The Covid-19 pandemic has starkly illustrated the vulnerability of global health systems and economies to emergent microbial threats. Yet, running in parallel to this immediate crisis is another slow-burning but equally dire issue: antimicrobial resistance (AMR). Like the sudden emergence of the Covid-19 virus, AMR has the potential to alter the landscape of public health rapidly and irrevocably. A study published in Lancet estimated 4·95 million deaths associated with bacterial AMR in 2019. It threatens to make common infections untreatable, jeopardise medical procedures that rely on antibiotics, and thereby exponentially increase the health burden in the future. In fact, studies conducted during the Covid-19 pandemic found that AMR prevalence was high in Covid-19-positive patients.
If the world doesn’t address it now, the upcoming pandemic could be even more devastating than Covid-19. The growth in AMR following the coronavirus crisis is a fact we can't ignore. As we look ahead, it's projected that we'll face a severe shortage of effective antibiotics, given the rising number of cases that are resistant to multiple drugs or even extensively drug-resistant.
As microorganisms become resistant to commonly used drugs, infections that were once easily treatable now require prolonged medical attention, leading to an increase in healthcare professionals' workloads and longer patient hospitalizations. This extended care inevitably results in greater healthcare expenditures. Moreover, the alternative medications required to combat these resistant strains are often costlier and may come with more severe side effects, further escalating the financial burden on health systems and individuals.
The World Bank in its report titled “Drug-Resistant Infections” estimated that In a best-case scenario, global GDP could drop 1.1 per cent by 2050 due to low AMR impacts, costing over $1 trillion annually after 2030. In a worst-case scenario, annual GDP could fall 3.8% by 2050, with a $3.4 trillion annual loss by 2030. Since these pre-Covid calculations are dated (2017), the number would have significantly gone up.
The devastating impact of AMR is disproportionately borne by developing and least developed nations. A staggering 99.65 per cent of AMR-related deaths among children under five occur in low- or middle-income countries. Furthermore, children in sub-Saharan Africa face a 58-fold greater risk of dying from AMR compared to their counterparts in high-income nations. The data speaks volumes about the acute and unequal burden of AMR, necessitating urgent global intervention.
In developing countries, factors exacerbating AMR include the over-prescription of antibiotics, inadequate healthcare infrastructure, limited access to quality medicines, and poor public awareness about proper antibiotic use. Additionally, the agriculture sector plays a significant role. In dairy, poultry, and meat industries, antibiotics are frequently used not just to treat infections but also as growth promoters and preventive measures. This overuse in animals accelerates the emergence of drug-resistant strains, which can then transfer to humans through the consumption of non-therapeutically treated animal products, posing a grave public health challenge.
Philosophers such as Hannah Arendt have explored the consequences of failing to act upon what we know; in this context, her insights remind us that inaction is a form of action, often leading to catastrophic outcomes. While WHO has declared that AMR is one of the top 10 global public health threats facing humanity, nothing much has happened. Scholars in the field of epidemiology and public health have been sounding alarms about AMR for decades, emphasising the ethical imperative of stewardship over the antibiotics that we have.
WHO launched a Global Action Plan on AMR in 2015. But nothing much has happened. Now a few weeks back, WHO published a “Global research agenda for antimicrobial resistance in human health”. It has a list of 40 priority areas. While WHO’s outlined research priority areas for combating AMR are comprehensive and address critical issues, there are several notable limitations. The focus leans heavily towards the clinical and diagnostic aspects, somewhat underrepresenting the broader socio-economic, cultural, and environmental factors that contribute to AMR. There is also limited emphasis on interdisciplinary approaches that integrate medical science with other fields like economics, policymaking, and sociology to offer more holistic solutions. Further, the detailed, prescriptive nature of the research areas may inadvertently stifle innovative or unconventional research topics that fall outside these pre-defined categories. The plan also lacks specific mention of One Health approaches, which consider the interconnectedness of human, animal, and environmental health in tackling AMR. Lastly, while it addresses the needs of low- and middle-income countries to some extent, it could benefit from a stronger focus on the implementation and scalability of AMR interventions in these resource-limited settings, including infrastructural challenges and public awareness campaigns.
Further, the lack of global funding for new antibiotics is a critical failure, leaving us with a dwindling drug pipeline. Without global consensus on how to finance R&D, we can't secure access to new antibiotics or curb misuse, especially in developing countries. India's G20 presidency has brought this conversation to the fore, framing it as a multidimensional threat requiring a "One Health" approach that encompasses human, animal, and environmental health. This nuanced stance has catalysed international commitments to reinforce multi-sectoral governance, spur research and development, and implement effective antimicrobial stewardship programs across health sectors. Notably, India has encouraged the G20 nations to augment AMR surveillance through the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and prioritize the development of novel antimicrobials. The articulation of a comprehensive strategy that includes infection prevention, awareness-raising, and sustainable production of antimicrobials signals an unprecedented level of collaboration. The forthcoming UN High-Level Meeting on AMR in 2024 should seek a global collaboration on this issue.
In the face of staggering human and economic tolls, the global community cannot afford to turn a blind eye to the urgent crisis of AMR, particularly as its weight falls so cruelly on developing nations. The suffering inflicted by this silent epidemic transcends borders and sectors, demanding an unprecedented, collective crusade that melds science, policy, and empathy. If there ever was a moment for global unity, for setting aside myopic self-interests in recognition of our intertwined fates, it is now.
Aditya Sinha (tweets @adityasinha004) is Officer on Special Duty, Research, Economic Advisory Council to the Prime Minister of India. Views expressed are personal.
Given the accelerating spread of AMR and the long lead-in time to develop antibiotics, we can’t afford to continue overlooking the problem.