May 2, 2019

Drug resistance could kill 10M people per year by 2050, experts say

Illustration: Sarah Grillo/Axios

Infectious disease experts tell Axios they agree with a dire scenario painted in the UN report posted earlier this week saying that, if nothing changes, antimicrobial resistance (AMR) could be "catastrophic" in its economic and death toll.

Threat level, per the report: By 2030, up to 24 million people could be forced into extreme poverty and annual economic damage could resemble that from the 2008–2009 global financial crisis, if pathogens continue becoming resistant to medications. By 2050, AMR could kill 10 million people per year, in its worst-case scenario.

"There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation."
— per the report

What they're saying: Experts tell Axios action must be taken or the scenario will come true.

"Unfortunately, I think if we don't do anything differently, the estimates are absolutely realistic. ... Like global warming, the longer we delay action, the worse it's going to get."
— Amy Mathers, director, The Sink Lab at the University of Virginia
"If global action fails to stem the tide of AMR, a century of medical advancement will be lost, damage to the environment will be irreparable, more people will fall into extreme poverty, [and] global health security will be imperiled."
— Tarik Jasarevic, spokesperson, World Health Organization
"We are currently losing the arms race against bacteria! ... Soon routine surgeries and treatments for diseases like cancer ... may become life-threatening and too risky to be implemented because of the probability of bacterial infections."
— Stéphane Mesnage, lecturer, The University of Sheffield

By the numbers: Currently, at least 700,000 people die each year due to drug-resistant diseases, including 230,000 people from multidrug-resistant tuberculosis, per the UN. Common diseases — like respiratory infections, STDs and urinary tract infections — are increasingly untreatable as the pathogens develop resistance to current medications.

  • The Centers for Disease Control and Prevention says AMR causes more than 23,000 deaths and 2 million illnesses in the U.S. annually.
  • "In India, the CDC estimates that more than 58,000 babies under the age of 1 die every year of a drug-resistant pathogen," Mathers points out.

What needs to be done: Jasarevic says the economic and health systems of all nations must be considered, and targets made to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

1. The mindset around current antibiotics usage must be altered.

  • "We need to think about antibiotics as a shared and finite resource," Mathers says. Usage to promote animal growth "must be eliminated" and doctors need to stop prescribing medicines "just in case" their patient needs it.
  • Pamela Yeh, assistant professor at UCLA, agrees. "An enormous amount of antibiotics — around [roughly] 80% — used in this country [are] used in industrial agriculture. Not to make sick animals healthy, but to make healthier animals grow a little faster. ... There needs to be political will to stop using our few and precious antibiotics in these situations". 

2. Incentives for companies to develop new antibiotics need to be fostered.

  • "We need to think of antibiotics (developing and protecting them) as a public good — much like we invest in things like national parks, public libraries, roads, bridges, traffic lights," Yeh says.
  • Mathers says the traditional drug manufacturing process doesn't work for public companies because investors prefer drugs that need to be taken regularly rather than ones with sporadic usage. She points to the case of Achaogen, a California biotech company that generated buzz when it won one of the few antibiotic approvals in recent years with Zemdri, but was recently forced to file for bankruptcy.

But, but, but: Some progress has been made.

  • Some new antibiotics are proving to be life-saving, Mathers says, pointing to a new type of combination antibiotics that is "saving lives."
  • Research continues, such as this study published today in the journal PLOS Pathogens that says they've figured out how the superbug Enterococcus faecalis is able to cause disease — it modifies a polysaccharide on its cell surface — although they're still trying to figure out why the immune system doesn't recognize it. But, the discovery of this change "will allow the design of novel drugs targeting this process critical for the infection," study author Mesnage says.
  • Antibiotic use in animal husbandry is slowly being tackled, although Mathers says "the reworking, cost and investment that will need to take place to overhaul the food chain is really enormous." Still, the FDA issued a 5-year plan to promote the proper use of antibiotics, and a group of companies and trade groups representing the entire food chain process recently agreed on a shared stewardship framework.

The bottom line: Action must be taken to avoid a catastrophic future.

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