaths in the 50-69 age group rose 33% and those over 70 by 55% between 2000 and 2019. Yet, there is still no routine public-sector provision for this vaccine for adults. A One Health Trust study showed a measurable decline in antibiotic consumption three to four years after PCV introduction in the private sector. Expanding that effect to the public sector for adults over 65 and high-risk populations would translate into reduced antibiotic demand and resistance. We are running out of effective antibiotics. Every treatment course prescribed for a preventable infection is a step toward a world where antibiotics stop working. India's path back from that edge runs directly through vaccines. India can deploy its existing manufacturing base, cold chain infrastructure, and immunization workforce to tackle this challenge but only if there is political will to treat vaccination not merely as a child health program, but as a core national strategy to tackle antibiotic resistance....