Over the past two years, the world has been brought to its knees by an ever-evolving virus. But while hearts and minds remain fixed on COVID-19, another, more insidious health crisis stealthily plots its course.
Sometimes dubbed the “silent” or “slow-moving” pandemic, antimicrobial resistance may have slipped from the headlines but remains among the biggest threats to health worldwide. A new paper is a shocking wake-up call, revealing a death toll about double that of previous best estimates.
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Antibiotics are the foundation of modern medicine, but their overuse is leaving doctors and nurses in every country unable to treat common illnesses — from urinary tract infections to blood poisoning, and gonorrhea.
In the past, we’ve lacked firm data to quantify the problem. Now, there’s no escape from the truth. The Global Research on AntiMicrobial resistance, or GRAM, paper, published in the Lancet today, is the most comprehensive picture to date on the global impact of AMR. Commissioned by organizations including Wellcome, Fleming Fund, and the Bill & Melinda Gates Foundation, the findings of the paper span almost every corner of the globe.
The paper finds that a staggering 1.27 million deaths in 2019 were attributable to AMR — verging on double the at least 700,000 annual deaths estimated by the landmark O’Neill report in 2016.
And with AMR confirmed to have played a role in almost 5 million deaths in 2019, we are already frighteningly close to the 10 million annual deaths the O’Neill report predicted by 2050.
In the years since the data in this paper were collected, the COVID-19 pandemic may have further fuelled drug resistance — with clinicians overprescribing antibiotics and overstretched, clustered wards accelerating the spread.
This is very ominous, but there is a silver lining. We already have a strong understanding of drug resistance, and how to tackle the problem.
Around the world, pioneering projects are exploring solutions to drug resistance. In Ghana, Kenya, Malawi, and Uganda, a data partnership with Pfizer is adding much-needed granularity on its impact in different settings. The global think tank SEDRIC, which Wellcome launched in 2018, is bringing together international experts to harness data and create more resilient health systems. This will be complemented by a newly launched policy development resource at the Global Strategy Lab.
In a similar vein, the Global Pandemic Radar, which was launched last May, will bolster disease surveillance globally by setting up a network of “hubs” across the world.
By forging connections with hospitals everywhere, we can better understand the global context — such as which pathogens are the biggest threats in each country, and how they are spreading.
A constant flow of reliable and accessible data is critical, but we also need to overhaul the broken antibiotic market. The industry-led AMR Action Fund — a more than $1 billion initiative — is a major step forward, supporting small biotechs as they enter late-stage development.
But without governments matching this ambitious action, long-term sustainability hangs in the balance. We need governments to establish new ways of valuing and paying for antibiotics — such as a subscription style model that the United Kingdom’s National Health Service is currently piloting, or the United States-led PASTEUR Act, which could revolutionize the market.
And, finally, as well as developing new antibiotics, we must preserve those that still work by strengthening stewardship practices. Antibiotics are too often used as a cheap replacement for addressing structural issues. By improving access to clean water and sanitation, strengthening public health systems, and changing food production practices, we can reduce unnecessary use.
As we enter the third year of the pandemic, we must not lose sight of other urgent global health threats, or forget that they are often interlinked. We’ve seen the relentless suffering caused by a single virus. We cannot let AMR, which already emerges from many dangerous pathogens, undo a century of medical progress. We understand the problem and have the solutions. What more will it take for leaders to act?
About the author
Timothy Jinks
Timothy Jinks was appointed the head of Infectious Disease Interventions at Wellcome in 2021. He leads Wellcome’s work in advancing R&D for therapeutics and diagnostics, alongside research to support solutions for antimicrobial resistance. In his previous role, he designed and led Wellcome’s strategic priority area for combatting drug-resistant infections, deploying a budget of over £250 million. Before joining Wellcome in 2012, he accumulated over a decade of industry experience both in biologic therapeutic R&D and latterly as a consultant providing business development, licensing and commercial research services.
