Inequality is driving antimicrobial resistance. Here's how to curb it

Antimicrobial resistance (also known as AMR) is estimated to be directly responsible for 1.27 million deaths in 2019 alone, equivalent to approximately 3,500 people each day. This number is estimated to reach 10 million per annum by 2050 without substantial action.

The economic consequences of antimicrobial resistance for individuals, health systems and society are also considerable. Individuals who contract antimicrobial-resistant infections are at risk of mortality, treatment delays, long-term disability, lost income and debt or poverty from high health costs, with suffering and socio-economic impacts for families and communities.

Antimicrobial resistance increases financial pressure on health systems as it leads to more hospitalizations, longer stays, more expensive diagnosis and treatment and reduced ability to provide treatments such as chemotherapy and surgical care safely.

It can also negatively impact national economies, which may have fewer and less productive workers and populations spending more on health care. If infections cannot be prevented and treated, trade and agriculture can also be negatively affected, with increased death and illness among farmed animals.

However, the consequences of antimicrobial resistance are not equally distributed across society.

Social, cultural and biological factors mean that women are more likely than men to experience occupational exposure to antimicrobial resistance and to be prescribed antimicrobials for several infections.

The risk of its development is heightened in populations living in urban and overcrowded environments with limited access to clean water, sanitation, and hygiene (WASH) infrastructure, as is the case in many low- and middle-income countries. Populations with limited access to formal healthcare can experience increased inappropriate antibiotic use due to poorly regulated access. Many countries also experience persistent shortages of essential antimicrobials, leaving them infected for longer periods and given less targeted antimicrobials.

Conditions in conflict-affected areas make infections easier to spread, with populations who are forcibly displaced also facing fragile healthcare systems, supply of essential antimicrobials and access to WASH infrastructure. Implementing effective policies to combat antimicrobial resistance is also challenging in contexts with political instability, limited rule of law and higher levels of corruption.

Climate change is a significant driver of antimicrobial resistance as rising ambient temperatures increase the proliferation of bacteria while also contributing to extreme weather events that can disrupt healthcare services, displace communities and reduce access to sanitation.

The use of antimicrobials on animals, together with poor measures to prevent and control infections, can further drive antimicrobial resistance. Drug-resistant pathogens can be passed between animals and humans in occupational settings and through food contamination.

Pollution is also a major driver of antimicrobial resistance in the environment – for example, through waste from the pharmaceutical and healthcare industries, heavy metals from industrial and agricultural processes, particle pollution in the air and plastic waste in our water systems.

Until recently, policymakers and academics have primarily focused on the medical and microbiological factors that drive antimicrobial resistance. There has been insufficient focus on the relationship between the social and economic factors described here and the emergence of antimicrobial-resistant infections.

A new report published by the European Observatory on Health Systems and Policies, distilling findings from research supported by the World Economic Forum and the Novo Nordisk Foundation, sheds light on key socio-economic drivers and impacts of antimicrobial resistance and what this will mean for policy and research.

It helps explain how these factors can impact our health and economies and the effectiveness of measures to tackle antimicrobial resistance at the individual, health system and societal levels.

The policy report argues that four socio-economic elements must be built into the design of antimicrobial resistance policy and policy implementation, monitoring and evaluation (Figure 1):

The report describes how these overarching principles can be incorporated into four core antimicrobial resistance policy areas.

Many policymakers are currently revisiting their policy priorities related to antimicrobial resistance. At the international level, the UN General Assembly is holding a high-level meeting, which is expected to result in a political declaration on global antimicrobial resistance priorities and commitments. Simultaneously, many countries are revising their national action plans on antimicrobial resistance.

Policymakers and other stakeholders must leverage this critical window of opportunity to move beyond a “drugs and bugs” approach to antimicrobial resistance towards a more holistic, people-centred, equity-oriented approach that tackles key social and economic drivers and impacts of antimicrobial resistance.

Learn more by registering for the European Observatory webinar series “From evidence to practice in AMR prevention and control” on 21 May and 23 May 2024.