Antimicrobial resistance (AMR) is a big problem with a crappy marketing plan. It’s been termed a “silent pandemic,” and it has huge health and financial impacts that are only going to get worse if we don’t act. Unfortunately, even though we’ve been battling this issue for decades, the average person doesn’t know about it, or doesn’t care (mainly the former), and the lack of awareness leads to lack of motivation for both individual action and broader action to combat the problem.

We don’t hear about AMR during election season. In fact, we probably lose traction on AMR around election time because the general public doesn’t care (or they just care more about other things), but some interest groups do. If you’re a politician and you realize that something isn’t on the radar for average voters, but measures you’d take to address it cost money and might create friction with certain groups, you’re unlikely to act, and you’re particularly unlikely to take the ambitious steps that we need to address a wicked problem like AMR.

We need everyone to have a better understanding of why AMR matters and why we need to invest time, effort and money.

TLDR? AMR kills a lot of people, costs us billions of dollars every year, and has a major impact on the global economy. There are parallel issues with AMR in animals.

Here are a just a few more details:

Impact of AMR in humans

A few weeks ago, an updated assessment of the global burden of AMR on humans was released (Naghavi et al. 2024). The results weren’t too surprising to those of us in the field, but the numbers should (hopefully) shock people who haven’t been in the loop:

  • In 2021 alone, an estimated 1.14 million deaths were “directly attributable to AMR”*. That’s one death approximately every 30 seconds.
  • An estimated 4.7 million deaths were “associated with AMR”*.
  • Annual deaths increased minimally between 1990 and 2019, but are expected to start increasing.
  • By 2050, 1.9 million deaths globally could be directly attributable to AMR every year, with 8.2 million deaths associated with AMR.
  • AMR deaths in young children have decreased while deaths in individuals over 25 years of age have increased since 1990 (see Figure 4 from the paper, below), but children less than 5 years of age were still disproportionately affected. It’s particularly severe in sub-Saharan Africa, where 59% of deaths attributable to AMR were in children less than 5 years of age.
  • Deaths from 12 AMR pathogens decreased while deaths from 12 others increased. Streptococcus pneumoniae had the biggest decline while Staphylococcus aureus had the biggest increase.
  • The top 6 pathogens, all of which accounted for >100,000 deaths each, were S. aureus, Acinetobacter baumannii, E. coli, Klebsiella pneumoniae, S. pneumoniae and Pseudomonas aeruginosa (see Figure 5 from the paper, below).
  • Methicillin-resistant S. aureus (MRSA) boomed, going from 57,200 attributable deaths in 1990 to 130,000 in 2021.
  • Klebsiella pneumoniae, S. pneumoniae and E. coli had the biggest burdens in children.
  • Among specific drug/bug combinations, MRSA, multidrug-resistant tuberculosis (TB), carbapenem-resistant K. pneumoniae and carbapenem-resistant A. baumannii had the biggest impacts.
  • Using a “better case scenario,” they estimated that 92 million deaths between 2025 and 2050 could be cumulatively averted with better healthcare, better treatment of infections and improved access to necessary antimicrobials.

* “Attributable to AMR” is based on the outcome of a resistant infection compared to an equivalent susceptible infection. “Associated with AMR” is when resistant infections are compared to no infection.

Impact of AMR in animals

We don’t have as much information about the impact of AMR in animals vs humans, and it’s a really complex area. However, some of the issues are outlined in a recent report by the World Organisation for Animal Health (WOAH) and a group of collaborators, entitled Economic Impacts of AMR in Food-Producing Animals.

If we don’t take further action to curb AMR now, it’s estimated that it will have the following impacts:

  • By 2050, the loss of livestock production from AMR will equal the consumption needs of 746 million to 2 billion people per year.
  • A cumulative global gross domestic product (GDP) impact (loss) of $575-953 billion USD between 2025 and 2050. When considering the impact of AMR in animals and spillover impacts on humans, the impact on global GDP would be $1.1-5.2 trillion USD for the same period.
  • Conversely, a “reasonable” AMU reduction (30%) globally could increase the global GDP by $120 billion USD between 2025-2050.

Also, these figures doesn’t include AMR in companion animals. There are substantial impacts of this issue in pets too, including illness, increased treatment costs, an unknown but not inconsequential number of deaths, and corresponding impacts on animal welfare and the human-animal bond.

We need to pay attention more attention to AMR. AMR is too easy to dismiss or not think about, perhaps because it’s not as in-your-face as other issues that affect the daily lives of the public, and doesn’t lend itself to flashy media stories. But for something that kills millions of people, it doesn’t get enough attention. Inadequate attention leads to inadequate action. It’s time to act.