Failing to tackle drug-resistant infections will cause 10 million deaths a year and cost up to $100 trillion a year by 2050.

These are the stark headline figures from the first paper to be published by Review on Antimicrobial Resistance, set up by Prime Minister David Cameron in July and chaired by ex-Goldman Sachs chief economist Jim O'Neill. The study notes that for the majority of people, “including in leading policy and business circles around the globe, the threat of drug resistance might seem a distant and abstract risk, if it is known at all”.

To “bridge that gap between global perceptions of how bad the problem is today and how bad it is likely to become if the current trend is not altered”, the review commissioned studies from Rand Europe and KPMG to provide “their own high-level assessments of the future impact
of AMR”.  

Given the “severe lack of data”, the commissioned studies “are necessarily based on high-level scenarios of what is likely to happen [and] are a broad brush estimate, not certain forecasts”, the authors note. However, looking only at part of the impact of AMR shows that a continued rise in resistance by 2050 would lead to 10 million people dying every year and a reduction of 2% to 3.5% in Gross Domestic Product (GDP), hence the $100 trillion figure.

India, Nigeria, Indonesia, Russia at risk

The review notes that countries that already have high malaria, HIV or TB rates are likely to suffer as resistance to current treatments increases. Particular countries at risk include India, Nigeria and Indonesia (malaria), and Russia (TB) and if malaria and HIV drug resistance is not tackled, “Africa as a continent will suffer greatly”. Furthermore, drug-resistant malaria “could constrain the economic progress achieved by some countries in Asia”.

The analysis estimates that caesarean sections contribute about 2% to world GDP, joint replacements 0.65%, “the vastly improved cancer drugs that have been created since the early 1970s add more than 0.75%” and organ transplants add about 0.1%. “These are just a small number of the areas in modern medicine that risk being undermined if we do not have effective antibiotics in the future”.

Causes for optimism

However it is not all doom and gloom. The report’s authors note that “we have met a vibrant field of university researchers and biotech entrepreneurs teeming with ideas to solve this problem”, while “ambitious philanthropic initiatives could emerge for antibiotics in the wake of the achievements and lessons from the work of the Bill & Melinda Gates Foundation and others on malaria and HIV/AIDS”.

Also there is cooperation at the highest level in the European Union, and between the EU and the USA “for pushing more collaborative and innovative research for new antibiotics involving academics, clinicians and companies, large and small”. Also, advances in genetics, genomics and computer science “will likely change the way that infections and new types of resistance are diagnosed, detected and reported worldwide, so that we can fight back faster when bacteria evolve to resist drugs”.

Commenting on the report, Jeremy Farrar, director of the Wellcome Trust (which with the government is funding the Review on AMR), said that “by highlighting the vast financial and human costs that unchecked drug resistance will have, this important research underlines that this is not just a medical problem, but an economic and social one too”.

Dame Sally Davies, England’s chief medical officer, said the report is “a compelling piece of work, which takes us a step forward in understanding the true gravity of the threat”. It also demonstrates that “the world simply cannot afford not to take action to tackle the alarming rise in resistance”.