Generated Summary
This document examines the pressing issue of antimicrobial resistance (AMR) and the strategies for tackling it, focusing on the human health sector within G7 and OECD countries. It reviews the current and projected health and economic burdens caused by AMR, analyzes existing international and national policies, and evaluates innovative actions to prevent the development and transmission of antimicrobial-resistant microorganisms (ARMs). The study is based on a review of available evidence to guide policymakers in making informed decisions about effectively tackling AMR, with a primary focus on interventions within the human health sector. The study’s geographical scope primarily includes G7 and OECD countries and investigates policy options, focusing on interventions in the human health sector. The report acknowledges that while the focus is on the human health sector, the study does touch on potential policy options in the livestock sector and basic infrastructure aspects, including water and sanitation, are also considered.
Key Findings & Statistics
- The most recent estimates suggest that AMR caused about 23,000 deaths in the United States (in 2013) and 25,000 deaths in EU countries (in 2011). Globally, 700,000 deaths may be caused each year by ARMs.
- Compared to a world with no AMR, the economic impact associated with current rates of AMR may reach about 0.03% of GDP in OECD countries in 2020, 0.07% in 2030 and 0.16% in 2050. This would result in cumulative losses of about USD 2.9 trillion.
- In the United States, for example, antimicrobial use in the livestock sector accounts for about 80% of total annual consumption. Between 2010 and 2030, global consumption of antimicrobials in the livestock sector is projected to increase by about 67%.
- For example, about 31% of infections caused by a strain of S. Aureus (the leading cause of post-operative infections) are resistant to methicillin.
- Patients infected by ARMs are significantly more likely to develop complications (e.g. +13% limb loss and +71% complications in the central nervous system for infections by methicillin-resistant S. Aureus) and to die (e.g. up to 2-3 times higher mortality depending on the microorganism).
- The death toll in the United States and EU countries is estimated in about 50,000 lives a year (0.7 million globally).
- Hospitals spend on average an additional USD 10,000 to 40,000 to treat a patient infected by an ARM.
- The impact of lost economic outputs is likely to double this figure. This means that compared to a world without AMR, OECD countries may experience cumulative losses for USD 2.9 trillion (corresponding to about 0.16% of their GDP) by 2050.
- In 2015 chicken sales in Norway dropped by 20% (for some distributors) following the news that a resistant strain of Escherichia coli (E. coli) was found in chicken meat.
- If current resistance rates increased by 40%, we could expect an average of 10 million deaths per year between 2015 and 2050. Only 0.7 million of these additional deaths would occur in North America or Europe, with the largest numbers in Africa and Asia.
- Compared to a world with no AMR and if current resistance rates remained unchanged, OECD countries would experience a contraction of GDP equal to 0.03% in 2020, 0.07% in 2030 and 0.16% in 2050. This would result in cumulative losses for about USD 2.9 trillion.
- The death toll caused by AMR may reach massive proportions. The United Kingdom review on AMR calculated that if current rates of resistance increased by 40%, we could expect an average of 10 million deaths per year between 2015 and 2050.
Other Important Findings
- Antimicrobial resistance (AMR) is a global threat that spans all countries.
- Inappropriate prescription of antibiotics, poor adherence to therapies and insufficient hygiene practices, all contribute to a rapid spreading of antimicrobial-resistant microorganisms (ARMs).
- The spreading of ARMs from one country to others makes AMR a unique global health challenge requiring a multifaceted and comprehensive approach.
- G7 countries and the European Commission are deeply committed to fighting AMR.
- Policy response to AMR is sparser outside G7 countries. At the global level, only 25% of countries have implemented a national policy to tackle AMR and less than 40% of countries have put in place infection prevention and control programmes for AMR.
- The research and development (R&D) pipeline for new antimicrobial therapies is drying up.
- The G7 has consistently committed itself to tackling global health challenges, including the fight against infectious diseases, and positioned itself as a leading partner in reaching health-related Millennium Development Goals.
- Interventions to tackle excessive or unnecessary use of AMTs as well as interventions to prevent the transmission of ARMs are needed to contain the health and economic burden caused by AMR.
- G7 countries have developed specific policies to tackle AMR both in the human and animal sectors.
- G7 countries show rates of MDR-TB that are comparable to the world average.
- Patients infected by ARMs are significantly more likely to develop complications and long-term sequelae.
- The main drivers underlying the additional expenditure are the use of a more aggressive antimicrobial therapy and extra investigations.
- The contribution of second-line therapies to the increase in health expenditure should not be underestimated.
Limitations Noted in the Document
- The focus of this report is primarily G7 and OECD countries. It is beyond the scope of this report to comprehensively assess potential policy options in the livestock sector as well as basic infrastructure aspects.
- The analysis of the cost-effectiveness of actions aimed at tackling AMRs should also incorporate the positive effects on healthcare expenditure that such interventions have in limiting the spread of antibiotic-susceptible bacteria.
- The study does not capture the full health and economic burden caused by ARMs, as most studies can only assess the effects of a limited number of microorganisms and, for these agents, only the effects of resistance to a limited number of AMTs.
- The data on surveillance efforts is incomplete, and the data on the efficacy of interventions are limited, and is also often heavily centred on hospital and community interventions.
- The analysis of economic impact is limited by the complexity of the issue, and the data on the cost-effectiveness of different interventions is also limited.
- The literature review did not comprehensively assess potential policy options in the livestock sector as well as basic infrastructure aspects, including access to clean water and food, and separation of drinking and sewage water.
Conclusion
The document underscores the critical nature of antimicrobial resistance (AMR) as a global health and economic threat, emphasizing the need for urgent action. The findings highlight the substantial impact of AMR on mortality, healthcare costs, and economic productivity, with projections indicating potentially devastating consequences if current trends continue. The document emphasizes the importance of multi-faceted and collaborative approaches to effectively combat AMR, as the spread of ARMs from one country to others makes AMR a unique global health challenge. The study identifies key strategies for addressing AMR, including strengthening surveillance and monitoring systems, adopting measurable targets, scaling up effective interventions, fostering innovation, and promoting international cooperation. The report advocates for a concerted international approach to foster innovation as well as basic research in the antimicrobial sector to lower many barriers that currently hinder R&D. This approach should combine both upstream and downstream economic incentives; it should aim to de-link development incentives from sales, and encourage the participation of small to medium enterprises (SMEs) in R&D efforts. The document also emphasizes the need for a hybrid approach, combining both upstream and downstream interventions to ensure development is supported along the entire value chain. This involves leveraging global innovation and entrepreneurial thinking balanced against the notion of AMTs as social goods and the concerns of preservation and need-based access. The study identifies various policy interventions and their advantages and disadvantages, including tax incentives, product development partnerships, direct funding and grants, corporate bonds, and global collaboration platforms. It is necessary that the interventions are tailored and appropriate for their specific situations. The report stresses the importance of a global collaborative research platform using an open-source approach to engage the ‘global brain’ in developing new AMTs and conducting other complementary research is one of the more effective and efficient methods at our disposal. This could ensure development is supported along the entire value chain. In conclusion, the document emphasizes that addressing the issue of AMR requires a strong commitment and a multi-faceted approach, including: 1) enhancing existing efforts to rationalize antimicrobial use; 2) preventing the spread of ARMs through measures like early detection and improved hygiene; 3) fostering international cooperation and innovation; and 4) adopting a ‘one-health’ approach to include efforts across animals and the environment. The research emphasizes that G7 countries have a responsibility to lead in developing and implementing comprehensive action plans, coordinating their efforts with partner economies and implementing measures to tackle inappropriate use of antimicrobials and to overcome barriers to innovation. The focus of this report is on interventions in the human health sector and the geographical scope is primarily G7 and OECD countries. The ultimate goal is to protect global health and economic stability.