World Antimicrobial Awareness Week November 18-26 (Day 2): the nature of the threat of AMR

So how big a problem is antimicrobial resistance?

AMR is unquestionably a growing problem and indeed was endorsed as such by the WHO at the Sixty-Eighth World Health Assembly in May 2015.

It's also no coincidence that the year before that, in 2014, the then UK prime minister David Cameron had commissioned a review regarding what he was being advised was a worrying global phenomenon. “If we fail to act,” he warned at the time, “we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.” His doom-laden warnings were undoubtedly being stoked by his then Chief Medical Officer, Sally Davies, who (since leaving office in 2019) has become the UK’s official ‘special envoy on AMR’.

When the Review was published, some astonishing predictions emerged, reckoning that by 2050 “ten million lives a year” would be lost to AMR and a “cumulative cost of $100trn of economic output” would be wasted because of bacteria, viruses, fungi and parasites becoming increasingly resistant to antimicrobial treatment. It sounded like Sally Davies's warnings were right.

Job done back as intended? Not quite it would seem. While Jim O’Neill, the Chair of the Review wrote in his final report in 2016 that “the magnitude of the problem is now accepted,” six years later (today) that same blanket acceptance of the magnitude of a threat is worryingly hard to find and the issue is largely forgotten, the public health threat having been eclipsed by a pandemic.

This really shouldn’t be the case, however, because in 2016, O’Neill had also said that 700,000 people were already dying annually because of AMR. Given that AMR awareness has slipped so far from public consciousness, and recognising from recent experience how far from reality some epidemiological predictions can be, perhaps it’s fair to wonder whether his report and its predictions might have been a bit overblown given the subsequent coronaviral eclipse. Well, it seems not: a study published in the Lancet in January this year estimated that in 2019 there were nearly 5 million deaths “associated" with bacterial AMR…including 1.27 million deaths "directly attributable” to it.

The problem seems to be growing, in other words, and so O'Neill's team's dire predictions for 2050 still warrant grave consideration.

Davies, meanwhile, still continues to graphically identify the sorts of scenarios that should properly cause us such concern, bleakly identifying that without antibiotics we basically “no longer have modern medicine” because antimicrobials so fundamentally underpin today’s standard hospital care. In the course of treatment, she points out, a quarter of cancer patients contract and are successfully cured of infections that can otherwise kill without effective antibiotics. She further points out that AMR puts routine medical procedures that we take for granted (like hip replacements and caesarean sections) at high risk. If such operation-associated infections become no longer treatable, “then we’ve lost modern medicine” she warns, and we can even potentially die from an infection from a minor cut to a finger.

“Nobody is safe” Sally Davies warned as CMO about AMR, “until we’re all safe.” (Now where have we heard those words more recently?) She also has stated that antibiotics have awarded us as members of the human race “an extra twenty years of life” – something which perhaps which should give us all pause for thought.

So ends the second in a week's series of Blogs relating to WAAW. This one has attempted to identify the real threat from this phenomenon if it isn’t better addressed. With this better understanding of the problem, in the next blog we will identify some ideas as to what we can individually do to help reduce risk of an AMR infection, a risk which is both individual and collective.