Antibiotic resistance — where bacteria evolve to survive antibiotic drugs — is one of the most urgent public health threats of our time. Rates of resistance are increasing globally, making once‑treatable infections harder and sometimes impossible to cure.
In India, misuse of antibiotics — including self‑medication, over‑the‑counter sales without prescriptions, and inappropriate prescriptions — has fuelled a rise in resistant infections that endanger lives and strain the healthcare system.
To tackle this, the Union health ministry recently proposed a regulatory reform requiring all antimicrobial medicines to carry a distinct blue line on their packaging — a visual cue intended to make antibiotics instantly recognisable and discourage casual use.
Under an amendment to the Drugs Rules, 1945, antibiotics and other antimicrobial medicines would have a prominent blue vertical strip on the packaging label. This is meant to act as a behavioural nudge at the point of purchase — helping consumers identify these drugs and understand that they require prescriptions and cautious use.
This follows past efforts like the red line campaign, which advised consumers to take antibiotics only on a doctor’s prescription — yet misuse and overuse remain pervasive.
Several pharmaceutical industry groups, including the Himachal Drug Manufacturers Association and others linked to national trade bodies, have raised objections to the blue line rule. Their concerns include:
Operational disruption: Mandatory packaging changes would require firms to destroy existing stock, reprint materials, and potentially halt supplies — all of which add costs.
Lack of evidence: Industry bodies argue there’s no clear scientific proof that colour‑coded packaging changes prescriber or patient behaviour. They point out that prescribing practices and retail enforcement — not colouring — drive misuse.
Regulatory misalignment: Because international regulators like the WHO do not mandate similar colour identifiers, the change could complicate exports and harmonisation.
Existing controls: Antibiotics are already governed by prescription‑only regulations and warning labels under Schedule H/H1 of the Drugs Rules, reducing the perceived need for another visual marker.
Public health experts argue that incremental interventions matter given the scale of the antimicrobial resistance (AMR) crisis. Studies show a sharp rise in resistant infections worldwide, with resistance increasing across many bacteria–antibiotic combinations.
Even small behavioural nudges — like clearer labelling — could reinforce awareness among patients and pharmacists about the seriousness of antibiotic use. In a country where antibiotics are often purchased casually, visual cues might act as an additional checkpoint.
Moreover, broader strategies like India’s National Action Plan on AMR 2.0 emphasise coordinated efforts across sectors — from strengthening surveillance to promoting prescriber stewardship and public awareness.
Antibiotic misuse fuels resistant infections. Taking antibiotics without a prescription or not completing a full course contributes to resistance.
Visual identifiers can help awareness. Although controversial, better packaging cues could make antibiotics easier to recognise and discourage casual use.
Reform isn’t the whole solution. Stronger enforcement of prescription laws, improved stewardship among doctors and pharmacists, and public education remain essential.
The pharma industry’s resistance to the blue line reform highlights the tension between commercial interests and public health priorities. But with antibiotic resistance threatening lives globally, reforms that strengthen responsible use — even small ones like clearer packaging — may deserve broader support.
The fight against AMR requires collective action — from regulators and manufacturers to doctors and patients alike.
