Antimicrobial resistance (AMR) is a critical global health issue. Bacterial infections cause an estimated 7.7 million deaths annually, 4.95 million of which are associated with bacteria resistant to antibiotics we have to treat them. In a new Lancet series on AMR, modeling using novel data suggests deaths due to AMR in low- and middle-income countries (LMICs) could be reduced by 18 percent – around 750,000 a year – with preventive measures.

For the 2024 Lancet series on AMR, the One Health Trust’s Founder and President, Dr. Ramanan Laxminarayan, brought together leading experts on the issue to address the growing global AMR burden.  The Lancet Series on Sustainable Access to Effective Antibiotics addresses AMR by advocating for a multifaceted approach:

  1. Preventing Infections: This involves widespread vaccination, improving water, sanitation, and hygiene (WASH) standards and infrastructure, and implementing robust infection prevention and control measures. These steps are crucial in reducing the incidence of bacterial infections and, consequently, the need for antibiotics.
  2. Ensuring Access to Effective Antibiotics: Patients everywhere must have access to affordable and effective antibiotics. This includes ensuring that both first-line and second-line treatments are available to manage infections, especially drug-resistant ones.
  3. Investing in Innovation: There is a pressing need for investment in the development of new antibiotics, vaccines, and diagnostic tools. These innovations should be affordable and accessible, focusing on patient needs and forming the foundation for global strategies to tackle AMR.

By addressing these key areas, global health initiatives can significantly mitigate the impact of AMR and improve patient outcomes worldwide.

The series authors affirm that ensuring sustainable access to effective antibiotics requires political will, targets, accountability frameworks, and funding. The 2024 United Nations General Assembly (UNGA) High-Level Meeting on AMR offers a chance to set a bold goal: ensuring no one dies due to lack of access to effective antibiotics.

The 2016 UNGA meeting on antimicrobial resistance (AMR) began addressing the problem but lacked commitments on targets, accountability, and funding. A 2024 UNGA declaration can fill these gaps and harness the will of member states and relevant UN organizations.

The Lancet series authors propose global targets for 2030 relative to 2019:

  • 10 percent reduction in AMR mortality;
  • 20 percent reduction in inappropriate human antibiotic use;
  • 30 percent reduction in inappropriate animal antibiotic use.

These targets should be met within a framework of universal access to World Health Organization-classified “Access” antibiotics. Better diagnostics will ensure rational antibiotic use. Some countries may need to increase access to “Access” antibiotics and reduce inappropriate use of “Watch” and “Reserve” antibiotics. Improved WASH, vaccination, and infection prevention in healthcare settings can mitigate the effects of increased antibiotic use in LMICs.

Funding for AMR lags behind diseases with smaller burdens. Many countries fail to finance their AMR action plans domestically, and global donor investment is imbalanced, favoring research and development (R&D) over mitigation. Of the estimated $12.8 billion in R&D funding, most goes to research and operational costs, with little for vaccines, diagnostics, or implementation sciences.

To ensure accountability, the authors recommend establishing an Independent Panel on Antimicrobial Access and Resistance, supported by leaders from LMICs.

Dr. Laxminarayan said, “For too long, the problem of AMR has been seen as either not urgent or too difficult to solve. Neither is true.”

We need immediate action, and the necessary tools are available. The upcoming UN meeting must ensure the global will to act.

Read the The Lancet Series on Antimicrobial Resistance: The need for sustainable access to effective antibioticshere.


Image courtesy of The Lancet.