Antimicrobial resistance is a huge threat - new deal offers hope

Dr Tedros Adhanom Ghebreyesus is the director-general of the World Health Organization.

AMR threatens to unwind a century of medical progress, and could return us to the pre-antibiotic era, where infections that are treatable today could become much harder to treat and potentially deadly tomorrow.

AMR is caused largely by the misuse and overuse of antimicrobial medicines — such as antibiotics — making microbes resistant to them, and diseases more dangerous and deadly. It is associated with over a million deaths a year, with an escalating death toll projected over the coming decades.

The spread of AMR has implications for health-at-large. Health facilities are often where the most stubbornly treatment-resistant infections emerge and spread. AMR makes all manner of routine medical procedures riskier; in low- and middle-income countries (LMICs), approximately 11% of people who undergo surgery are infected in the process.

The burden of treatment-resistant infections falls heaviest on these countries, where AMR is worsened by a lack of access to clean water, stretched health systems, limited budgets, poor access to diagnosis and appropriate treatment, and a lack of enforcement of legislation. Sepsis in newborns that spreads in hospitals is a particularly dramatic illustration of how tough the situation is in LMICs.

The crisis in equitable access to new and existing antimicrobial medicines is also felt most acutely in poorer countries, where a lack of availability is a much bigger problem than misuse and overuse – the tools aren’t there in the first place.

AMR also compounds challenges in some of the world’s most difficult circumstances. From Gaza to Sudan to Ukraine, AMR makes wartime injuries harder to treat. Even before the current conflict, AMR was found to be significantly increasing in Gaza, with a 300% rise in resistance to specific antibiotics in injured patients after the 2018-19 demonstrations.

The drug-resistant infections that start in conflict zones rarely stay within them, as people flee, medical evacuations are arranged, and soldiers are cared for alongside civilians in hospitals, leading AMR to spread. Yet another reason why the best medicine is peace.

Addressing AMR is not easy. What we do know is that plans that span health, environmental, animal and agrifood systems lead to progress, but so far, they have only been pursued in high-income countries. This needs to change.

And although alarms on AMR have been blaring ever louder, solutions have not been developed fast enough, especially in the research and development of antibiotics. Since mid-2017, only 13 new antibiotics have been authorised, with only two representing a new chemical class and considered innovative.

The investment case for AMR is clear in light of the huge cost of inaction. A study led by WHO alongside partners estimates that globally AMR could lead to additional health care expenditures reaching as high as $412 billion annually in the next decade if a stronger AMR response isn’t mounted.

It would also impose workforce participation and productivity losses of $443 billion. But this study also shows that AMR is a ‘best buy’, with $7-13 expected in return on every $1 invested in critical AMR interventions.

The political declaration approved on Thursday at the United Nations in New York includes commitments and targets across human health, animal health, agriculture and the environment.

Headline commitments include reducing the global deaths associated with drug-resistant bacteria by 10% by 2030 and ensuring that at least 70% of antibiotics used for human health globally should belong to the safer WHO Access group, which have the lowest potential to cause AMR. Projections show that many of the AMR-related deaths are avoidable, including by ensuring access to life-saving antimicrobial medicines in LMICs.

We hope the New York meeting will become a springboard to bring in more funding, to turn the targets and commitments in its declaration into reality.

At the talks, participants heard from AMR survivors, Ella and John.

Ella lives with cystic fibrosis and has had to rely on an experimental treatment after no viable antibiotic options were left to treat the most severe drug-resistant infection she’d ever had. For John, surgery for a simple hip fracture turned into a year of hospital stays after an infection at the incision site spread to his bloodstream and became resistant to multiple drugs. His kidneys nearly stopped working.

A successful response to AMR relies on political commitment, sustainable financing, measuring progress with accountability and most importantly, placing Ella, John and all those affected at the centre of the response.