Models suggest preventive measures could reduce deaths in poorer countries by 18%, saving 750,000 lives annually

Every year, 750,000 deaths linked to drug-resistant superbugs could be prevented through better access to clean water, sanitation, infection control, and childhood vaccinations, research suggests. Antimicrobial resistance (AMR) poses a huge global challenge, with drug-resistant superbugs evolving due to factors like inappropriate and excessive antibiotic use. This raises the prospect of a future where modern medicine fails.

Experts warn that if the world does not prioritize action on AMR, the death toll will steadily increase. Infants, the elderly, and those with chronic illnesses or requiring surgical procedures face the highest risk. “It kills more people than HIV, malaria, and TB combined,” said Prof Ramanan Laxminarayan of Princeton University. Tackling AMR is crucial for meeting goals for newborn survival and healthy ageing.

The scenario where once-trivial infections prove fatal is becoming more likely. Crucial procedures in modern medicine, ranging from caesarean sections to cancer treatments and organ transplants, could become too risky to perform. In 2019, an estimated 4.95 million deaths were associated with bacterial AMR, including 1.27 million directly caused by drug resistance.

Low- and middle-income countries (LMICs) are disproportionately affected by AMR. Models created by Laxminarayan and colleagues suggest AMR-associated deaths in LMICs could be cut by 18%, equivalent to about 750,000 lives annually, through three key steps. Universal access to clean water and improved sanitation and hygiene could prevent an estimated 247,800 deaths. Better infection prevention and control in healthcare settings could prevent 337,000 deaths. Additionally, childhood vaccinations could prevent another 181,500 deaths, not only by preventing infections resistant to current drugs but also by curtailing inappropriate antibiotic consumption.

The team notes that 95,400 deaths among under-15-year-olds could be directly avoided each year through vaccines against four key bacterial infections. Vaccinations against viral infections also matter. “People get symptoms… they cannot distinguish whether it’s viral or bacterial and just to be safe they take the antibiotic. But in creating that safety, they are creating drug resistance,” said Laxminarayan, noting that influenza drives global antibiotic consumption.

The study, published in the Lancet, is part of a series on AMR which includes proposing global targets called “10-20-30 by 2030” goals. These refer to a 10% reduction in mortality from AMR relative to 2019, a 20% reduction in inappropriate human antibiotic use, and a 30% reduction in inappropriate animal antibiotic use. While ambitious, Laxminarayan believes the goals are feasible. He noted that deaths from AMR have risen since 2019, but inappropriate antibiotic use in animals has already fallen.

The researchers also emphasize the need for better access to and development of antibiotics, diagnostic tests, and vaccines. They call for establishing an independent panel on antimicrobial access and resistance, similar to the Intergovernmental Panel on Climate Change (IPCC), to gather evidence on AMR and inform guidelines. Time is critical. “The window of opportunity to ensure our ability to treat bacterial pathogens is shrinking,” they write.

Laxminarayan added that AMR is not an intractable issue. “Why wouldn’t the world want to solve a big solvable problem?” he asked. Prof Ben Cooper of the University of Oxford, who was not involved in the research, said the estimate of 750,000 preventable deaths was based on careful and thorough analysis. “The work highlights how we already have affordable tools that could make a major dent in the problem, but achieving these reductions will require addressing the chronic global underinvestment in tackling antimicrobial resistance.”

Dr. Danna Gifford, an expert in AMR at the University of Manchester, acknowledged the challenges. Sustained commitment and collaboration on an unprecedented global scale are needed to meet the proposed targets. Preventive measures are crucial. “It’s clear that reducing the global burden of resistance requires preventing the occurrence of infection, rather than simply relying on new antimicrobials,” she said.

Analysis

The recent study on antimicrobial resistance (AMR) underscores a critical global health crisis and offers a roadmap for significantly reducing the death toll. From a political perspective, addressing AMR requires international cooperation and substantial policy shifts. Governments must prioritize funding and infrastructure for clean water, sanitation, and healthcare improvements. This necessitates political will and collaboration, especially in low- and middle-income countries (LMICs) where resources are scarce.

Sociologically, AMR impacts various demographics differently. Infants, the elderly, and individuals with chronic illnesses are more vulnerable. These groups often have less access to healthcare and are more likely to be exposed to environments where drug-resistant bacteria thrive. Therefore, public health campaigns targeting these vulnerable populations are crucial. Education and awareness programs can help reduce inappropriate antibiotic use and promote vaccination.

Economically, AMR strains healthcare systems worldwide. Treating drug-resistant infections is more expensive and requires longer hospital stays and more intensive care. Implementing preventive measures, as suggested by the study, could significantly reduce these costs. Investing in clean water and sanitation infrastructure, while initially expensive, offers long-term savings by reducing the burden on healthcare systems and improving overall public health.

Locally, communities in LMICs suffer the most from the effects of AMR. Limited access to clean water and sanitation exacerbates the spread of infections. Local governments and NGOs must work together to implement sustainable solutions. Community involvement and local leadership can ensure that these measures are culturally appropriate and effectively implemented.

From a gender perspective, women, particularly in LMICs, often bear the brunt of inadequate healthcare and sanitation. Women are typically the primary caregivers and are disproportionately affected by the health consequences of AMR. Ensuring that women have access to vaccinations and proper healthcare is essential. Gender-sensitive approaches can help address the unique challenges women face in combating AMR.

Race and minority perspectives highlight that marginalized communities often have less access to healthcare and sanitation. These disparities contribute to higher AMR-related mortality rates. Addressing these inequities is essential for an effective global response to AMR. Policies must focus on providing equitable healthcare access to all communities, regardless of socioeconomic status or ethnicity.

Theoretical perspectives, such as public health theories and the social determinants of health, emphasize the importance of addressing the root causes of AMR. Preventive measures, such as improving water and sanitation and promoting vaccinations, align with these theories. By addressing the underlying social and environmental factors, we can reduce the incidence of AMR and improve health outcomes globally.

In conclusion, the fight against AMR requires a multifaceted approach. Political commitment, sociological awareness, economic investment, local action, gender-sensitive strategies, and equitable healthcare access are all critical components. The proposed preventive measures offer a feasible solution to a pressing global health crisis. By implementing these strategies, we can save millions of lives and ensure a healthier future for all.