Research shows that 750,000 deaths each year from drug-resistant superbugs could be prevented by improving access to clean water and sanitation, infection control and childhood vaccinations.
Antimicrobial resistance, or AMR, is a huge global challenge, with the evolution of drug-resistant superbugs, driven by factors such as inappropriate and excessive antibiotic use, raising the prospect of a future where modern medicine fails.
Experts have warned that if the world does not prioritize action against AMR, the death toll will steadily rise, with infants, the elderly and people with chronic diseases or who require surgical intervention being most at risk.
“It kills more people than HIV, malaria and tuberculosis combined,” said Prof. Ramanan Laxminarayan of Princeton University in the US, adding that tackling AMR was crucial to meeting newborn survival targets and healthy aging.
Experts have also warned of a scenario in which once-trivial infections prove fatal, and in which crucial procedures in modern medicine, ranging from caesarean sections to cancer treatments and organ transplants, become too risky to be feasible.
According to data for 2019 an estimated 4.95 million deaths were associated with bacterial AMR, including 1.27 million deaths directly caused by such resistance.
However, experts have warned that low- and middle-income countries (LMICs) were disproportionately affected by AMR.
Modeling by Laxminarayan and colleagues has suggested that deaths from AMR in LMICs could be reduced by 18%, equivalent to approximately 750,000 per year, through three key steps.
The team suggests that an estimated 247,800 deaths could be prevented through universal access to clean water and improved sanitation and hygiene, while 337,000 deaths could be prevented through better infection prevention and control in healthcare.
Another 181,500 deaths could be prevented through childhood vaccinations, they added. This is done not only by preventing infections that are resistant to current medications, but also by restricting the inappropriate use of antibiotics.
Although the team notes that 95,400 deaths among under-15s each year could be directly prevented by the use of vaccines against four major bacterial infections, vaccinations against viral infections were also important.
“People get symptoms… they can’t tell if it’s viral or bacterial and just to be safe they take the antibiotic. But by creating that safety, they create drug resistance,” says Laxminarayan, noting that influenza was the biggest driver of antibiotic consumption in the world.
The study, published in the Lancet, is part of a series on AMR including the proposal of global targets, the so-called “10-20-30 by 2030” targets. These refer to a 10% reduction in mortality from AMR compared to 2019, a 20% reduction in the inappropriate use of antibiotics in humans, and a 30% reduction in the inappropriate use of animal antibiotics.
Although ambitious, the goals were achievable, according to Laxminarayan. He noted that while deaths from AMR have increased since 2019, inappropriate antibiotic use in animals has already decreased.
The researchers also emphasize the need for greater access to and development of antibiotics, diagnostic tests and vaccines, and have called for the establishment of an independent panel on access and resistance to antimicrobials, similar to the Intergovernmental Panel on Climate Change (IPCC) , to gather evidence on AMR and establish guidelines.
The team emphasizes that time is of the essence. “The opportunity to ensure that our ability to treat bacterial pathogens is reduced,” they write.
Laxminarayan added that AMR is not a persistent problem. “Why wouldn’t the world want to solve a major solvable problem?” he said.
Prof. Ben Cooper from the University of Oxford, who was not involved in the study, said the estimate of 750,000 preventable deaths was based on careful and thorough analysis. “The work highlights how we already have affordable tools that we know can make a big dent in the problem, but achieving these reductions will require addressing the chronic global underinvestment in tackling antimicrobial resistance.”
Dr. Danna Gifford, an expert on AMR at the University of Manchester, also said there will be challenges, requiring sustained commitment and collaboration on an unprecedented global scale to achieve the proposed targets.
But, she said, preventative measures were crucial. “It is clear that reducing the global burden of resistance requires preventing infections, rather than simply relying on new antimicrobials.”