The Threat of AMR
Effective antimicrobials, particularly antibiotics, are cornerstones of modern health systems and societies.
Antimicrobials are essential for treating and preventing infections in humans, animals and plants, and for enabling fundamental and lifesaving medical interventions. Since the groundbreaking discovery of penicillin in 1928, modern medicine has thrived and penicillin alone has saved millions of lives worldwide. Antibiotics have contributed to an extended life expectancy in all parts of the world.
However, this is now in jeopardy due to the emergence and spread of microorganisms in humans, animals and the environment that has developed resistance to antimicrobial drugs that once killed them. This is referred to as antimicrobial resistance, or “AMR”.
While the development of antimicrobial resistance can occur naturally, the over- and misuse of antimicrobials in all sectors have accelerated the occurrence dramatically. Simultaneously, poor infection prevention and control, and inadequate biosecurity and environmental discharge practices, have facilitated the emergence and spread of antimicrobial resistance and disease between humans, animals, plants and the environment.
Alarming rates of antimicrobial resistance have now been identified and rates continue to increase all over the world. The consequences are evident in all countries regardless of income status, but are greatest for low- and middle-income countries.
A Threat to Health, Society and Economies
Antimicrobial resistance is one of the greatest threats to health, society, and economies worldwide and the World Health Organisation has classified antimicrobial resistance in the top 10 threats to global health. Antimicrobial resistance threatens the achievement of Universal Health Coverage and the United Nations Sustainable Development Goals, directly and indirectly affecting 15 out of the 17 goals. Without concrete action, progress made will be lost.
The Independent O’Neill Review estimated that over 700,000 people died in 2016 due to antimicrobial resistance, and projected this to rise to 10 million by 2050 – more deaths than cancer and diabetes today combined. In 2017, a report from the World Bank predicted that the economic impact will be bigger than the financial crisis of 2008/9 as it will last longer, increase inequalities within countries and impact low and middle income countries the most. Antimicrobial resistance can also affect international trade, with livestock and livestock products being particularly vulnerable.
The World Bank report also showed that investing in mitigating antimicrobial resistance constitutes one of today’s highest yield investments, regardless of income status. Without urgent action, by 2050 global GDP will drop by 1.1-3.8%, by 2030 the global GDP shortfall will be 1-3.4 trillion US$, and by 2030 an additional 24 million people will be pushed into extreme poverty.
Increased Awareness but Need for Accelerated Action in Low- and Middle-Income Countries
International awareness has increased in recent years with the publication of the Global Action Plan on Antimicrobial Resistance in 2015, resolutions at the United Nations General Assembly in 2016, the United Nation Environment Assembly in 2017, the World Health Assembly, the World Organisation for Animal Health and the Food and Agricultural Organisation in 2019. These set out the high-level policy agenda and demonstrate significant global consensus on the high-level policies and interventions needed.
In response, over 170 countries now have a national action plan developed or in development, and several antimicrobial resistance research and international development initiatives are established internationally and nationally.
Yet, as the final report of the United Nations Interagency Coordination Group on Antimicrobial Resistance (IACG) highlighted in April 2019, the global response does not sufficiently match the scale and scope of the issue and challenges remain in implementation, particularly in Low and Middle Income Countries.