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Status Brief

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:




Gallagher, James, “NDM-1 Superbug Enzymes ‘Photo fit’ Taken,BBC News, September 6, 2001 Last Checked 9/6/2011

  1. “The structure of the protein which stops some of medicine’s most powerful antibiotics working has been determined by researchers.”
  2. “The protein has larger ‘jaws’ which allow it to attack more antibiotics than other enzymes.” *”Carbapenem antibiotics are considered the last line of defense against resistant bacteria. However, some are now resistant even to these drugs.”
  3. “Bacteria with a gene for New Delhi metallo beta lactamase (NDM-1) are able to produce an enzyme which breaks antibiotics down.”
  4. “The way bacteria freely exchange genes between themselves, and even between species, means this resistance gene could spread to other disease-causing bacteria.”
  5. “Professor Sharon Peacock, a member of the Medical Research Council Infections and Immunity Board, said: ‘identifying the structure of NDM-1 is a crucial step towards ensuring that drug development is based on a sound understanding of the mechanism of bacterial resistance to antibiotics.’”

NDM-1, Drug Resistance, India


Fuhrmann, Matthew, “Making 1540 Work:  Achieving Universal Compliance with Nonproliferation Export Control Standards“,  World Affairs (Washington, D.C), Win 2007, Volume 169, No.3, pages 143-52.

  1. “An effective nonproliferation export control system must license or approve the export, re-export, transit, and transhipment of proliferation-sensitive commodities.” p 144
  2. “For an export control system to be effective, frontline personnel must enforce regulations at border crossings and governemnts must punish those who intentionally or inadvertently corcumvent the system.” p 144
  3. “Governments with little experience in [restricting trade] often perceive that export control directly conflicts with one of their primary objectives — to augment national wealth by promoting exports and imposing few restrictions.” p 145
  4. “The most glaring points of nonconvergence remain India’s failure to join the export control regimes, which it has historically viewed as discriminatory.” p 146
  5. “New Delhi has harmonized its nuclear and missile control lists with those of the NSG and the MTCR and is currently working to harmonize those lists pertaining to chemical, biological, and conventional dual-use secorts with the relevant export control regimes.”  pp. 147-148
  6. “Russia is not a member of the AG, though its control lists closely match the AG’s lists of controlled items, and it is a signatory of the Biological and Toxin Weapons Convention (BTWC).”  p 148



Raghunath, D., “New Metallo β-lactamase NDM-1”, Published November 2010, Indian Journal of Medical Research, Vol. 132 Issue 5, pg.478-481.

  1. “The métallo ß-lactamases (MBL) are the more versatile enzymes that can convert the host bacteria into almost total ß-lactam insusceptibil.” (pg.478)
  2. “The first bacterial isolate carrying the MBL later designated blaNOM-1 was a Klebsiella pneumonia urinary isolate from a patient with insignificant bacteria along with other multi-resistant bacteria from wound swabs.” (pg.478)
  3. “The NDM-1 gene is normally carried on a variety of plasmids along with other resistance factors. The bacteria also showed broad antibiotic resistance to all classes except colistin and ciprofloxacin.” (pg.478)
  4. “Rarely the gene was integrated into the chromosome. The sequencing of the gene showed that it was a new enzyme unrelated to hitherto known MBLs.” (pg.478)
  5. “NDM-1 confers on its host bacteria almost all ß lactam resistance and is accompanied by extensive antibiotic resistance. Such bacteria would be difficult to eliminate in clinical situations.” (pg.478)
  6. “Briefly, blaNDM-1 is a novel MBL with ability to confer resistance to almost all the ß lactams.” (pg.478)
  7. “A number of isolates from nine locations in India, eight cities in Pakistan and Dhaka, Bangladesh have been confirmed to carry NDM-1 (by PCR) indicating that the plasmid is perhaps quite widely distributed in the subcontinent. While this fact leads credence to the ‘Indian’ origin, it may not be necessarily so.” (pg.478)
  8. “However, the statement blaNDM-1 is widespread in the Indian environment is true.” (pg.479)
  9. “A heated debate in Indian professional and media circles is the assertion of the authors that patients from the West who would travel to the Indian sub-continent for elective surgery are at risk of post-operative infections due to bacteria carrying NDM-l resulting in higher treatment costs.” (pg.479)
  10. “This would negate any economy that would accrue to the NHS from contracted outsourcing of elective surgery to ‘countries such as India’.” (pg.479)
  11. “Septicaemia caused by a bacterium carrying NDM-1 would be well nigh impossible to treat if it has the accompanying resistances. However, the mere presence of the organism in the environment would not translate to infection if control measures are in position, as they would be, in the major corporate hospitals that cater to medical tourism.” (pg.479)
  12. “The National (UK) Resistance Alert in vol 3 (4) of the Health Protection Report (referred to 28) in this paper warns about carbapenemases but does not mention about the MBL blaNDM-1. However, a fresh alert specifically mentioning blaNDM-1 has been issued on July 3, 2009.” (pg.479)
  13. “There has been little evidence of clonal spread of NDM-1 bearing E.coli or K.pneumoniae except in the case of the isolates within Haryana.” (pg.479)
  14. “The epidemiology of the focus has not been systematically studied either. This needs to be done soon.” (pg.479)
  15. “The prescription habits, lack of infection control and easy access to even top line antibiotics add up to a dismal scenario prompting observers to write an ‘obituary’ to antibiotic treatment.” (pg.479)
  16. “These factors along with poor sanitation and personal hygiene foster the generation of resistant bacteria and their dissemination.” (pg.480)
  17. “The belief that multi-resistant pathogens are physically hampered and incapable of surviving in nature is no longer valid. Numerous instances of hospital generated or strains acclimatized to high levels of environmental antibiotic pressures living and spreading ‘merrily’ in the community are now known.” (pg.480)

NDM-1, India, Drug Resistance


Cheng, Maria, “Researchers find superbug gene in New Delhi water,” Santa Cruz Sentinel, April 7, 2011. Last Checked April 9, 2011.

  1. “A gene that can turn many types of bacteria into deadly superbugs was found in about a quarter of water samples taken from drinking supplies and puddles on the streets of New Delhi, according to a new study.”
  2. “Experts say it’s the latest proof that the new drug-resistance gene, known as NDM-1, named for New Delhi, is widely circulating in the environment – and could potentially spread to the rest of the world.”
  3. “Bacteria armed with this gene can only be treated with a couple of highly toxic and expensive antibiotics. Since it was first identified in 2008, it has popped up in a number of countries, including the United States, Australia, Britain, Canada and Sweden.”
  4. “Last fall, British scientists analyzed more than 200 water samples from central New Delhi, including public tap water and water that collected in the streets. They found the superbug gene in two of the drinking water samples and 51 of the street samples. Researchers found the gene in 11 different types of bacteria, including those that cause dysentery and cholera.”
  5. “Mark Toleman, a senior research fellow at Cardiff University and one of the study authors, said the superbug gene was being spread through New Delhi’s water supply, but that experts didn’t know how many people were being sickened by it. He guessed about a half million people in New Delhi are now carrying the superbug gene naturally in their gut bacteria.”
  6. “Indian officials called the study “unsupported” and denied the gene was a public health threat. They cited a random sample of nearly 2,000 women in a New Delhi hospital which they said showed no sign of it.
  7. “We know that such bacteria with genes are in the atmosphere everywhere,” said V.M. Katoch, director-general of the Indian Council of Medical Research. “This is a waste of time,” he said. “The study is creating a scare that India is a dangerous country to visit. We are condemning it.”
  8. “Since the superbug gene was found in the U.K. last year, British officials say there have been about 70 cases of it in the U.K. including a small hospital cluster.”
  9. “‘We have a vested interest in sorting out sanitation problems in India,” Toleman said, adding the West should invest more money in clean water projects in Asia. ‘Otherwise (superbugs) could filter out from Asia and will spread through the world.’”

NDM-1, Drug Resistance, India


Editors, “United States and India sign Cybersecurity TreatmentDepartment of Homeland Security, 19 July, 2011,

  1. “NEW DELHI—The United States and India signed a Memorandum of Understanding (MOU) today to promote closer cooperation and the timely exchange of information between the organizations of their respective governments responsible for cybersecurity.”
  2. “The agreement helps fulfill the joint commitment of both nations to advancing global security and countering terrorism, one of the pillars of the U.S.-India Strategic Dialogue launched on July 20, 2009.”
  3. “Previously, Secretary of Homeland Security Janet Napolitano traveled to India in May to launch the U.S.-India Homeland Security Dialogue (HSD) with Indian Minister of Home Affairs P. Chidambaram.”
  4. “he 2011 HSD was the first comprehensive bilateral dialogue on homeland security issues between the United States and India.”
  5. “During her visit, the countries agreed to create the MOU, and negotiations for the non-binding arrangements were concluded at the June 2011 meeting…”
  6. “The MOU establishes best practices for the exchange of critical cybersecurity information and expertise between the two governments through the Indian Computer Emergency Response Team (CERT-In)…”
  7. “Through this arrangement, the respective governments and broader cybersecurity communities in both the United States and India will have the ability to coordinate with their counterparts on a broad range of technical and operational cyber issues.”

Cybersecurity, India, Homeland Security


Sinha, Kounteya,Drug resistance growing among TB patients,” The Times of India, November 15, 2011 Last Checked November 15, 2011

  1. “Drug resistance is spreading among tuberculosis (TB) patients in India.”
  2. “According to India’s revised national TB control programme (RNTCP), latest studies conducted in Maharashtra, Gujarat and Andhra Pradesh have found that around 12% to 17% of all TB re-treatment cases are drug resistant.”
  3. “Dr. Kumar told TOI, ‘At present we have only 6-7 effective drugs against TB.’”
  4. “Random and irrational use of these drugs, especially by private doctors, is making patients drug resistant.”
  5. “There have been no new TB drug classes for nearly 50 years and irrational courses to patients is leading to resistance among whatever drugs are available.”
  6. “The government has plans to put in place 43 labs to diagnose MDR-TB.”
  7. “According to Dr. Kumar, ‘most patients start treatment of TB in the private sector. The private doctors use irrational combinations to treat them making them drug resistant. They finally land up in the government treatment programme.’”
  8. “The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually.”

Tuberculosis, India, Drug Resistance, Vaccination, Public Health


Dasgupta, Sunil and Cohen, Stephen, “Arms Sales for India Subtitle: How Military Trade Could Energize U.S.-Indian Relations,” March 2011-April 2011, Council on Foreign Relations Inc., Vol. 90, No. 2.

  1. “Obama announced that the United States would sell $5 billion worth of U.S. military equipment to India, including ten Boeing C-17 military transport aircraft and 100 General Electric F-414 fighter aircraft.”
  2. “Although the details are still being worked out, these and other contracts already in the works will propel the United States into the ranks of India’s top three military suppliers, alongside Russia and Israel.”
  3. “With India planning to buy $100 billion worth of new weapons over the next ten years, arms sales may be the best way for the United States to revive stagnating U.S.-Indian relations.”
  4. “Since coming to power, the Obama administration has shifted course, partly on the grounds that Bush gave India too much, especially in regard to the nuclear deal. The Obama administration wants greater reciprocity — including Indian support for U.S. policies on global energy and trade, India’s granting of more freedom of action in Afghanistan and Pakistan, and weapons contracts for U.S. firms. Obama also wants to develop ties more incrementally. One reason is that his administration’s primary interest in the region is stabilizing Afghanistan and Pakistan.”
  5. “Obama’s two years of trying to bring Pakistan on board with Washington’s plans has led only to frustration and has highlighted the importance of renewing cooperation with India in order to make progress on Afghanistan.”
  6. “Russian military suppliers enjoy strong relationships with the Indian military establishment and its research agency, the Defense Research and Development Organization, relationships that were developed during the Cold War.”
  7. “But now, after a decade of rapid economic growth that fattened India’s military budgets, the Indian armed forces have set their sights on buying a range of new weapons, from traditional machinery, such as tanks, ships, and aircraft, to the most advanced innovations, such as unmanned aerial vehicles and the technology for electronic warfare. And India is increasingly turning to Israeli and Western suppliers, especially since its ties with Russian sellers started souring in early 2010, when the Russians forced a repricing of the aircraft carrier Admiral Gorshkov from $1 billion to $2.3 billion.”
  8. “The Indian-Israeli arms trade amounts to more than $2 billion annually, and Israel has become India’s number two military supplier. Like Russia, it offers India access to military equipment without imposing political conditions, and Israeli firms have also been able to woo the DRDO with offers of joint development of high-tech weaponry.”
  9. “The United States clearly has the technological edge to win Indian military contracts, but the U.S. law banning the transfer of technologies that have military uses is a major stumbling block. India’s leaders have made it clear that if they purchase machinery from the United States or U.S.-based firms, they expect to be granted access to the manufacturing processes and technology behind it. On the other side, the U.S. government would have to overcome significant legal hurdles to allow technology transfers to India.”
  10. “There are questions about whether technology transfers would actually motivate India to make the political concessions the United States seeks and worries that Washington would have to keep offering more and more to secure Indian friendship in the future.”
  11. “The Obama administration is apprehensive that getting too close to India would jeopardize U.S. objectives in Afghanistan and Pakistan, especially if the Indian military were to use equipment it received from the United States against Pakistan. Even U.S. companies, which hope to profit from India’s military market, are reticent about sharing their prize technologies.”
  12. “In 2009, India’s leaders signed an end-use monitoring agreement that would allow U.S. representatives to periodically inspect and inventory items transferred to India — and they did so despite criticism that the agreement’s terms eroded India’s sovereignty.”
  13. “During his visit to India in November, Obama promised to lift some export-control restrictions on India and to remove some restrictions on trade with India’s space and military research agencies.”
  14. “But some major obstacles remain. For one, India needs to fix its broken procurement system. Although the Indian Ministry of Defense has issued a series of new military procurement guidelines in the last few years, transparency, legitimacy, and corruption problems continue to plague the process. Indian law also requires foreign suppliers to source components and invest in research and development in India, while prohibiting them from creating wholly owned or majority-owned subsidiaries in the country. These two provisions are intended to ensure that the technology used by foreign suppliers will eventually be transferred to Indian companies. But the U.S. government and U.S. companies would not agree to this unless the U.S. law governing technology transfers were relaxed and India began to guarantee the protection of intellectual property rights.”
  15. “The new nuclear liability bill that India passed in August will also have a chilling effect on U.S.-Indian military trade. It holds foreign suppliers responsible for accidents at nuclear power plants for up to 100 years after the plants’ construction. The law applies to companies that supply equipment to the contractors building the reactors, even if these companies do not have a physical presence in India. Progress on the construction of any new reactors under the U.S.-Indian nuclear deal will almost certainly be slowed by this law, as U.S. companies seek to protect themselves from liability.”
  16. “The United States can get around its own legal restrictions on technology transfers by pursuing such ambitious long-term projects, because if a technology does not currently exist, U.S. law does not protect it.”
  17. “Not only would the United States gain a huge foothold in the Indian military market; it could also channel any offset money it is required to invest in India into joint development projects.”
  18. “So far, however, the Obama administration has not wanted to think big and seriously consider joint technology development. This is a mistake. Short-term differences between India and the United States caused their estrangement during the Cold War. A similar rift now would not be in the long-term interest of either country.”

Export Control, U.S. Foreign Policy, India, Military


Stobbe, Mike, Naqvi, Muneeza, (AP), “India reports new strain of ‘totally drug-resistant tuberculosis”,, Jan 16, 2012.
last checked 1/17/12

  1. ”Indian doctors have reported the country’s first cases of “totally drug-resistant tuberculosis,” a long-feared and virtually untreatable form of the killer lung disease.”
  2. ”Since 2003, patients have been documented in Italy and Iran. It has mostly been limited to impoverished areas, and has not spread widely.”
  3. ”No one expects the Indian TB strains to rapidly spread elsewhere. The airborne disease is mainly transmitted through close personal contact and isn’t nearly as contagious as the flu.”
  4. ”Indeed, most of the cases of this kind of TB were not from person-to-person infection but were mutations that occurred in poorly treated patients.”
  5. ”The World Health Organization hasn’t accepted the term and still considers the cases to be what’s now called extensively drug-resistant TB, or XDR.”
  6. ”Ordinary TB is easily cured by taking antibiotics for six to nine months. However, if that treatment is interrupted or the dose is cut down, the stubborn bacteria battle back and mutate into a tougher strain that can no longer be killed by standard drugs.”
  7. ”’These three patients had received erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners,’ wrote the doctors from P.D. Hinduja National Hospital and Medical Research Center in the journal Clinical Infectious Diseases.”

Tuberculosis, Drug Resistance, India, WHO


Palmer, Randall, “Canada Firms to Capitalize on Nuclear Trade with India”, November 6, 2012, Reuters, U.S. Edition, Last checked February 14, 2013.

  1. ”Canadian firms will be able to export uranium and nuclear reactors to India for the first time in almost four decades under an agreement between the two nations, their prime ministers said, but more work is needed to implement the deal.”
  2. ”Once implemented, the agreement will end a ban on nuclear cooperation Canada imposed in 1976 after India secretly exploded its first nuclear bomb in 1974, commonly called the “Smiling Buddha”, using material from a Canadian-built reactor in India.”
  3. ”India aims to lift its nuclear capacity to 63,000 MW in the next 20 years by adding nearly 30 reactors. The country currently operates 20 mostly small reactors at six sites with a capacity of 4,780 MW, or 2 percent of its total power capacity, according to the Nuclear Power Corporation of India Limited.”
  4. ”However, the CNSC official said India would now be required to notify Canada of any transfers to a third country and trade could only go to facilities that are safeguarded by the IAEA.”

Export Control, Nuclear, Canada, India


Jeremy Laurance, “One doctor’s dream: to keep India’s last polio ward empty.” March 1, 2013, The Independent, Last Checked, March 4, 2013.

  1. “In the early 1990s there were 3,000 cases of paralytic polio each year in India. Now there are none.”
  2. “In a country of 1.2 billion people, the monumental scale of that achievement – successfully vaccinating 95 per cent of children aged five and under – is a tribute to Indian diligence. India’s passion for bureaucracy may burden businesses with paper work (and drive visa applicants to despair) but here has proved it can also save lives.”
  3. “The centrepiece of the campaign is the national immunisation days (NIDs), begun in 1995, around which all other activities are organised. The aim is to vaccinate 172 million children under five on a single day, employing 2.5 million vaccinators who are moved in 155,000 vehicles (including boats, elephants and camels) carrying over six million ice packs (to keep the vaccine cool) and supplying over 700,000 vaccination booths – set up in hospitals, on street corners and out of the back of cars. The NID is followed by a five day mop up phase in which vaccinators move from house to house, following a meticulously planned route, seeking out those missed.”
  4. “The task is a logistical nightmare. The local distribution centre for Mukundpur, north west Delhi, is in a dingy office in the Jagiwan Ram Government hospital where the boxes of vaccine are kept in a freezer. At 6.30am last Sunday the vaccine was loaded into insulated containers with a packet of ice – it must be kept between four and eight degrees centigrade – and dispatched in one of 15 vehicles to supply 160 booths.”
  5. “Until the 1950s polio outbreaks occurred regularly across the world, terrifying parents and causing death and disability to thousands of children.”
  6. “The polio virus infects nerve cells, destroying muscle function and eliminating tendon reflexes, especially in the legs, leaving the victim severely paralysed. In the worst cases it spreads into the brain stem, destroying the nerve cells that control breathing and swallowing. Survival then depends on artificial ventilation – thousands were treated in iron lungs – and tube feeding until the acute phase of the illness is past.”
  7. “Albert Sabin argued that his oral polio vaccine, launched in 1960, could be used to eliminate the disease. Coming five years after Jonas Salk’s vaccine (made from killed virus and injected), it had two advantages: it was easy to administer and, as a live virus, produced a mild contagious illness that spread immunity.”
  8. “A trial in the 1950s in Toluca, Mexico, a town with a 100,000 population in which polio had broken out, proved its potential. In four days Sabin’s team vaccinated 26,000 children and in weeks polio disappeared from Toluca. In 1995 India used a trivalent vaccine against three types of the virus. Type 2 was eradicated in 1999, but not Type 3 and Type 1. Single vaccines were introduced in 2005 for each type and alternated each year, but Type 3 spiked in 2007-8. In 2010 a bivalent vaccine was introduced –and within a year, India had recorded its last polio case.”

Vaccination, Polio, India