New estimates reveal that at least 1.27 million deaths per year are directly attributable to antimicrobial resistance (AMR), requiring urgent action from policymakers and health communities to avoid further preventable deaths. This includes 51,000 deaths directly attributable to AMR in West Europe in 2019.1 p
Based on estimates across 204 countries and territories2, the ‘Global burden of bacterial antimicrobial resistance in 204 countries and territories in 2019’ paper provides the most comprehensive estimate of the global impact of antibiotic resistance to date and reveals that AMR has now become a leading cause of death globally. Published in The Lancet following rigorous external peer review by independent experts, 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.3In the Western Europe region, which includes the UK, over 51,000 people died as a direct result of AMR.
Antimicrobial Resistance (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 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.
In Western Europe, resistance has been found to treatments for the common infections: E. coli, S. aureus, K. pneumoniae, E. faecium, P. aeruginosa which are often acquired in hospitals and can cause deadly infections such as sepsis.
1 The Global Burden of Diseases (GBD) super region map,
https://www.healthdata.org/sites/default/files/files/images/GBD_map_GBD2010_regions_super-regions.png 2 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 204 countries and territories in 2019: an analysis for the Global Burden of Disease Study. The Lancet 2022; published online Jan 20. https://doi.org/10.1016/S0140-6736(21)02724-0
3 GBD 2019 Disease and Injuries Collaborators. ‘Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019’. The Lancet 2019; publish online Oct 20. https://doi.org/10.1016/S0140-6736(20)30925-9. In 2019, Malaria accounted for around 830,000 deaths and HIV/AIDs 1,120,000 deaths.
Current action plans on AMR are not ambitious or fast enough to control the threat.
Previous estimates had predicted as many as 10 million annual deaths from AMR by 2050.4In 2022, as we now have access to these robust estimates, we now 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.
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 so we can control the threat and avoid further preventable deaths."
We are not innovating fast enough to develop effective 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). • Whilst all seven of the leading bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO) only two have been a focus of major global health intervention programmes – S. pneumoniae (primarily through pneumococcal vaccination) and M. tuberculosis.
And with high levels of hospitalisations from COVID-19, there is a risk that the burden of AMR has already accelerated due to increased use of antibiotics.5 However, more evidence is needed to ascertain the true impact.
Talking about the need for political action on AMR, UK Special Envoy on Antimicrobial Resistance, Dame Sally Davies said: ““AMR is already one of the greatest challenges facing humanity. Behind these new numbers are families and communities who are tragically bearing the brunt of the silent AMR pandemic. We must use this data as a warning signal to spur on action at every level.”
There are immediate actions that can help countries around the world protect their health systems against the threat of AMR:
1. We need to take greater action to monitor and control infections, globally, nationally and within individual hospitals.
2. We must accelerate our support for infection prevention and control, as well as expand access to vaccines and clean water and sanitation.
3. We must optimise our use of antibiotics unrelated to treating human disease, such as in food and animal production, taking a One Health* approach and recognising the interconnection between human and animal health.
4. It’s time to be more thoughtful about our use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed, minimising use where they are not necessary to improve human health, and acting according to WHO Global Action Plan and AWaRe guidelines6.
5. We must increase funding at every stage of the development pipeline for new antimicrobials targeting priority pathogens - from research for high priority