Antimicrobial Resistance: The Silent Pandemic
by José Luis Cárdenas Tomažič
Adapted from the Spanish column originally published in El Economista on May 18th, 2023 (Resistencia antimicrobiana: la pandemia silenciosa)
Antimicrobial resistance (AMR) is a phenomenon that occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop resistance to the medicines used to treat the infections they cause. These medicines, known as antimicrobials, include antibiotics, antivirals, antifungals, and antiparasitic drugs. AMR poses a major risk to both human and animal health and has become a global public health challenge.
In fact, the World Health Organization (WHO) has identified AMR as one of the top ten global public health threats facing humanity. It is currently responsible for more than 700,000 deaths annually, a figure that could rise to 10 million by 2050—surpassing the number of people who currently die from cancer—unless urgent action is taken.
AMR occurs naturally over time, usually through genetic changes. Antimicrobial-resistant organisms can be found in humans, animals, food, plants, and the environment (including water, soil, and air). They can spread from person to person, between people and animals, and through food of animal origin. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation, and hygiene for both people and animals; poor infection prevention and disease control practices in healthcare facilities; inadequate access to affordable, high-quality medicines, vaccines, and diagnostics; lack of awareness and knowledge; and insufficient enforcement of regulations, particularly regarding medical supervision of antimicrobial use.
AMR can make infections more difficult to treat and increase the risk of serious complications such as sepsis and pneumonia. In extreme cases, it can lead to death. Additionally, prolonged illness results in longer hospital stays, the need for more expensive medications, and a greater burden on healthcare systems.
In the case of common bacterial infections, high levels of resistance have been observed worldwide against antibiotics frequently used to treat them. For example, resistance rates to ciprofloxacin—a commonly prescribed antibiotic for urinary tract infections—ranged from 8.4% to 92.9% for Escherichia coli and from 4.1% to 79.4% for Klebsiella pneumoniae among countries reporting to the Global Antimicrobial Resistance and Use Surveillance System (GLASS).
As AMR becomes increasingly widespread, public policy solutions are essential to address the problem.
First, antibiotics must be used responsibly. This means prescribing them only when necessary and ensuring that they are not sold without a medical prescription, whether in human or veterinary healthcare. It also requires patients to adhere properly to their prescribed treatment. At the same time, the development of new antibiotics is urgently needed. According to the WHO, the antibiotic development pipeline has stalled, despite the growing need for treatments effective against resistant infections. To address this challenge, several countries have introduced economic incentives, such as the United States’ Generating Antibiotic Incentives Now (GAIN) Act and the ongoing discussion in the European Union regarding so-called transferable exclusivity vouchers.
Improving AMR surveillance is also critical to identifying resistance patterns and trends and informing decisions on antibiotic use. Finally, international cooperation is essential, as AMR is a global health issue that affects every region of the world.
In this regard, many countries have committed to the framework established by the 2015 Global Action Plan on Antimicrobial Resistance, adopted during that year’s World Health Assembly, which aims to develop and implement multisectoral national action plans. This commitment was further endorsed by the governing bodies of the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH, formerly OIE). The pharmaceutical industry has also joined forces through the AMR Industry Alliance to advance policies and initiatives related to antimicrobial resistance.
Awareness campaigns play a key role in addressing AMR, including World Antimicrobial Awareness Week (WAAW), held annually in November. Despite these efforts, there is still limited understanding of the level of awareness and knowledge about AMR, particularly among healthcare professionals. Measuring this knowledge is important in order to better target educational and policy efforts, as suggested by several studies.
Ultimately, the global population faces an enormous challenge that threatens us silently and requires coordinated international action to be addressed effectively. We are racing against time. The greater the awareness and the more attention that is given to solutions alongside other urgent priorities, the better positioned we will be to confront the growing threat of AMR and ensure that effective antimicrobials remain available for the patients who need them.
