Antimicrobial Resistance (AMR) is the ability of microbes (such as bacteria, viruses, fungi) to counteract the effectiveness of antimicrobial drugs (such as antibiotics, antivirals, antifungals) used against them. Even when used appropriately, antimicrobials can develop resistance. However, the development of resistance is accelerated by the misuse and overuse of antimicrobials in human, animal, and plant health along with the pollution of the environment with antimicrobials and antimicrobial resistance genes
Economic Cost of AMR
AMR is the greatest health threat of our time and has serious socio-economic ramifications. Currently, at least 700,000 people die every year due to AMR (WHO, 2019). In Europe that number is reported to be 33,000 annually, while the U.S. sees 23,000 deaths attributed to AMR each year (CDC). However, because there is no global mandate to report AMR statistics, the death toll is likely far higher. This number is predicted to rise and by 2050, could reach 10 million per year if no action is taken (WHO, 2019). Furthermore, the economic impact of AMR is also enormous with estimates putting it at 100 trillion USD per year by 2050 (World Bank Group, 2016). At the moment, the World Health Organization (WHO, 2019) states that infections due to multidrug-resistant bacteria cost the European Union (EU) alone more than 1.5 billion Euro per year in healthcare expenses and productivity losses. In terms of individuals, the AMR Review estimates that by 2050, 1 person on average will die every three seconds and every individual in the world today will be 10,000 USD worse off.
By using the 2003 severe acute respiratory syndrome (SARS) outbreak in China as the reference point, a study estimated the direct output loss in China’s animal husbandry industry if a full-blown AMR crisis were to occur. They found the costs would be over 467 billion Yuan at minimum.
AMR cannot be solved with a one-dimensional strategy as it is a global and multisectoral issue. Indeed, with globalisation and the movement of people and animals across the globe, microbes that ‘hitch a ride’ can also spread globally. If resistant bacteria develop somewhere in Europe, Asia, etc., they could quickly be transported by a carrier (human, animal, food) to another continent. Furthermore, the causes of AMR have roots in a variety of sectors, including health, food safety, agriculture, environment, and trade, making it a truly multisectoral issue. If these sectors do not act on the threat of AMR, it will not be solved (WHO, 2019). To this end, the WHO has proposed their “One Health” approach which is designed to facilitate communication and cooperation between all relevant sectors in order to implement programmes, policies, legislation, and research to combat AMR (WHO, 2019).
Research and Development
Economic investment will be crucial in research and development (R&D) because discovering new antimicrobials and using them inherently poses the risk that those new drugs may develop resistance over time. Ideally, the newly discovered antimicrobials should be restricted for last resort use only, which makes the market unattractive for the private sector in terms of profits.
Developing a new antibiotic can take over a decade and cost more than €850 million (Drive-AB, 2018). It can generally be divided into two main phases; first there is initial R&D, which is done by SMEs and public institutions, including research facilities and universities. Following that, drug development and testing is conducted by larger pharmaceutical companies. The AMR Industry Alliance reports investment of around 2 billion USD into AMR research across 22 companies in 2018 (AMR Industry Alliance, 2018). While a number of companies are producing antibiotics (IFPMA; Access to Medicine Foundation), many of them are variations on existing antibiotics. These are a safer bet for companies to invest in as less research is needed and approvals are faster due to similarities to existing approved drugs. However, these slightly modified antibiotics only overcome resistance for a short period of time. Research into novel antibiotic classes is very low.
As our last-resort antibiotics, such as colistin and carbapenem, lose their efficacy (CIDRAP, 2017; Meletis, 2016) it is imperative that antibiotic R&D is prioritised so that we may have new and effective antimicrobials in time.