New Lancet series: 750,000 deaths linked to antimicrobial resistance could be prevented every year

Improving and expanding existing methods to prevent infections, such as hand hygiene, regular cleaning and sterilization of equipment in healthcare facilities, availability of safe drinking water, effective sanitation and use of pediatric vaccines, could prevent over 750,000 deaths associated with antimicrobial resistance (AMR) every year in low- or middle-income countries (MICs), estimates a new modeling analysis as part of a new four paper series on antimicrobial resistance published in The Lancet. Joseph Lewnard, associate professor of epidemiology at UC Berkeley School of Public Health, is a series co-author.

Each year, an estimated 7.7 million deaths globally are caused by bacterial infections—one in eight of all global deaths—making bacterial infections the second largest cause of death globally. Out of these bacterial infection deaths, almost 5 million are associated with bacteria that have developed resistance to antibiotics. Authors of the series call for support for sustainable access to antibiotics to be central to ambitious and actionable targets on tackling AMR introduced at a meeting of the United Nations General Assembly in September 2024.

AMR puts the most vulnerable at further risk

Series co-author Iruka Okeke of the University of Ibadan, Nigeria, says, “Access to effective antibiotics is essential to patients worldwide. A failure to provide these antibiotics puts us at risk for not meeting the UN sustainable development goals on child survival and health aging. Effective antibiotics prolong lives, reduce disabilities, limit healthcare costs and enable other life-saving medical actions such as surgery. However, antimicrobial resistance is on the rise—accelerated by inappropriate use of antibiotics during the COVID-19 pandemic—threatening the backbone of modern medicine and already leading to deaths and disease which would have once been prevented.”

The new Series highlights how babies, children, the elderly and people with chronic illness are most vulnerable to AMR as they have a higher risk of contracting bacterial infections in general.

AMR is a huge threat to newborn survival around the world. A third of deaths in newborn babies globally are caused by infections and half of those by sepsis (a potentially lethal system-wide response to infection). Increasingly, the bacteria or fungi which cause these infections are no longer responding to most readily available antibiotics. For example, in a study including 11 countries across Africa, Asia, Europe, and Latin America between 2018–2020, 18% of babies with sepsis did not survive despite being given antibiotics.

Elderly and chronically ill people also face significant risk from AMR, especially when seeking treatment for medical conditions in hospitals and long-term care facilities. AMR undermines the safety of common medical procedures such as organ transplants, joint replacements, cancer chemotherapy, and treatment of non-communicable diseases such as cardiovascular disease, diabetes, and chronic lung illnesses.

Existing infection prevention methods can prevent AMR-associated deaths

According to Lewnard, “Focusing on interventions with demonstrated effectiveness in preventing infections must be at the heart of global action to tackle AMR. Preventing infections reduces the use of antibiotics and reduces selection pressure for AMR so that the drugs will work when they are most needed.”
Novel modeling analysis undertaken for the series estimates existing infection prevention methods could prevent 750,000 deaths associated with AMR infections a year. The analysis estimates:

• Improving infection prevention and control in healthcare facilities including better hand hygiene and more regular cleaning and sterilization of equipment, could save up to 337,000 lives a year.
• Universal access to safe drinking water and effective sanitation in community settings could prevent approximately 247,800 deaths annually.
• Expanding the roll out of some pediatric vaccines, such as pneumococcal vaccines that help protect against pneumonia and meningitis, and introducing new ones, such as RSV vaccines for pregnant mothers, could save 181,500 lives a year.

The series also looks at the evidence for preventing resistance emerging in bacteria, alongside preventing infections in the first place.
Antibiotic stewardship (reducing the use of antibiotics when the benefit to patients is limited) is thought to reduce the selection pressure on bacteria to develop resistance, however there is a lack of research in this area.

A rethink of antibiotic development investment is needed

Co-author Ursula Theuretzbacher of the Center for Anti-Infective Agents in Vienna, Austria, says, “We need to see a complete rethink in how we approach discovery and development of new antibiotics with a focus on innovation, affordability, and sustainable availability.”

The increasing number of bacterial infections that are no longer responding to any available antibiotics indicate an urgent need to invest in—and ensure global access to—new antibiotics, vaccines, and diagnostic tests.

The traditional model of drug development, which depends on the likelihood of high profits to motivate investment, is not working for antibiotics. Most new antibiotics are not registered in LMICs, but even if registered, they would likely be unaffordable.

The authors say new, publicly funded models of antibiotic development based on public-private partnerships could increase the amount of novel alternatives, as well as lower patients’ out-of-pocket cost, making them more accessible.

AMR targets for 2030 must address the need for sustainable access to effective antibiotics

AMR will be addressed as part of the upcoming United Nations General Assembly in September 2024.

The series proposes ambitious yet achievable global targets for 2030, which authors argue should be adopted at the meeting within a framework of universal access to antibiotics: the “10-20-30 by 2030” goals:

• A 10% reduction in mortality from AMR by scaling up public health interventions to prevent infections in the first place, reducing both antibiotic use and resistance and enabling great access.
• A 20% reduction in inappropriate human antibiotic use by reducing use of antibiotics for mild respiratory infections that generally do not require antibiotics.
• A 30% reduction in inappropriate animal antibiotic use to be achieved by incremental actions in many sectors. Policy examples could include:
  • no use of medically important antimicrobials for growth promotion in animals
  • no use of highest-priority, critically important antimicrobials for preventative treatment in animals
  • all antibiotics to be given under the guidance of a veterinary professional.

The Series also calls for the establishment of an independent scientific body—an Independent Panel on Antimicrobial Access and Resistance—to expand the evidence base for policy implementation and to inform new targets.