At the United Nations General Assembly in New York, all countries approved a major new political declaration to radically scale up efforts to combat antimicrobial resistance (AMR)—a major threat to modern medicine. AMR threatens to unravel 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’s an issue that 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.
The burden of treatment-resistant infections falls heaviest on LMICs, 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 of inequitable access to new and existing antimicrobial medicines is also felt most acutely in LMICs, where a lack of availability is a much bigger problem than misuse and overuse (the tools aren’t there in the first place). A lack of access to vaccines increases the risk of drug-resistant infections, and a lack of access to diagnostics makes it harder to detect drug-resistant infections and prescribe the right treatments.
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.
AMR is associated with over a million deaths a year, with an escalating death toll projected over the coming decades.
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.
But while 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 political declaration just approved 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 belong to the safer WHO Access group, which has the lowest potential to cause AMR. Projections show that many of these deaths are avoidable, including by ensuring access to life-saving antimicrobial medicines in LMICs.
This meeting's biggest opportunity is to become a springboard for more funding and to turn the targets and commitments in its declaration into reality. The investment case for AMR is clear in light of the huge cost of inaction. Quadripartite and OECD estimates show that AMR could lead to additional global healthcare expenditures reaching as high as $412bn annually in the next decade if a stronger AMR response isn't mounted.
