Antimicrobial resistance (AMR) is a global health issue that affects every country, regardless of their economic status. All around the globe, frequent travel, international economic transfers of labor, food, and animals contribute to the rapid dissemination of microorganisms that are resistant to antibiotics. AMR causes about 700,000 deaths each year, and this number could increase to up to 10 million deaths by 2050. Aside from the health threat, this phenomenon also causes significant economic losses. To address the situation and combat AMR, joint efforts and urgent measures are essential. What are the main factors causing this rise, and what are the potential solutions? Check some Experts’ Opinions below.
Key Takeaways:
- If AMR rates continue to rise, the direct healthcare costs could reach US$159 billion annually by 2050, which would account for 1.2% of global health spending.
- Among the main factors contributing to AMR are the misuse and over-prescription of antibiotics in healthcare and agriculture, self-medication, lack of regulation, and poor hygiene practices.
- The rise in drug-resistant infections leads to increased healthcare costs, extended hospitalizations, and productivity loss.
- According to experts, solutions include rapid diagnostic tools, AI-driven drug discovery, and bacteriophage therapy that targets resistant bacteria.
- The One Health approach, which integrates human, animal, plant, and environmental health, is crucial for controlling AMR.
DevelopmentAid: What are the main factors contributing to the rise of drug-resistant pathogens, and how do these differ across various regions?
“Antimicrobial resistance occurs naturally but is accelerated by human activities, particularly the misuse and overuse of antimicrobials across the human, animal, and plant health sectors. Key factors include healthcare over-prescription, excessive use of livestock and fish farming, inadequate infection control in homes, farms, and medical facilities, limited access to care, poor awareness, and weak enforcement of antimicrobial prescription laws. AMR affects all regions and income levels, but low- and middle-income countries are particularly vulnerable due to poverty, limited access to healthcare, and easy antimicrobial availability without professional oversight. Physician uncertainty, patient demands, self-medication, and non-compliance further drive resistance. In some areas, counterfeit or expired drugs worsen the issue, disproportionately impacting vulnerable populations in low-resource settings.”
“In my opinion, the main factors leading to the increase in pathogen resistance to drugs are (i) incorrect and poor-quality drug prescriptions; (ii) self-medication of antibiotics; (iii) uncontrolled consumption of antibiotics; (iv) lack of control over the sale of drugs; (v) intensive livestock farming especially in developed countries; and (v) the lack of equipped national laboratories especially in developing countries. These factors differ depending on the region due to the orientation and performance of health systems. In Africa, the catastrophically low health expenditure leads to populations self-medicating and often over-consuming before seeking care from a health professional. It is also necessary to note the illegal sale of drugs. These factors are more or less the same in other low-income countries. In developed states, resistance is instead caused by the over-consumption of antibiotics. Due to intensive farming, the excessive consumption of drugs is observed in animals. This also leads to antimicrobial resistance. Animal health is therefore severely affected in addition to human health.”
“The rise of drug-resistant pathogens is a growing global threat, driven by several interconnected factors. Key contributors include the over-prescription and misuse of antibiotics in both healthcare and agriculture, inadequate infection control practices, and a lack of access to clean water and sanitation. While the drivers of resistance differ by region, they share common threads. High-income countries struggle with overprescribing in healthcare settings, while low-income countries face challenges with unregulated access to antibiotics and inadequate healthcare infrastructure. In Southeast Asia and Africa, limited access to diagnostic testing and poor sanitation significantly compound these issues. The agricultural sector’s antibiotic use, which accounts for approximately 70% of total consumption in many countries, is particularly concerning. This widespread misuse not only contributes to the emergence of resistant strains but also accelerates their global spread. Additionally, global travel and trade facilitate the rapid spread of resistant strains across borders, exacerbating the issue.”
“Antimicrobial resistance constitutes a crucial global public health and developmental threat. The improper utilization and excessive application of antimicrobials in humans are the primary factors contributing to the emergence of drug-resistant bacteria. Poor hygiene, poor sanitation, and ineffective infection control are three interrelated issues that facilitate the proliferation of resistant bacteria in healthcare settings, agricultural settings, and communities. Antimicrobial resistance affects countries across all geographical regions and income levels. The factors that cause resistance and repercussions are intensified by poverty and inequality, with low- and middle-income countries being the most impacted. Antibiotics are extensively accessible without a prescription in numerous Low- and Middle-Income Countries, resulting in their widespread misuse. Self-medication is frequently the result of inadequate healthcare access, which serves to heighten resistance. In outpatient settings, overprescription is also a concern in High-Income Countries. Nevertheless, misuse has been somewhat mitigated by stringent regulations and public awareness campaigns. In sub-Saharan Africa and Southeast Asia, poor access to clean water, inadequate sanitation, and insufficient infection control in healthcare institutions intensify the proliferation of resistant bacteria. Enhanced infection control measures mitigate transmission in clinical environments; nonetheless, resistance persists due to additional variables such as agriculture and tourism in Europe and North America.”
“Two factors: Health systems (drug administration) and genetic factors. The latter is not easy to control. The first could serve as an area to correct errors. In developing countries, where health systems are not strong, the environment is another contributing factor for drug-resistant pathogens, as infectious diseases are of the most concern. Populated by more young people than elsewhere, the big burden of the threat of drug-resistant pathogens will be located in developing countries. This is considered by the World Bank as “a threat to our economic future: … low-income countries would experience larger drops in economic growth than wealthy countries, so economic inequality between countries would increase. The differential impacts on GDP result from higher infectious disease prevalence and greater dependence on labor incomes in countries with lower per capita incomes.”
“Drug-resistant pathogens pose a significant global health threat, having caused increasing illness and death over recent decades and being projected to cause 39 million deaths over the next 25 years. This rise is largely due to human activities, including the irrational use or misuse of antibiotics, poor sanitation, and weak infection prevention and control measures, particularly in healthcare facilities and on farms. While antibiotic misuse is a universal issue, regions with weaker healthcare systems face higher risks of resistance due to insufficient frameworks ensuring responsible antibiotic use.”
“The gradual rise of drug-resistant pathogens is a multifaceted issue influenced by numerous factors that differ significantly across regions. One primary contributor is the overuse and misuse of antibiotics, particularly in healthcare settings. In hospitals, especially intensive care units, the pressure to use broad-spectrum antibiotics can lead to the emergence of multidrug-resistant organisms. This phenomenon is exacerbated in regions with inadequate infection prevention and control practices, where nosocomial infections thrive, increasing resistance rates. Geographical disparities also play a critical role in the prevalence of specific resistant strains. For instance, a study by Liu et al. (2022) indicated that the resistance profiles of pathogens such as Escherichia coli and Klebsiella pneumoniae vary significantly between countries, influenced by local antibiotic prescribing practices and public health policies. In Europe, the emergence of drug-resistant pathogenic strains such as Neisseria gonorrhea highlights how regional epidemiological factors shape resistance trends, necessitating tailored public health responses. Furthermore, environmental factors, such as agricultural antibiotic use, contribute to resistance patterns, particularly in the global south’s low- and middle-income countries. Thus, addressing antimicrobial resistance requires a multi-sectoral understanding of these regional differences and implementing targeted strategies to mitigate the spread of drug-resistant pathogens globally.”
DevelopmentAid: What are the potential economic consequences of the projected deaths due to drug-resistant pathogens?
“For the health system, the economic implications of the projected deaths due to pathogen resistance can be either (i) the increase in the need for care on multiple occasions will lead to an escalation of costs (outpatient care, intensive care, etc.) for the patient, or (ii) the purchase of increasingly innovative and expensive medical technology in order to solve the problems resulting from antimicrobial resistance and to avoid deaths. All in all, an increase in health expenditure in the health system will be observed. At the level of the global economy, high population death rate causes a lack of healthy human resources for economic activity and subsequently economic losses due to the non-participation of these people in economic activity. To this should also be noted the deaths of livestock which cause economic losses in the agricultural sector. Thus, all these effects will lead to probable declines in the GDP of countries which could lead to other unfavorable economic phenomena.”
“The economic ramifications of drug-resistant pathogens are profound and far-reaching. The projected loss of over US$100 trillion in global GDP due to drug-resistant infections reflects the immense financial burden on both healthcare systems and economies. Extended hospitalizations, the use of more expensive second- and third-line antibiotics, and the rising prevalence of chronic illnesses will significantly strain healthcare resources. In addition to increasing treatment costs, drug resistance can lead to reduced workforce productivity, as individuals experience longer periods of illness and recovery. The agricultural sector is also vulnerable, with potential impacts on food security and overall agricultural productivity due to the rising prevalence of resistant infections in both humans and animals. The economic toll is especially severe in low- and middle-income countries, where healthcare infrastructure is already under pressure. These regions may face compounded challenges in addressing resistance, as the strain on their healthcare systems could hinder economic development and exacerbate poverty.”
“Antimicrobial resistance incurs substantial expenses for healthcare systems and national economies as a whole. For example, it demands more costly and intense treatment, diminishes the productivity of patients or their caregivers due to extended hospitalization, and adversely impacts agricultural productivity. The median cost of treating a resistant infection per hospital admission is subject to significant variation, ranging from US$100 to US$30,000, depending on the type of infection and the income level of the country. The direct health care costs of AMR are expected to increase to US$159 billion annually by 2050, which is equivalent to 1.2% of global health expenditure, if resistance rates continue to follow historical trends since 1990. This increase is ascribed to the economic growth and increased treatment intensities in the regions most impacted by AMR. The continuous development of new antibiotics and treatment approaches is imperative as resistance continues to rise. However, the investment in research and development for antimicrobials is expensive, particularly in light of the uncertain profitability of new antibiotics. Resources are strained and the capacity to treat other conditions is reduced as a result of the additional burdens imposed on healthcare staff and infrastructure.”
“The World Health Organization identifies AMR as a leading global health and development threat, with bacterial AMR responsible for 1.27 million deaths and contributing to 4.95 million more in 2019 alone. AMR strains health systems and economies, as it necessitates costly, intensive care, prolongs hospital stays, reduces patient productivity, and impacts agricultural productivity. It also increases risks and costs for medical procedures such as surgeries, C-sections, and cancer treatments. Economically, AMR could add US$1 trillion in healthcare costs by 2050, with projected GDP losses of US$1 to US$3.4 trillion per year by 2030, according to the World Bank.”
“The economic implications of projected deaths due to drug-resistant pathogens are profound, affecting both healthcare systems and global economies. Healthcare systems face mounting financial pressure from increasing drug-resistant infections. The economic impact extends beyond direct medical costs, as illness and premature deaths from these infections significantly affect workforce productivity and economic stability. In 2022, the U.S. CDC reported that antibiotic resistance alone costs the U.S. healthcare system over US$20 billion annually in treatment expenses. In addition, the misuse of antibiotics in livestock agriculture contributes to resistant strains that affect human health. Conclusively, the projected deaths due to drug-resistant pathogens pose significant economic challenges. The interplay between increased healthcare costs, productivity losses, and agriculture’s role in AMR underscores the need for coordinated efforts to combat this escalating public health crisis.”
“Not only deaths, if we include all the implications of the issue, and in accordance with the World Bank, “in the optimistic case of low AMR impacts, the simulations found that, by 2050, annual global gross domestic product (GDP) would likely fall by 1.1%, relative to a base-case scenario with no AMR effects; the GDP shortfall would exceed $1 trillion annually after 2030. In the high AMR-impact scenario, the world will lose 3.8 percent of its annual GDP by 2050, with an annual shortfall of $3.4 trillion by 2030”.
“The economic impact of drug-resistant pathogens is likely to be significant, placing additional strain on healthcare systems and hindering productivity. Higher healthcare costs, extended hospital stays, more expensive treatments, and reduced workforce capacity from rising illness and death all threaten economic growth, especially in low-income regions.”
DevelopmentAid: What innovative approaches are being developed to combat drug-resistant pathogens, and how effective do you believe these solutions will be in the next decade?
“In terms of innovative approaches to be developed, we can mention:
- Strengthening the links between animal health and human health (One Health)
In developing countries, strengthening reference laboratory systems - In low- and middle-income countries, controlling the prescription and consumption of antimicrobials
- Strengthening the capacities of human and animal health professionals in terms of antimicrobial resistance (especially in low- and middle-income countries)
- Raising awareness among all stakeholders (scientists, hospital and non-hospital practitioners, civil society, the private health sector, the livestock sector)
- Over the next decade, training and awareness-raising activities with players in the various sectors of human and animal health, as well as with the general public, will be crucial to reducing the effects of antimicrobial resistance.”
“Innovative strategies are emerging to combat the growing threat of drug-resistant pathogens, offering new hope in the fight against resistance. Novel diagnostic tools that enable the rapid detection of resistance are helping clinicians to choose the most effective treatments, while advances in immunomodulation and microbiome manipulation aim to restore balance and enhance the body’s ability to fight infections. Bacteriophage therapy, which is used to target specific bacteria, has shown promise in treating infections that are resistant to conventional antibiotics. In addition, AI-driven drug discovery is accelerating the development of new antibiotics, with the potential to overcome some of the limitations of traditional drug development. However, the effectiveness of these solutions will depend on several factors, including regulatory support, sufficient funding, and strong global collaboration. Furthermore, global surveillance and antimicrobial stewardship programs are critical to curbing the misuse and overuse of antibiotics, which continue to fuel resistance. While these innovative approaches are promising, they must be integrated into a broader strategy that includes policy reforms and improvements in healthcare practices. The next decade will be pivotal in determining whether these advances can meaningfully address the growing threat of drug-resistant pathogens.”
“Multidisciplinary collaborations and coordinated efforts are necessary to address drug-resistant pathogens at the local, national, and international levels. In order to more effectively regulate the use and sale of antibiotics for both humans and animals, it is essential to have a strong political commitment that is able to influence the formulation of policy, implementation, and regular educational updates based on scientific evidence. An integrated strategy that incorporates improved management of bacterial infections, the development of new antibiotics, augmented vaccination initiatives, and greater access to WASH would provide the most significant decrease in healthcare expenditures. Empowering the Global Surveillance Networks by using AI and big data to track resistance patterns globally allows for real-time surveillance and the prediction of resistance trends. This can help with timely responses and identifying hotspots for targeted interventions. AI and big data can enable real-time surveillance and prediction of resistance trends by tracking global resistance patterns. This can link to live data, thereby facilitating an early response and a targeted presence at the critical hot spots. AI-based predictive models are likely to incorporate, among other things, monitoring adaptations. This will happen on a global scale over the next decade, improving readiness and providing valuable information for public health decisions to curb resistance.”
“The world is facing an antibiotic crisis due to limited research and development pipelines and rising resistance levels, highlighting the urgent need for equitable access to vaccines, diagnostics, and medicines. Innovation and investment are essential for developing epidemiological research, improving surveillance, and creating new antimicrobials. To tackle AMR effectively in human health, key actions include infection prevention, access to quality diagnostics, optimized antimicrobial use, and support for healthcare workers. The One Health approach, which integrates human, animal, plant, and environmental health, is crucial for controlling AMR. By encouraging collaboration across sectors, One Health promotes the coordinated design, implementation, and monitoring of policies and programs to curb AMR and achieve better health and economic outcomes. However, without significant investments, expanded One Health initiatives, and improved access to care, the prospect of tackling AMR effectively in the coming decade remains bleak.” (Fernanda Rick, infectious disease specialist)
“Due to the escalating threat posed by AMR, innovative approaches to combat drug-resistant pathogens are becoming increasingly vital. One promising method is the development of antivirulence drugs, which target bacteria’s harmful traits rather than killing them outright. This strategy helps to prevent bacteria from becoming resistant to antibiotics and treatments. Another emerging strategy utilizes biogenic nanoparticles, particularly silver and zinc oxide, which have demonstrated effectiveness against resistant infections. Antimicrobial stewardship (AMS) is crucial to combating AMR by ensuring appropriate antibiotic usage. AMS programs have successfully reduced infections and enhanced patient outcomes by carefully managing antibiotic prescriptions and ensuring that patients receive antibiotics only when necessary and in the right amounts. The next decade is expected to improve diagnostic tools and healthcare provider education to strengthen AMS initiatives. The future of treating drug-resistant infections lies in exploring multiple approaches, including combination therapies, bacteriophages (bacteria-targeting viruses), and immune system-enhancing treatments. These developing technologies and robust AMS practices provide promising pathways for managing drug-resistant pathogens. By integrating these various strategies, healthcare providers can better address the growing challenge of antimicrobial resistance.”
“Among approaches and strategies, we can find the early detection and mapping of drug resistance cases. This should be done prior to any rapid and effective responses to limit the selection and spread of cases. The mapping and early detection of cases should benefit from Information and Communication Technology. I believe in the effectiveness of all those solutions. However, some unpredictable effects related to nanotechnology, as they tend to be extensively applied in the curative healthcare system, are not yet totally mastered. So, this does not ensure a solution for the next decade.”
“Innovative solutions such as rapid diagnostics, AI-driven drug discovery, and phage therapy are emerging. However, the success of these promising approaches will depend on their widespread adoption and global collaboration. Enhanced regulation, improved antimicrobial stewardship, and investment in research and development are crucial to tackling the threat of drug-resistant pathogens in the coming decade.”
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