Drug-resistant infections are a rapidly escalating global health crisis – we need to fight back

If the lessons of Covid-19 are anything to go by, the latest data on antimicrobial resistance (AMR) and its worldwide impact should stir policymakers into immediate action.

As concern around coronavirus recedes in parts of the globe, the long shadow cast by AMR grows with each day. A striking new study published in The Lancet – the most comprehensive of its kind to date – estimates that 1.27 million people died as a result of antibiotic resistant infections in 2019. A further 3.68 million deaths were linked to these “superbugs”.

This is almost double previous estimates for the death toll from AMR and points to a global health threat that is rapidly escalating beyond the clutches of our control. The estimates for 2019 indicate that antimicrobial resistance is now killing more people than HIV or malaria, making it one of the world’s leading causes of death.

As the use of drugs has increased in recent decades thanks to the progress of modern medicine, pathogens responsible for infection and disease have grown immune to the effects of such treatment.

Some microorganisms naturally survive exposure to drugs which should kill them, enabling them to pass on their resistance to others. However, the overuse of antimicrobial drugs speeds up this natural process. When antimicrobial drugs are used, they kill the bugs without resistance genes, so only the ones that are immune to the treatment survive.

AMR has soared since the 1970s and even now, amid a global pandemic, is considered one of the biggest public threats. Without effective antibiotics, infections – like sepsis, or food poisoning – can kill. Non-fatal infections would keep people in hospital longer, require more expensive drugs to treat and cause more damage.

And as more and more bacteria become resistant, routine medical procedures which rely on antibiotics to prevent infection – like Caesarean sections, chemotherapy, organ transplants and joint replacements – will become highly dangerous or impossible.

The use of antibiotic drugs in livestock has seemingly accelerated the issue. Worldwide, two-thirds of all antibiotics are given to meat animals to curb the spread of disease. This has come at a cost, though, fuelling the evolution of drug-resistant pathogens that are capable of doing as much harm to us humans as animals.

A widely-cited UK-led review, commissioned by former prime minister David Cameron and published in 2016, estimated that superbugs killed 700,000 people a year. It also warned that 10 million people a year would die from AMR by 2050 if action wasn’t taken.

These figures appear to be a gross underestimate of the reality we’re now facing, according to The Lancet study.

It found that found that high-income countries, in spite of their advanced healthcare systems, have “alarmingly high levels” of AMR burden. E. coli, which most commonly causes kidney infections, and Staphylococcus aureus, a hospital-acquired infection that is resistant to the drug meticillin, are among the biggest killers.

However, as is always the case with matters of global health and disease, it is the poorest countries who are being hardest hit. Western sub-Saharan Africa – a region that includes Cameroon, Nigeria and Gabon – has the highest fatality rate attributable to AMR, at 27.3 deaths per 100,000 people.

Infections of the respiratory tract, bloodstream and stomach that were once treatable are now killing hundreds of thousands, the analysis shows.

Our valuable defences against some of the world’s biggest killers are also falling down in the face of AMR. In 2018, an estimated half a million people fell ill with a form of tuberculosis that has become resistant to what was one of the most effective treatments.

The outlook is undeniably bleak. It does not feel an exaggeration to say that AMR holds the potential to weaken the foundations of modern medicine; in this sense, it is one of the greatest challenges facing humanity.

Those behind The Lancet study, the Global Research on Antimicrobial Resistance project, have called for governments to swiftly respond to the unfolding crisis – not an easy ask when many countries are continuing to grapple with Covid-19.

So what does meaningful action look like? Minimising the spread of AMR in the first place is vital, the scientists say. That involves improving hospital and community care-based infection prevention measures. Clean water and effective sanitation infrastructures are crucial, too.

Then there are vaccines, which can protect against infection all together and reduce the need for antibiotics. Scientists are crying out for investment into developing jabs against many of the pathogens behind AMR. The Covid vaccines have shown that when there’s a will, there’s a way, so why should the response to antimicrobial resistance be any different?

Other measures to tackle AMR include reducing exposure to antibiotics unrelated to treating human disease, such as in livestock farming, and minimising the use of these drugs when they are not necessary to improve human health, such as treating viral infections.

Covid-19 has shown us what happens when the world is caught off-guard, culminating in the loss of millions of lives. But it has also demonstrated the capacity of science, alongside the resilience of the human spirit, to overcome the dark side of nature.

AMR is another catastrophe waiting to happen. The writing is on the wall. There can be no time for delays in starting the global fightback.