Two years ago I was tasked by the then UK Prime Minister David Cameron to lead an independent global review into antimicrobial resistance (AMR) — the worsening problem of drug-resistant infections. As a result of increasing rates of resistance our antibiotics, as well as antimalarial and antiretroviral drugs, are already becoming less effective, and in some cases completely ineffective.
This is exacerbated by too much unnecessary use of antibiotics in both humans and animals, while at the same time many people who are in most need of these drugs do not have access to them. At a low estimate, 700,000 people already die every year from AMR. This is not just a future health threat — it is already a medical emergency in many parts of the world. To make matters worse, we are not creating anywhere near enough new drugs to combat this problem — no new class of antibiotics has been developed in decades. The medicine cupboard is bare.
The problem of resistance has been recognised by scientists for as long as we have had antibiotics, but it is clear to me that if the world is to tackle this threat we need much more focus on this problem from global finance and economic development ministries. This has been a focus of my review since we began, when we explored the human and economic costs of resistance if we do not take action now. We estimated that by 2050 the yearly death toll could rise to a staggering 10 million people every year, with a cumulative cost to world GDP of around $100trn. To put this in context, this cumulative loss is larger than the world economy is today.
In a study published recently, the World Bank confirmed our estimates of the future economic impact, suggesting it could cause damage to the world economy on par with the 2008 financial crisis. While this kind of impact may seem like a stretch, the risks and cost of AMR become easier to grasp — and more startling still — when one realises how much modern medicine is reliant on effective antibiotics. Without antibiotics to control infections, hip replacements, gut surgery, chemotherapy and caesarean-sections would all become either highly risky or impossible.
It is clear that this is an economic threat and needs to be on finance ministers’ agendas as they are going to be faced with picking up the bill if these costs come to be realised. Not to mention the terrible human cost of inaction that is already affecting far too many people across the world. I have advocated the G20 focussing on this issue since I began this work and was very pleased to see the detailed recognition of AMR in the September communiqué. The role the G20 gave to the OECD will also be critical in developing proposals to tackle the market failures for new antibiotics and diagnostics, to be agreed at next year’s G20.
AMR is a problem for all parts of the world — bacteria do not respect borders and the world is more linked today than it ever has been. However, a common misperception when I started this review was that AMR is a problem for the “rich world”. This is far from the truth — the biggest burden is, and will continue to be, felt in low and middle-income countries, as is sadly true for many infectious disease threats. This is why it also needs to be at the top of the development agenda. As one example, you only need to look at the terrible impact that drug-resistant TB is having already – around one third of the current 700,000 deaths from AMR every year are due to resistant TB. This is a disproportionate problem for many low and middle-income countries, which face the damaging triple burden of TB, HIV/AIDS and Malaria.
If the policies to develop new drugs and use the ones we have better are successfully delivered, we can stay ahead of this critical health threat and avoid huge economic costs. The total cost of my proposals is around $40bn over 10 years. Investing $40bn over a decade to save a $100tr cost seems to me like one of the best investments that could be made.
We have made exciting progress this year on AMR but without the continued support and collaboration of governments, industry and international NGOs we will not deliver the change needed to avert this threat. The G20 has committed to come back to this problem in 2017 and in two years a UN taskforce will report back to the Secretary General, providing great opportunities for further progress. We are not static observers of history — we must act now to help secure the health of future generations.
Jim O’Neill is Chair of the Review on Antimicrobial Resistance.