Another global health crisis is unfolding in the shadow of the coronavirus pandemic. Antimicrobial resistance, the tendency of bacteria and other pathogens to evolve so they fight or evade lifesaving drugs, is a long-term threat to modern medicine. A new study, drawing from a vast array of data, estimates that 1.27 million deaths were caused worldwide by bacterial antimicrobial resistance in 2019, exceeding the combined toll of HIV/AIDS and malaria. Only ischemic heart disease and stroke that year accounted for more deaths.
This is a long-festering problem that resembles climate change — a slow but escalating tide of danger, requiring action on many fronts. The new study suggests some of the poorest corners of the earth are suffering the highest burdens of antimicrobial resistance.
In 2014, a major report on antimicrobial resistance by British economist Jim O’Neill estimated that it was responsible for at least 700,000 deaths worldwide each year. The new study, based on data from 204 countries and territories, took into account 471 million individual records or samples, and examined 23 bacterial pathogens and 88 drug-pathogen combinations. It used statistical modeling to estimate direct deaths at nearly twice the earlier figure, a more comprehensive picture of the global burden of antibiotic resistance than was available until now.
Health economist and professor Christopher J.L. Murray, of the Institute for Health Metrics and Evaluation at the University of Washington, and a large team of collaborators found that bacterial resistance to drugs “is a major global health problem” that “poses the largest threat to human health in sub-Saharan Africa and south Asia, but it is important in all regions.” The researchers found that the top six pathogens leading to deaths associated with drug resistance are Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.
What’s at stake is the effectiveness of antibiotics, essential for surgery, chemotherapy, organ transplants and other medical procedures. Antibiotics were “wonder drugs” when discovered in the past century, starting with penicillin, but it has been known for decades that bacteria evolve to resist the drugs — and that overuse and abuse of antibiotics in human health and agriculture have contributed to the problem. A report by the Centers for Disease Control and Prevention in 2019 urged Americans to “Stop referring to a coming post-antibiotic era — it’s already here.” The study found that deaths because of antimicrobial resistance in the United States had dropped 18 percent since a 2013 report, largely due to improved procedures in hospitals, while pointing to continuing challenges outside health care.
What to do about antimicrobial resistance has been clear for some time. We need better stewardship of antibiotics — avoiding overprescribing or wrongly prescribing them for viral infections. More attention must be devoted to preventing resistant infections in the first place. Accelerated development of new antibiotics is essential. New drug development requires large investments, but antibiotics yield smaller returns because they are used for a limited period of time. Thus, public-private partnerships for drug development are essential, such as Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator, a multinational effort.
The problem of antimicrobial resistance isn’t going away, and it demands a broad response even in the throes of the coronavirus pandemic.