Antibiotic emergency ‘could claim 40 million lives over the next 25 years’

Dame Sally Davies has a clear message about the year ahead. We are facing a growing antibiotic emergency that could have devastating consequences for men, women and children around the world, she says.

Davies, a former chief medical officer of England, has become a leading advocate for global action to combat the scourge of superbugs.

She told me Observer that there is a real danger that routine procedures – from surgery to childbirth – pose widespread life-threatening risks due to the spread of bacteria that possess antimicrobial resistance (AMR). “About a million people die every year due to the spread of microbial resistance, and that figure will increase over the next 25 years,” she said. “It’s really scary.”

Estimates suggest that death rates from AMR will double by 2050, with figures suggesting that almost 40 million people will lose their lives to superbugs over the next 25 years, with the elderly particularly at risk.

“Recent data shows that AMR is declining in children under the age of five, which is good news. Among the over-70s, death rates have increased by 80% since 1990; that is very worrying.”

As the population ages, more people suffer from chronic diseases, making them more vulnerable to AMR, researchers say.

Faced with these threats, doctors have tried to limit antibiotic prescribing as much as possible, while pressuring patients to complete courses of treatment. However, medical misuse of antibiotics is not the only way resistance spreads. The landscape itself plays a crucial role, a problem that arises from the fact that around 70% of all antibiotics are given to livestock, creating a pool of animals in which resistance can develop.

“We’re essentially throwing antibiotics at cows, chickens and sheep as cheap alternatives to giving growth promoters or prophylactics to prevent the spread of disease,” says Davies. Such actions help microbes evolve so that they develop the ability to fend off antibiotics, a resistance that then spreads around the world.

“If you have intensive agriculture where antibiotics are used a lot or a busy hospital with a poor sewerage system, resistant bacteria can enter waterways,” Davies adds. “The wind blows over these places of contaminated land or water and picks up bacteria and genes with resistance, and then rains them down in other places. That’s how damaging this problem has become.”

The reason AMRs are spreading is simply a matter of “survival of the fittest,” Davies added. “Bacteria need about twenty minutes to multiply. They also mutate a lot, and if they do that in the presence of antibiotics and that mutation protects them, these strains will multiply. It is crucial that they can pass this on to the bacteria they come into contact with.”

The ease with which AMR spreads means it is increasingly important that we do not misuse the antibiotics we have. It also creates a need for the development of new antibiotics – and this again raises problems, Davies said.

“No new classes of antibiotics have been in routine use since the late 1980s and the market model that would favor the creation of new types is broken. When developing a new antibiotic, a person may use it for a weekly course once a year. Where is the profit in that?”

“In contrast, blood pressure medications that must be taken every day, or cancer medications that must be administered for months, offer pharmaceuticals much greater profits. So there is no incentive for them to try to develop new antibiotics. It’s a real headache.”

The challenges ahead in tackling AMR are not insurmountable, Davies points out, but they must be tackled with a greater sense of urgency. The G7 forum of industrialized countries has at least acknowledged the crisis. However, there is still a lack of adequate action and this must be addressed as a matter of necessity in the coming year, she stressed.