Antibiotic resistance poses threat to world health

Antibiotics were once the discovery that revolutionised medicine. They became the bedrock for the 20th century’s most important medical breakthroughs. They transformed the processes of giving birth and receiving essential surgery; from life-threatening procedures that had a 50% survival rate, into commonplace occurrences. However, Antimicrobial Resistance (AMR) now poses a threat by directly attacking its piece de resistance.

“There could be profound health and macroeconomic consequences for the world, especially in emerging economies, if antimicrobial resistance (AMR) is not tackled,” says Jim O’Neill, chairman of The Review on Antimicrobial Resistance.

AMR has been steadily on the rise for the last decade. Bacteria and other pathogens are constantly adapting to the antibiotics we use to combat them, rendering them ineffective. Resistance has increased rapidly in recent years, as our medical industry battles to keep up with the pace of adaptation. The rate of discovery and manufacture of new antibiotics with the capability to cull the resistant strains of bacteria is too slow; in part because the number of novel antibiotics left are limited, but mostly due to a lack of funding and industry interest.

The difficulty caused by the lack of new antibiotic development is fueled by our increased use of current antibiotics, as this allows a larger variety of bacteria to become exposed, and therefore resistant, to the medicine circulating the market at present.

Jim O’Neill adds that, “Global consumption of antibiotics in human medicine rose by nearly 40% between 2000 and 2010 … The BRIC countries plus South Africa accounted for three quarters of this growth.”

The main reasons why the use of antibiotics has increased are:

In many areas antibiotics are available over the counter or without prescription, leading to overuse and misuse.
Prescribing practices differ greatly from country to country. In some regions, counterfeit and substandard products are being released into the market, aggravating the situation further.

However, many dedicated health professionals, such as O’Neil and his team, are working hard to calculate the economic and health risk that AMR poses and to raise awareness within the industry in order to prevent a world health crisis, one that has the potential to do more damage to our society than the current Ebola crisis.

The Review on Antimicrobial Resistance reports that AMR infections currently claim over 50 000 lives per annum throughout Europe and the US, with many hundreds of thousands more dying worldwide.

While AMR has the ability to devastate third world countries with poor or insufficient healthcare infrastructure it is by no means a concern isolated to these areas. It has, for example, been reported that in 15 European countries, more than 10% of bloodstream Staphylococcus aureus infections are caused by antibiotic-resistant strains, with several of these countries seeing resistance rates closer to 50%.

O’Neill emphasises the importance of recognising AMR as a global health problem, one that requires international involvement in order to be resolved. As he puts it, we live in a global economy where widespread travel is inevitable. This allows for different strains of bacteria to meet and genetically mutate, making it even more difficult to predict and treat the number of new drug resistant strains that can develop.

The Review has estimated the global economic cost of AMR, if left unchecked, by 2050 will lead to 10 million people dying per annum and a reduction of 2%-3.5% in GDP. The cost to the global economy will total one hundred trillion US Dollars and will create widespread human suffering.

“The world’s economy could lose more than 7% of its GDP by 2050, or a total of 210 trillion USD over the next 35 years,” confirms O’Neill.

Studies done by both RAND Europe and KPMG estimate that 300 million people are expected to die prematurely due to AMR over the next 35 years. Furthermore, in the short term, they anticipate that the world’s GDP will be 0,5% smaller by 2020 and 1,4% smaller by 2030 with the occurrence of over 100 million premature deaths.

RAND Europe’s study based its calculations on resistance rising 100% in the next 15 years, with infection rates remaining stable. KPMG chose to examine the possibility of resistance rising 40% while the number of infections double.

UK’s Prime Minister David Cameron has added his concern to science saying, “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.”

The value of delay is potentially enormous and, as such, it has become of vital importance to discover ways to speed up the process of creating new antimicrobial medication.

The solution, according to Kevin Outterson, head of a recent Chatham House report on new business models for antibiotics, is to separate the return on investment received for the medication from volume sales.

“Instead of companies getting their return on investment by selling volumes of product, they would be paid something by governments or health players for access to that antibiotic,” he explains.

The industry is also looking at the possibility of using older drugs developed as far back as the 1970’s. The development of new drugs will take time and the situation is far too urgent to delay filling the gap. The hope is that the improved use of older antibiotics will be able to stabilise the increase of AMR until new drugs are released.