A new paper, ‘Global burden of bacterial antimicrobial resistance in 204 countries and territories in 2019’, from the Institute for Health Metrics and Evaluation (IHME), provides comprehensive estimates of the global impact of antibiotic resistance to date and reveals that antimicrobial resistance (AMR) has now become a leading cause of death globally.
The paper highlights specific areas of concern and equips governments and health communities with the information they need to act quickly and develop a proportionate response. Estimates included in the paper show that AMR is a leading cause of death globally, higher than HIV/AIDs or Malaria. The report was published in The Lancet.
AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.
Common infections such as lower respiratory tract infections, bloodstream infections, and intra-abdominal infections are now killing hundreds of thousands of people every year because bacteria have become resistant to treatment. This includes historically treatable illnesses, such as pneumonia, hospital-acquired infections, and foodborne ailments. An estimated 4.95 million people who died in 2019 suffered from at least one drug-resistant infection and AMR directly caused 1.27 million of those deaths.
Everyone is at risk from AMR, but the data shows that young children are particularly affected. In 2019, one in five deaths attributable to AMR occurred in children under the age of five – often from previously treatable infections.
Sub-Saharan Africa faces the highest burden, with 255,000 deaths due to AMR in just one year and a particularly high number from vaccine preventable pneumococcal bacterial disease. However, high income countries also face alarmingly high levels, most notably for Escherichia coli, which commonly causes kidney infections, and Staphylococcus aureus, which is often acquired in hospitals and can cause bloodstream infections.
Current action plans on AMR are not ambitious or fast enough to control the threat.
Past projections estimated that as many as 10 million annual deaths from AMR could occur by 2050. In 2022, we know that we are already far closer to this figure than expected. AMR is already threatening the ability of hospitals to keep patients safe from infections and undermining the ability of doctors to carry out essential medical practice safely, including surgery, childbirth and cancer treatment since infection is a risk following these procedures.
We are not innovating fast enough to develop effective vaccines, medicines and treatments:
- Between 1980 and 2000, 63 new antibiotics were approved for clinical use. Between 2000 and 2018, just 15 additional antibiotics were approved.
- Out of the seven deadliest drug-resistant bacteria, vaccines are only available for two (Streptococcus pneumoniae and Mycobacterium tuberculosis).
- Seven of the leading bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO) but only two have been a focus of major global health intervention programs – S. pneumoniae (primarily through pneumococcal vaccination) and M. tuberculosis.
- And with high levels of hospitalizations from COVID-19, there is a risk that the burden of AMR has already accelerated due to increased use of antibiotics.
Discussing the importance of the new estimates to direct urgent action, Director of the Institute for Health Metrics and Evaluation, Professor Chris Murray said: “This paper is a critical step that allows us to see the full scale of the challenge. We now need to leverage these estimates to course-correct action and drive innovation if we want to stay ahead in the race against AMR.”
New estimates from the paper were pre-released to Health Ministers at the G7 in June 2021, who agreed that AMR must be prioritized as part of plans to strengthen global health systems.
There are immediate actions that can help countries around the world protect their health systems against the threat of AMR:
- We need to take greater action to monitor and control infections, globally, nationally and within individual hospitals.
- We must accelerate our support for infection prevention and control, as well as expand access to vaccines and clean water and sanitation.
- We must optimize our use of antibiotics unrelated to treating human disease, such as in food and animal production, taking a One Health approach and recognizing the interconnection between human and animal health.
It’s time to be more thoughtful about our use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed, minimizing use where they are not necessary to improve human health, and acting according to WHO Global Action Plan and AWaRE guidelines.
