In his book River of Life, River of Death: The Ganges and India’s Future, Victor Mallet traces the journey of the river from source to mouth. Mallet, the former South Asia bureau chief for the Financial Times, writes in the book that “Indians are killing the Ganges with pollution, and that the polluted Ganges, in turn, is killing Indians.” The book includes chapters on the history of the Ganga, the distressing fate of the river in Varanasi, the extent of the toxicity of its waters, as well as its significance in the country’s water crisis. In the following extract from the book, Mallet describes the Ganga as a “Superbug river”—host to bacterial genes that expose the water’s users to infectious diseases that are resistant to modern antibiotics. The journalist discusses the role the Ganga and its tributary Yamuna play in the spread of blaNDM-1—a bacterial gene that codes for a protein called NDM-1, or New Delhi metallo-beta-lactamase, and whose presence can make the carrier highly resistant to antibiotics. Mallet writes that the spread of the gene is a political issue that is closely connected to the Ganga’s state, its sacred position among Hindus, and to India’s sanitation problem.
Vipin Vashishtha, a paediatrician in Bijnor, a town in Uttar Pradesh on the Ganges, described his horror when babies starting dying in his hospital in 2009 because bacterial acquisition of blaNDM-1 had made infections resistant to antibiotics. “What I found out was that there is a deadly epidemic going on. And very few of us have any clue ... The bacteria in our water, sewage, soil, even the bacteria within us—they are all immune to nearly all antibiotics.”
But what might a patient’s death from a superbug infection in a hospital in New York or London have to do with India, let alone the Ganges—particularly if the victim has never travelled to south Asia? The answer is that the NDM genes that make bacteria highly drug-resistant are being spread across the country in humans and other animals, and through sewers, streams, and rivers, and are ultimately transported onward in people’s guts to every part of the world.
This is a politically sensitive matter, of course. Some Indian officials and doctors were furious with The Lancet for naming the new NDM gene in 2010 after New Delhi, the Indian capital, and the origins of this particular part of the drug-resistance problem are less important now that such genes have spread around the world. But both Indian and international scientists accept that South Asia has been one epicentre of the crisis and agree that India (soon to overtake China as the world’s most populous nation) urgently needs to improve hygiene and build toilets and effective sewage treatment plants. It also needs to curb the misuse and overuse of antibiotics that accelerate the evolution of drug-resistant strains of bacteria.
Of all the academic papers on antibiotic resistance that I examined, the most arresting on the subject of the Ganges was written by scientists based in India and the UK and carried the less than catchy title: “Increased waterborne blaNDM-1 resistance gene abundances associated with seasonal human pilgrimages to the upper Ganges River.” It confirms that NDM-1 genes are found in the Yamuna River, a Ganges tributary that runs through Delhi, and in the main stream of the Ganges River. It also shows that high levels of the gene are associated with high levels of faecal coliform bacteria and therefore with the flow of human waste into rivers. More significantly, the samples demonstrate that the (relatively) pristine reaches of the upper Ganges near Haridwar suffer surges of bacterial pollution and, in turn, blaNDM-1 pollution during visits by thousands of urban Indians during the May–June pilgrimage season. Devout Hindus, in other words, are unwittingly spreading diseases, and antibiotic resistance to diseases, in the very river to which they have come to pay homage.