Deaths from infections resistant to common antibiotics, antivirals and anti-parasitic drugs could increase more than ten-fold to 10 million deaths annually by 2050, warns a ground-breaking United Nations report released today.

“There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation,” warns the report by the UN Ad Hoc Interagency Coordinating Group on Antimicrobial Resistance (IACG), led by the World Health Organization together with the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE).

The report, “No Time to Wait: Securing the Future from Drug-resistant Infections,” also warns that by 2030, antimicrobial resistance (AMR) could force up to 24 million people into extreme poverty, due to the combined effects of AMR on human health as well as food systems.

“Antimicrobial resistance is one of the greatest threats we face as a global community. This report reflects the depth and scope of the response needed to curb its rise and protect a century of progress in health,” Amina Mohammed, UN Deputy Secretary-General and Co-Chair of the IACG, said in a joint press release issued by the IACG, WHO and FAO.

“It rightly emphasizes that there is no time to wait, and I urge all stakeholders to act on its recommendations and work urgently to protect our people and planet and secure a sustainable future for all.”

Currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people from multidrug-resistant tuberculosis alone, according to the report.

More and more diseases, including respiratory tract infections, sexually transmitted infections and urinary tract infections, are failing to respond to drug treatment, and lifesaving medical procedures are becoming much riskier due to threats of untreatable infections, the report warns.

Just as alarming are the threats to food systems, due to the rampant use of various anti-microbial agents on crops, livestock and fish as growth and production promoters.

“Misuse and overuse of existing antimicrobials in humans, animals and plants are accelerating the development and spread of antimicrobial resistance,” the report’s summary of recommendations bluntly states.

The UN report calls for a coordinated, multisectoral “One Health” approach to combat the interlinked human, animal, food and environmental health aspects of AMR threats. Solutions need to cover the entire chain of threats and issues, including new drug innovation, more judicious production and use in humans and in food systems, and better waste management, the report stresses, reflecting growing recognition of the complexity of the AMR challenge.

Recommendations call for immediate action by governments, the private sector, civil society and academia, and include the following:

• Surveillance, regulatory frameworks, professional education and oversight – strengthen all aspects of antimicrobial prescription and use, “to ensure responsible use of antimicrobials and minimize resistance in humans, animals, plants, food and the environment.”
• Infection prevention and control in health care facilities and farms – ensure “access to clean water, sanitation and hygiene in health facilities, farms, schools, household and community settings” to minimize disease transmission, and the emergence and transmission of antimicrobial resistance in humans, animals, plants, food and the environment;
• WHO List of Highest Priority Antimicrobial Agents for Human Medicine – “immediately stop” use of these agents as [livestock] growth promoters as an “essential first step” towards completely phasing out the use of antimicrobials for [animal] growth promotion;
• Spur innovation in antimicrobial medicines, diagnostics, vaccines, waste management tools, as well as safe and effective alternatives to antimicrobials and alternative practices;
• Invest in ambitious research and development for new technologies to combat antimicrobial resistance.

At the same time, many people around the world still do not have access to quality infection control agents and therefore, “[e]nsuring equitable and affordable access to quality antimicrobial agents and their responsible and sustainable use is an essential component of the global response to antimicrobial resistance,” the report underlines.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and IACG Co-Chair, described this moment as a “critical point in the fight to protect some of our most essential medicines. This report makes concrete recommendations that could save thousands of lives every year.”

A key industry spokesperson also welcomed the report and its conclusions. Thomas Cueni, director general of the IFPMA and chair of the AMR Industry Alliance, told Health Policy Watch: “The threat of superbugs has galvanized action on all fronts and there is, today, a much deeper understanding of the complex environment around AMR.”

“As the report says, the challenges of AMR are complex and multifaceted, but they are not insurmountable. In fact, measures will almost certainly be cheaper than the cost of inaction,” Cueni added. “The world can’t afford to delay action on the global crisis of antimicrobial resistance; the life-science industry has demonstrated it is willing to put its resources at risk, and is calling for further action and accountability from governments.”

“The report’s recommendations recognize that antimicrobials are critical to safeguard food production, safety and trade, as well as human and animal health,” said José Graziano da Silva, Director-General of the Food and Agriculture Organization of the United Nations (FAO), calling for “responsible use across sectors, including sustainable food systems and farming practices that reduce the risk of antimicrobial resistance.”

Monique Eloit, Director General of the World Organisation for Animal Health (OIE) said the report “demonstrates the level of commitment and coordination that will be required as we face this global challenge to public health, animal health and welfare, and food security. We must all play our part in ensuring future access to and efficacy of these essential medicines.”

The IACG was formed in 2016 at the request of UN member states in the wake of the first-ever UN High-Level Meeting on Antimicrobial Resistance. It brings together partners across the UN, international organisations and representatives from civil society. The IACG expert group includes leading scientists in human, animal and plant health, as well as the food, animal feed, trade, development and environment sectors.

The new report is perhaps the most comprehensive blueprint yet produced on the issue; it underlines the threat that AMR poses to achieving a range of UN Sustainable Development Goals (SDGs) related not only to health (SDG 3), but also to eradicating poverty and hunger (SDGs 1& 2), clean water and sanitation (SDG 6), and responsible consumption and production (SDG 12).

Image Credits: WHO/Quinn Mattingly, UN.