Tackling AMR: a call for global action to preserve medical progress

COVID-19 may have slipped from most people's daily consciousness, but it has by no means vanished.

As Swiss Re Institute recently documented in an analysis entitled "The future of excess mortality after COVID-19", the pandemic continues to have lasting effects on mortality in countries like the US and UK, where excess deaths could linger for a decade.

However, another health crisis is gaining momentum, one that many are less aware of: Antimicrobial resistance (AMR), what the World Health Organisation (WHO) calls "the silent pandemic."

AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines that were once used to contain them.

Quietly but steadily, AMR is claiming lives. In 2019, it contributed to the deaths of 5 million people, many in global hotspots where resistant bacteria have proliferated. Clearly, AMR deserves an elevated place on the global agenda.

Earlier this month, the United Nations General Assembly held a high-level meeting on AMR, an event which provided an excellent springboard for world leaders to shine a brighter light on this wide-ranging threat to global health and commit to actionable targets in addressing it. I applaud the commitments that emerged from the meeting in New York City for decisive action to reduce human deaths from bacterial AMR by 10% by 2030 timeline, among other targets.

These commitments should be translated into action. Like WHO Director-General Tedros Ghebreyesus said on the sidelines of the meeting:

"AMR could unwind 100 years of medical progress, making infections that are easily treatable today a death sentence. No country is immune to this threat, but low- and middle-income countries bear the greatest burden."

The accelerated spread of antimicrobial resistance has been attributed to excessive and improper use of antibiotics in both humans and animals. Similarly, a recent Swiss Re Institute report "Antimicrobial resistance: a silent threat to our future" also pinpointed over- and misuse of antibiotics as the crux of the problem.

During the pandemic, this took a worrying turn: the WHO has reported that while only 8% of hospitalised patients had bacterial co-infections, 75% were treated with antibiotics. That means most patients received no benefit, while the risk of promoting antibiotic-resistant bacteria increased. Poor infection prevention and control practices contribute to the problem.

Failure to make strides means AMR may kill many more people in coming decades: a study published in The Lancet projects some 1.91 million annual deaths attributable to AMR and 8.2 million annual deaths linked to AMR globally by mid-century.

The study does contain some positive news: AMR mortality in children under five years has declined by 50% since the 1990s, in part as sanitation infrastructure improvements pay dividends. This illustrates the importance of investing in infection prevention. Still, older people face rising AMR risks, a reminder that there is still much left to do.

And while AMR is a global challenge, its impacts are unequally distributed, disproportionately affecting people in the most vulnerable regions. AMR-associated death rates in India are some 50% higher than those of Europe or the US, while in sub-Saharan Africa, death rates are double those of developed countries. On continents whose combined populations will approach 4 billion people by 2050, AMR is a tragedy with all the makings of a catastrophe.

Climate change is also exacerbating AMR, as geographies where drug-resistant microbes are likely to thrive are expanding. A warming planet is intensifying hazards that accompany extreme weather, as well, producing floods that can disrupt sanitation systems and potentially introduce resistant pathogens into the environment.

Additionally, as some regions grow less hospitable, climate-driven migration could become a larger source of international AMR spread like we have seen with the rise of drug-resistant tuberculosis. People in informal settlements or refugee camps with inadequate health infrastructure may be particularly exposed.

Armed conflicts that destabilise healthcare systems also intensify exposure to drug-resistant pathogens. In Ukraine, scientists examining the wartime spread of antimicrobial-resistant organisms recently wrote that high pre-war AMR rates, combined with traumatic wounds and strain on healthcare facilities, were driving increased detection of multidrug-resistant organisms. This adds to worries about war as a vector for the spread of dangerous superbugs.

With these varied risk drivers converging, the UN's high-level meeting in September was a prime opportunity to raise even more awareness and focus more attention on AMR, something that will be critical if we are to add momentum to existing efforts to overcome this challenge that stops at no border.

For example, a recent US programme aims to better track how resistance starts and accelerate the hunt for new antibiotics. The EU is also stepping up its efforts to combat AMR. Companies can contribute, too: Swiss Re has partnered with a public-private consortium that brings together drugmakers, reinsurers and researchers to develop digital solutions against AMR.

More such efforts are needed. Ultimately, stewardship programmes that promote the appropriate use of antimicrobials will be critical to preserving the effectiveness of existing medications. In addition, renewed drug development efforts to invent novel antibiotics are necessary, with resistant species emerging more quickly after a new drug's introduction.

AMR is an evolving risk with the potential to severely disrupt healthcare systems worldwide. In the most pessimistic scenarios, common medical and surgical procedures may once again prove to be life threatening. A collaborative approach is needed to ensure that improvements flow to nations whose populations are amongst the most vulnerable.

COVID-19 was a pandemic that shouted in our faces. While AMR may be "the silent pandemic," it demands that nations lift their voices in unison to address it. Increased awareness, ongoing global surveillance, and cooperation across sectors and borders are the keys to overcoming this challenge.