Antimicrobial resistance could kill 10 million people every year by 2050 – or one person every 3 seconds – unless global action is taken to tackle the problem. This is the conclusion of a final international review chaired by British economist Lord Jim O’Neill, which sets out 10 areas that need to be addressed to combat the threat of “superbugs.”
Antimicrobial resistance (AMR), or antibiotic resistance, occurs when microorganisms develop resistance to antimicrobial agents that once had the ability to kill them.
In the United States alone, these so-called superbugs are responsible for more than 2 million infections and 23,000 deaths every year.
Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA) are among the biggest threats for drug-resistant infections in the U.S.
In 2014, the World Health Organization (WHO) released their first ever report on AMR, which provided much-needed insight into the global threat of drug-resistant infections.
The report led the WHO to declare that the world is heading toward a “post-antibiotic era,” where common infections that have been treatable for decades could kill once again, and it highlighted the need for global collaboration in order to tackle the problem.
On the back of the WHO report, the United Kingdom’s Prime Minister David Cameron enrolled Lord O’Neill to conduct a review of AMR and develop a plan to stop the world being “cast back into the dark ages of medicine.”
Now, the final recommendations of this global plan have been released, and Lord O’Neill claims that unless the plan is put into action, we may reach a point where AMR causes more deaths than are currently caused by cancer.
In the review, Lord O’Neill sets out 10 points that need to be addressed on a global scale in order to reduce the threat of AMR, and there are four points that he highlights as being particularly important.
Firstly, he points to the initiation of a global public awareness campaign as an urgent priority, in order to educate the general public – particularly children and teenagers – about the threat AMR poses to health worldwide.
The report recommends an international collaboration from campaign developers, industry experts, and non-governmental organizations to launch a global awareness campaign for AMR, with the aim of reducing unnecessary antibiotic prescription and use.
“I think this is something that could, and should, begin this summer if we are to really make progress on AMR, and it could be supported at the UN General Assembly in September,” notes Lord O’Neill.
Another key priority highlighted by the review is the development of new antibiotics.
It has been decades since new antibiotics have been created, meaning we have been using the same ones repeatedly for years, fueling microorganisms’ ability to develop drug resistance.
Lord O’Neill notes that a lack of incentive for investment into new antibiotics has led to reduced research and development of such drugs, alongside the fact that the “low-hanging fruit” has already been picked in terms of uncovering potential compounds for antibiotic development.
The review claims that it is down to policymakers to lead the development of new antibiotics.
“[…] we need a group of countries such as the G20 to get together and provide for a reward to developers of new antibiotics after they are approved for use by patients.
These ‘market entry rewards,’ of around $1 billion each, would be given to the developers of successful new drugs, subject to certain conditions to ensure that the new drugs are not ‘over-marketed’ and yet are available to patients who need them wherever they live.”
Lord Jim O’Neill
This proposal, however, has been met with some criticism.
“The O’Neill report proposes considerable new funding to overcome the failures of pharmaceutical research and development but the proposals do not necessarily ensure access to either existing tools or emerging new products,” says Dr. Grania Brigden, TB and AMR advisor for Médecins Sans Frontières/Doctors Without Borders (MSF).
“Instead, in some cases, the report’s solution is simply to subsidize higher prices rather than trying to overcome them.”
Reducing unnecessary use of antibiotics is key to overcoming the problem of drug resistance, and the review states that in order to achieve this, the diagnostic methods for bacterial infections need to be improved.
“I find it incredible that doctors must still prescribe antibiotics based only on their immediate assessment of a patient’s symptoms, just like they used to when antibiotics first entered common use in the 1950s,” says Lord O’Neill.
“When a test is used to confirm the diagnosis it is often based on a slow technology that hasn’t changed significantly since the 1860s.”
He says this is “not acceptable” and stresses the need for better use of already available rapid diagnostic tests, as well as the development of new ones.
With this in mind, the report requests that by 2020, all governments of the richest countries ensure all antibiotic prescriptions are informed by up-to-date surveillance data, alongside a rapid diagnostic test, where possible.
“This will spur investment by giving diagnostics developers the assurance that effective tests will be used,” says Lord O’Neill.
The global use of antibiotics in agriculture is another area Lord O’Neill highlights as requiring urgent attention.
The review points out that in the U.S., 70 percent of the antibiotics deemed as medically important for humans by the Food and Drug Administration (FDA) are sold for animal use.
“Many countries are also likely to use more antibiotics in agriculture than in humans, but they do not even hold or publish the information,” adds Lord O’Neill.
In order to tackle this issue, the review recommends improved surveillance of antibiotic use in agriculture in countries where such data is lacking, which will help get a better understanding of the extent of the problem.
Furthermore, it is recommended that each country sets their own targets for antibiotic use in agriculture.
“Alongside this we need to make much faster progress on banning or restricting the use in animals of antibiotics that are vital for human health,” says Lord O’Neill.
The report estimates that the costs of putting all recommended strategies into action will be up to $40 billion over 10 years.
But Lord O’Neill says this is much less than the cost of taking no action, which he estimates could be as much as $100 trillion by 2050.
And, of course, the cost of inaction could be even greater for public health, with the report estimating that AMR could kill 10 million people annually by 2050 if nothing is done.
“The actions that I’m setting out today are ambitious in their scope – but this is a problem which it is well within our grasp to solve if we take action now.
I call on the governments of the G7, G20 and the UN to take real action in 2016 on the 10 proposals made by my review, to avoid the terrible human and economic costs of resistance that the world would otherwise face.”
Lord Jim O’Neill
Dr. Margaret Chan, director-general of the WHO, says the organization “warmly welcomes this thorough and compelling review.”
“Importantly, the review tackles the burning need to find incentives that can get new products into the pipeline,” she adds. “If not, the scenario it paints for 2050 will surely jolt the last remaining skeptics into action.”