The rising death toll from drug-resistant insects is “very scary” and people don’t even realize it’s happening, the UK’s special envoy for antimicrobial resistance (AMR) has said.
Superbugs kill more than a million people every year, but neither governments nor the public recognize the extent of the threat, doctors complain. The crisis is largely driven by the misuse of antibiotics – about 70% of which are given to livestock – which encourages the evolution of microbes too strong for modern medicine to deal with.
“We need to use antibiotics safely and appropriately,” said Sally Davies, who stepped down as England’s chief medical officer in 2019 to fight the UK’s fight against superlice.
By 2050, drug-resistant bugs are projected to kill off almost 2 million people every year and plays a role in the deaths of 8 million people. The figures put AMR in a similar ballpark to the Covid-19 pandemic, which the World Health Organization (WHO) estimates led to 4 million excess deaths in 2020 and 10 million in 2021.
Data published on Thursday showed an increase in serious antibiotic-resistant infections to 66,730 cases in 2023, above pre-pandemic levels. E coli has caused 65% of cases in the UK over the past five years.
“Some people talk about [AMR] a pandemic is – it is,” Davies said. “Is it a slow-developing one, an insidious one, or what? I don’t care what words you want to use, but it’s pretty awful.”
World leaders have taken little action to reduce AMR-related deaths, but they pledged to reduce it by 10% by 2030 at the UN general assembly in September. Public health experts are frustrated by the lack of interest from governments and the lack of awareness among the public.
“It’s clearly a lack of prioritization – and it has to be a failure of our communication,” Davies said. “It’s partly the name, ‘antimicrobial resistance’, AMR, partly the complexity, and the big bit that’s hidden … they [doctors] don’t tell people what they’re dying of.”
Davies, who previously served on the WHO executive board, lost her goddaughter to antimicrobial resistance two years ago. “It was horrible. She had cystic fibrosis, she knew she had AMR, and she knew she was going to die from it because it infected her lung transplant,” she said.
“She told me: Sally, you’ve been working on this for years, you have to use my case [to raise awareness]. She was very brave.”
Doctors have urged people to play their part in fighting the rise of superlice by only using antibiotics when prescribed and then taking the full course.
They also point to the big role that animal agriculture plays behind the scenes. The growing hunger for meat is increasing demand for livestock and the use of antibiotics — some of which are used to treat animals that aren’t sick, sometimes as a substitute for keeping them in clean conditions, Davies said.
“It drives the development of resistance,” she said, “which can then be on the meat when it’s sold and people pick it up that way. It can be passed on to abattoir workers going home to their families. And it certainly reaches farm workers and their families.”
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Most antibiotics are flushed from an animal’s body in its excrement, Davies said. “If you have high-intensity farming, you’re going to get antibiotics in the fields and in the runoff… It can get into the water table. But also, it seems, can wind that comes along picking up bacteria and bits of genes, take them up into the sky and clouds, and rain them down somewhere else.”
Antibiotic use in farm animals is correlated with antimicrobial resistance in humans, a study found last year. It found an “extremely high”. E coli resistance of 73.3% to aminopenicillins, which are used in animals, but “very low” resistance of 0.78% to glycylcyclines, which are banned in animal husbandry.
For S aureusthe researchers found a resistance to the macrolide group of antibiotics of 56%, while resistance to vancomycin, a more recent antibiotic banned in animal farming, was only 0.22%.
EU rules to encourage better farming practices have reduced the amounts of antibiotics given to animals, with little impact on the industry. In Denmark, a leading producer of pork, pigs consume one fifth of the world average. In France, which is famous for its cheese, cows consume about one quarter of the average.
Alan Dangour, who leads the climate and health team at Wellcome, a not-for-profit research organisation, said scientists discovering new treatments were in a race against the bugs.
“It’s clear that if we don’t find a different set of antibiotics or responses to bacterial infections, more and more people will get infections that no longer respond to the medicines we have,” he said. “It’s very dangerous. Imagine going back to a world before the invention of antibiotics, where people were dying left, right and center from being cut…we don’t want to go back to that world.”
