Death toll from antibiotic resistance to reach 39 million by 2050

More than 39 million people worldwide could die from antibiotic-resistant infections over the next 25 years, and another 130 million could die of related causes, according to a landmark new study that comes days before global leaders convene in New York to sign off on a pledge to combat the growing public health threat.

Antimicrobial resistance (AMR) – when bacteria or other pathogens evolve to the point where antibiotics are no longer effective against them – happens when people overuse antibiotics in medicine and animal and crop farming.

These so-called superbugs make infections harder to treat as doctors scramble for alternatives, and have directly killed about a million people every year since 1990, according to the new study, published in The Lancet journal.

The hazards of AMR are on the rise. By 2050, there could be 1.91 million deaths directly from AMR and 6.31 million deaths from AMR-related causes, meaning a drug-resistant infection played a role in someone’s death, but resistance itself may or may not have been a factor, according to the new estimates from the Global Research on Antimicrobial Resistance (GRAM) Project.

“This is really a very silent pandemic, and it’s growing. Our attention needs to be there now,” Ahmed Ogwell, vice president of global health strategy at the UN Foundation and former acting director-general of the Africa Centres for Disease Control and Prevention (Africa CDC), told Euronews Health.

For the new study, researchers used 520 million records to estimate the number of deaths and disability-adjusted life-years (DALYs) – a quality-of-life measure – that can be directly attributed to or associated with AMR across 22 pathogens, 84 pathogen-drug combinations, and 11 infections. The analysis spanned 204 countries and territories.

They found that from 1990 to 2021, AMR-related deaths fell by roughly 60 per cent among children younger than 5, but surged by more than 80 per cent for adults 70 and older. That’s because vaccination programmes and other infection prevention and control measures protected children, and because many countries’ ageing populations left older people vulnerable.

Older people will continue to bear the brunt of the rising death toll in the coming years, the analysis shows. But they are far from the only ones at risk.

“Regardless of where people live, they’re going to require antibiotics if they go through procedures, cancer chemotherapy, if they are hospitalised ever, because everyone is at risk of a bacterial infection,” Ramanan Laxminarayan, who leads the research institute One Health Trust, told Euronews Health.

“Antibiotics don’t work reliably anymore because of drug resistance,” he added. “Twenty years ago, the chance of that happening was like a one in 100 chance, maybe less than that. Today, that likelihood is one in three [or] one in four, and that makes all of these other aspects of modern medicine much more risky”.

People in South Asia, including India, Pakistan, and Bangladesh, as well as other parts of southern and eastern Asia, sub-Saharan Africa, and Latin America and the Caribbean, are also expected to be hard hit.

Lower- and middle-income countries are grappling with a dual challenge, given many patients lack access to antibiotics in the first place, according to Laxminarayan, who was not involved with the new report but contributed to a Lancet series on antimicrobial resistance earlier this year.

That means that simply developing new antibiotic drugs only tackles half the problem.

“Drug resistance is not their primary issue [in low-access regions] – their primary issue is bacterial infections itself,” Laxminarayan said.

Despite the disparities, no region is immune from the risks. The annual number of AMR-attributable deaths in high-income countries is expected to grow from 125,000 to 192,000 between 2021 and 2050, the study found. Many hundreds of thousands more will die from associated causes.

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Steps to counter AMR

The United Nations General Assembly will meet next week for its second-ever high-level meeting on AMR, the last one being in 2016. Global leaders are expected to sign off on a political commitment to curb human deaths from AMR.

But the declaration was also watered down during negotiations in recent months, underscoring the lack of consensus on specific AMR targets. For example, a goal to curb antimicrobials in animal farming by at least 30 per cent, which was included in a prior draft, was stripped out in the latest version and replaced with a promise to “strive meaningfully” to reduce their use.

“We have had a tough ride on this one,” Dr Sally Davies, the United Kingdom’s special envoy on AMR and England’s former chief medical officer, told Euronews Health.

“We would like to steadily ratchet up and improve where we’re going … but governance is a very difficult thing, and at this point, we don’t have an effective governance mechanism”.

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Davies called for the creation of an independent scientific panel on AMR, additional data collection and funding, a greater focus on the risks to food systems and the environment, and incentives for drug companies to develop new antibiotics. Eventually, she’d like global AMR cooperation to resemble the international tobacco treaty, which entered into force in 2005.

According to the Lancet study, many of the projected AMR deaths could be curtailed with a few key measures such as better infection control, widespread immunisations, the development of new antibiotics, and minimising their use when it isn’t necessary in medical and farm settings.

With improved antibiotic access and better infection care, for example, 92 million deaths could be avoided between 2025 and 2050. If drugs are developed to target Gram-negative bacteria – which are some of the most antibiotic-resistant – 11.1 million deaths could be averted.

“You just need each sector to deliver on what they need to do,” Davies said.

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Some countries and industries have already taken steps to reduce their reliance on antimicrobials. Norwegian fish farms, for example, started using vaccines in the late 1980s, leading to a steep drop-off in antibacterial use.

Across the European Union, average microbial use for medical treatment fell by 2.5 per cent between 2019 and 2022, indicating the bloc is making “slow progress” toward its goal of curbing use by 20 per cent by 2030, according to the EU public health agency.

Despite that progress, however, lessons from other global health crises, such as the COVID-19 pandemic and the HIV/AIDS epidemic, suggest that high-income countries could be slow to rein in a problem that disproportionately impacts low- and middle-income countries.

“We must budget in our response that the situation is not going to change rapidly,” Ogwell said, “which means that the planning of low- and middle-income countries needs to accommodate that, and they need to put in place policies that make it easier for them to work together”.

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He added that better surveillance and data-sharing will be key to identifying and responding quickly to emerging pathogen threats.

Beyond government or industry action, people can also take steps to protect themselves, Laxminarayan said.

“It doesn’t require someone else to tell you to wash hands, to get vaccinated, to make sure that you don’t overuse antibiotics, to make sure that when you buy chicken – if you do eat chicken – that it is antibiotic-free,” Laxminarayan said.