Drug-resistant Infections: A Threat To Our Economic Future

Generated Summary

This report, commissioned by the World Bank Group, examines the economic and development consequences of antimicrobial resistance (AMR) on a global scale. It utilizes economic simulation tools to quantify the potential losses to the global economy between 2017 and 2050 if measures to contain the AMR threat are not taken. The report’s central argument is that the failure to contain AMR will result in severe economic repercussions, particularly in low-income countries, and that investing in AMR containment is a high-yield investment opportunity. The research also examines the potential benefits of One Health approaches and emphasizes the need for international cooperation, particularly in low- and middle-income countries, to tackle the multifaceted challenges posed by AMR. It investigates laboratory-based AMR surveillance, measures to improve antimicrobial use in human health care, and strategies to rationalize antimicrobial use in livestock production. The report’s methodology involved economic simulations to project the economic impacts of AMR, using data from various sources including the World Bank Group and other institutions. The report also incorporates case studies from six low- and middle-income countries to highlight country-specific challenges. The structure of the report focuses on key areas for country action: health, agriculture, and water, sanitation, and hygiene. Key recommendations include strengthening public health systems, implementing international health regulations, and promoting One Health approaches.

Key Findings & Statistics

• The report’s economic simulations project that, by 2050, annual global gross domestic product (GDP) would likely fall by 1.1 percent in the low-AMR scenario, and by 3.8 percent in the high-AMR scenario, compared to a base-case scenario without AMR effects. The GDP shortfall would exceed $1 trillion annually after 2030 in the low-AMR scenario and $3.4 trillion by 2030 in the high-AMR scenario.
• In the high-AMR scenario, low-income countries would experience larger drops in economic growth than wealthy countries, so economic inequality between countries would increase.
• By 2050, the volume of global real exports may fall below base-case values by 1.1 percent in the low-AMR scenario and by 3.8 percent in the high-AMR scenario.
• Livestock production in low-income countries would decline the most, with a possible 11 percent loss by 2050 in the high AMR-impact scenario.
• By 2050, annual health care expenditures may exceed the base-case level by some 25 percent in low-income countries, 15 percent in middle-income countries, and 6 percent in high-income countries. The additional expenditures in 2050 would be $1.2 trillion annually in the high-AMR scenario and $0.33 trillion in the low-AMR scenario.
• In the high-AMR scenario, an additional 24 million people would be forced into extreme poverty by 2030.
• The cost of AMR containment measures is estimated at $9 billion annually in low- and middle-income countries. About half of this amount is for investments in, and operation of, core veterinary and human public-health systems in 139 countries.
• The expected cumulative global benefits from AMR containment in 2017–2050 range between $10 trillion and $27 trillion, far greater than the investment costs of $0.2 trillion. The net present value is thus between $9.8 trillion and $26.8 trillion.
• High-income countries would still obtain benefits of $0.9 trillion and $2.7 trillion, in the low AMR-impact and high AMR-impact cases, respectively. This is four times and thirteen times more than the global investment cost of $0.2 trillion
• The expected economic rate of return (ERR) on the $9 billion annual investment ranges from 31 percent annually (if only 10 percent of AMR costs are mitigated) up to 88 percent annually (if 75 percent of AMR costs are avoided).

Other Important Findings

• The report underscores the critical responsibility of public authorities, especially national governments, in protecting the global public good of effective antimicrobial treatment.
• The spread of AMR is largely a human-made problem, caused by poor governance, irrational practices, and lack of understanding.
• Building core human and veterinary public-health and infectious disease surveillance capacities in all countries is the critical step in confronting the AMR threat.
• AMR-specific actions are those whose primary purpose is combating AMR (though they may bring other benefits, too). An example is tightening legislation and enforcement on the sale of antimicrobials without a prescription. AMR-sensitive measures are those whose main purpose is not actually AMR-related, but which can be designed and implemented in such a way that they contribute indirectly to AMR containment.
• Universal health coverage (UHC) provides the best enabling framework to tackle AMR. UHC designs lead to greater breadth and depth in the population coverage of health services, which includes services like vaccination, preventative care, and hygiene measures that lower the need for antimicrobials and thus slow the spread of AMR.
• The implementation of the International Health Regulations (IHR) can accelerate AMR action and focus global support. Under the IHR, 196 countries have committed to work together to prevent, detect, report, and manage public health emergencies, such as infectious outbreaks.
• In the livestock sector, systematic reduction and eventual elimination of antibiotic use for livestock growth promotion is critical for long-term AMR control.
• The OIE Terrestrial and Aquatic Codes provide guidance on how to assess AMR risk arising from the use of antimicrobials in animals.
• The findings of the case study emphasized services that clinicians value most strongly such as blood and cerebrospinal fluid cultures.

Limitations Noted in the Document

• The economic simulations were based on assumptions about the pace of AMR emergence and spread, which inherently involve uncertainty.
• The simulations did not fully capture all economic effects, such as the value of lost wages due to premature death.
• The report acknowledges limitations in the literature reviews and case studies, which may not fully represent all relevant policy areas.
• The case studies did not always have fully comparable data, which limits the scope for generalizations.
• The study recognizes that the success of AMR containment efforts depends on the capacity of public health authorities, which varies across countries.
• The study relies on models and simulations that, while informative, are not predictions, and the findings are subject to the limitations inherent in the chosen methodologies.

Conclusion

The central argument of the report is that the global community must take immediate and comprehensive action to address the growing threat of antimicrobial resistance (AMR). The report uses economic simulation tools to highlight the potential scale of economic losses, particularly for low-income countries, if AMR is not effectively contained. The report stresses the importance of viewing AMR as a global public good, underscoring the critical responsibility of public authorities, especially national governments, in protecting this good. The report emphasizes the need for a multi-sectoral approach, integrating human and animal health, along with environmental and economic considerations. It highlights the need for strong leadership from international organizations and sustained political support. Furthermore, it calls for robust legislation and regulation to prevent overuse and misuse of antimicrobials, and to promote access to effective medicines. This includes strengthening of regulatory frameworks, promoting better information and communication strategies, and incentivizing pharmaceutical companies to engage in antimicrobial research. A key aspect is also in strengthening the health systems in low- and middle-income countries to create a better structure for control and prevention of AMR. The report provides insights into key areas of action, including strengthening laboratory-based surveillance, improving antimicrobial use in human health care, and rationalizing antimicrobial use in the livestock sector. The report’s recommendations align with the Global Action Plan on AMR and emphasize the need for country-led efforts. In the agricultural sector, systematic reduction and eventual elimination of antibiotic use for livestock growth promotion is essential. The report concludes that investing in AMR containment is a high-yield investment opportunity. It highlights that a comprehensive, coordinated, and sustained effort is needed. It underlines that the World Bank Group is committed to supporting countries in their efforts to contain AMR through financial assistance, technical expertise, and collaborative partnerships. The report’s message is clear: bold action today is crucial to safeguard global health and prosperity for future generations.