Written by Luisa Antunes.
Antimicrobial resistance (AMR) is a global, multidimensional phenomenon occurring in humans, animals, and environmental ecosystems. It is the ability of microbes, e.g. bacteria, viruses, fungi and protozoa, to survive in the presence of medicines designed to kill or inactivate them (antimicrobials: antibiotics, antivirals, antifungals and antiprotozoals). At patient level, AMR hampers the effective treatment of microbial infections, leading to prolonged, severe disease and, in some cases, death. At community level, it amplifies the risk of infection outbreaks, epidemics and pandemics.
AMR is a growing problem, predicted to cause millions of deaths worldwide in the coming decades. The research and development pipeline for new antimicrobials has dried up, partly because of an oligopolistic market structure in a research area considered to give a low return on investment. Concerted EU and Member State action has led to an overall decrease in antimicrobial consumption; however, the relative use of both broad-spectrum and last-resort antimicrobials continues to grow. The lack of investment in prevention, diagnostics and adequate healthcare infrastructure is further driving the preventive prescription of antimicrobials.
Under-investment in good-quality healthcare is one of the main drivers of AMR. Tackling the socioeconomic determinants of health – such as reducing overall poverty and economic inequality, ensuring basic standards of living, education, and health – is imperative to reduce the burden of infection and the spread of AMR. Addressing the causes of AMR requires a multidisciplinary and multisectoral approach, involving not only the health sector but also other sectors, such as agriculture, environment and trade. The forthcoming revision of the pharmaceuticals package will be a chance for the EU to drive forward policies to ensure equitable access to safe, effective and affordable pharmaceuticals for unmet medical needs, and to define strategies for incentives to promote research into innovative antimicrobials.
Penicillin, first discovered in 1928, contributed to the success of Allied troops in the Second World War and ushered in a new era for medicine. The period between the 1940s and 1960s witnessed a ‘golden age‘ of antimicrobial development, where the impact of serious conditions such as tuberculosis, pneumonia and diarrhoea could finally be mitigated, thus contributing to an increase in quality of health and global life expectancy.
However, the abuse and misuse in consumption of wide-spectrum antimicrobials has led to a progressive increase in antimicrobial-resistant infections, with 35 000 deaths in the EU each year (more than HIV/AIDS and malaria deaths combined), and €1.1 billion worth of losses to healthcare systems. The past 20 years have seen the emergence of microbes resistant to all available antimicrobial classes.[i] By 2050, AMR could cause 10 million deaths worldwide, surpassing cancer as the second largest killer; it could also cause up to 3.8 % of global gross domestic product (GDP) to be lost.
Read the complete briefing on ‘Tackling antimicrobial resistance: From science to pharmaceuticals policy‘ in the Think Tank pages of the European Parliament.