Each year, 750,000 deaths linked to drug-resistant superlice could be prevented through better access to clean water and sanitation, infection control and childhood vaccinations, research suggests.
Antimicrobial resistance, or AMR, is a major global challenge, with the evolution of drug-resistant superbugs, driven by factors including inappropriate and excessive antibiotic use, raising the prospect of a future where modern medicine fails.
Experts have warned that if the world does not prioritize action against AMR, there will be a steady rise in the death toll, with infants, the elderly and those with chronic illnesses or requiring surgical procedures at the highest risk.
“It kills more people than HIV, malaria and TB combined,” said Prof Ramanan Laxminarayan, from Princeton University, in the US, adding that tackling AMR is essential to achieving goals for newborn survival, as well as healthy ageing. .
Experts have also warned of a scenario where once-trivial infections are fatal, and crucial procedures in modern medicine, ranging from caesarean sections to cancer treatments and organ transplants, become too risky to be feasible.
According to data for 2019 an estimated 4.95m deaths have been associated with bacterial AMR, including 1.27m deaths directly caused by such resistance.
However, experts warned that low- and middle-income countries (LMICs) were disproportionately affected by AMR.
Models created by Laxminarayan and colleagues suggested that AMR-related deaths in LMICs could be reduced by 18%, equivalent to about 750,000 per year, through three key steps.
The team suggests that an estimated 247,800 deaths could be prevented through universal access to clean water and improved sanitation and hygiene, while 337,000 deaths could be prevented through better infection prevention and control in healthcare settings.
Another 181,500 deaths are preventable through childhood vaccinations, they add. This is not only by preventing infections that are resistant to current drugs, but by limiting inappropriate consumption of antibiotics.
While the team notes that 95,400 deaths among under-15s each year could be directly avoided through the use of vaccines against four major bacterial infections, vaccinations against viral infections also mattered.
“People get symptoms… they can’t tell if it’s viral or bacterial and just to be safe they take the antibiotics. But by creating that safety, they create drug resistance,” Laxminarayan said, noting that influenza was the biggest driver of antibiotic consumption in the world.
The study, published in the Lancet, is part of a series on AMR which includes proposing global targets called “10-20-30 by 2030” goals. This refers to a 10% reduction in mortality due to AMR relative to 2019, a 20% reduction in inappropriate human antibiotic use, and a 30% reduction in inappropriate animal antibiotic use.
Although ambitious, the goals were achievable, Laxminarayan said. He noted that while deaths from AMR have increased since 2019, inappropriate antibiotic use in animals has already fallen.
The researchers also emphasize the need for better access to and development of antibiotics, diagnostic tests and vaccines, and called for the establishment of an independent panel on antimicrobial access and resistance, similar to the Intergovernmental Panel on Climate Change (IPCC). , to gather evidence on AMR and inform guidelines.
The team emphasizes that time is of the essence. “The window of opportunity to ensure our ability to treat bacterial pathogens is shrinking,” they write.
Laxminarayan added that AMR was not an unsolvable issue. “Why wouldn’t the world want to solve a big solvable problem?” he said.
Prof Ben Cooper, from the University of Oxford, who was not involved in the research, said the estimate of 750,000 preventable deaths was based on careful and thorough analysis. “The work highlights how we already have affordable tools that we know can make a big dent in the problem, but achieving this reduction will address the chronic global underinvestment in tackling antimicrobial resistance.”
Dr Danna Gifford, an expert in AMR, at the University of Manchester, also said there would be challenges, with sustained commitment and collaboration on an unprecedented global scale needed to achieve the proposed targets.
But, she said, preventive measures were crucial. “It is clear that reducing the global burden of resistance requires preventing the occurrence of infection, rather than simply relying on new antimicrobials.”
