Here’s why antimicrobial resistance matters, according to the UK’s superbug expert

“People are suffering and dying because they have caught untreatable infections. We’ve got to stop this.”

As the UK government’s Special Envoy on Antimicrobial Resistance, Dame Sally Davies is concerned about the growing threat of superbugs and the burden they are placing on healthcare systems.

Antimicrobial resistance (AMR) is when bacteria, viruses, fungi and parasites stop responding to the drugs used to treat and prevent them. These strains are often referred to as ‘superbugs’, and they have been declared as one of the top 10 global public health threats facing humanity by the World Health Organization (WHO).

Each year, AMR directly kills about 1.3 million people worldwide – more deaths than HIV/AIDS or malaria – and is associated with 5 million more deaths.

“AMR is out of control – and it’s getting worse,” Davies says.

Although we often look at AMR through the lens of human health, it is a far bigger problem, Davies says. AMR is a ‘One Health’ issue, meaning it affects people, animals and the environment in an interlinked way.

As well as health security, it also impacts the security of our food chains: we use antimicrobials to treat sick animals and plants.

Overuse and misuse of antibiotics and other drugs drives mutations for resistance and leads to the emergence of superbugs. Examples of this include prescriptions given for the wrong issue – like an antibiotic to treat a virus. Or people buying antibiotics rather than being prescribed them. Around the world antibiotics are also used to promote growth in animals.

The problem is then amplified when the treatments contaminate the environment through human and animal waste, or through effluent from factories producing the pharmaceuticals. Increased migration and the climate crisis are also having an impact.

World AMR Awareness Week takes place this year on 18-24 November, with the aim of improving awareness and understanding of AMR, and promoting best practices.

The link between antibiotic misuse and overuse is strongly tied to rising AMR – India has both the highest level of antibiotic consumption and the highest rate of AMR globally.

“[The problem is] aggravated by poor diagnostics and no access to diagnostics in many places, and an empty pipeline of new drugs,” Davies explains. “When I was a young doctor, the microbiologist would say, ‘Oh, Sally, we've got a patient who's got an infection resistant to that antibiotic. Just open the cupboard and get antibiotic Y out’. There were more antibiotics to use, but now the pipeline of new antibiotics is empty, and that's very worrying. We've got to stimulate innovation or we will be lost.”

“The face of AMR is very difficult to find,” says Davies, because doctors and nurses rarely attribute deaths to the superbugs. They are more likely to consider their patient died of pneumonia which was hard to treat, for example.

“So somehow to really galvanize people to move forward on this, we've got to find a face. Imagine living with cystic fibrosis where you repeatedly get infections. Most of them get resistant infections.”

Pressure from health systems to produce masses of antibiotics cheaply to save money has left no money in the system for research, Davies argues. As a result, most of the big pharmaceutical companies have withdrawn from this area, and the biotechs and start-ups with promising or interesting new drugs struggle to sell them on for development.

We need industry and governments to focus on how to sort the market failure, she says. Davies is a member of the World Economic Forum’s Global Future Council on the Future of Tackling Antimicrobial Resistance, an initiative dedicated to finding new approaches to tackling AMR.

Part of solving the problem will be new antibiotics and antivirals, for example, but other solutions may come from helping get rid of resistance once it has developed. Bacteriophages, a virus which infects bacteria, could also be used in future, Davies suggests.

“We need industry and governments to focus on how to sort the market failure. We need the food chain to not use antibiotics for growth promotion and never to use medically critical antibiotics unless an animal is very sick. We need humans to have access to the drugs they need of high quality. Put all of that together with good laboratory diagnostics and we will be a long way to mitigating AMR and saving lives,” she summarizes.