Antimicrobial Resistance between Lack of Access and Excess

Abstract

The use of antimicrobials, primarily antibiotics, but also antivirals, antiparasitics, and antiseptics is rapidly rising around the world - and with it, antimicrobial resistance (AMR). The current COVID-19 pandemic illustrates both the burden on the health system and the economic costs a pathogen can pose when no medication is available. Concerning resistance, the crux of the matter lies in balancing the need to reduce overall antibiotic consumption while at the same time expanding access in countries where such antibiotics are not easily accessible. The rising use of antibiotics in health and agricultural sectors are driving the increase in antimicrobial resistance. The quick expansion of access and use along with ineffective stewardship have led to alarming resistance rates, particularly in fast-growing middle-income economies - a problem these countries must urgently address. If AMR is not tackled more efficiently, it is estimated that by 2050 ten million people will die each year from common infections that will then no longer be treatable. Concomitant with this will be substantial economic losses predicted to total 2.5 to 3 per cent of global GDP. Hence, the pressure is mounting to secure more international commitment to combat AMR. Lowering antibiotic consumption might slow the pace of the spread of resistance, as every dose raises the risk of resistance building. Hence, the continuous development of new medicines is crucial and requires market intervention to take place. An oft-neglected aspect of the debate over AMR is that especially in low- and middle--income countries many life-saving antibiotics are not or not sufficiently available. This situation undermines controlled distribution and promotes a vicious cycle of poverty and antimicrobial resistance. Antimicrobial resistance is a serious concern and, particularly given the presence of COVID-19, one where action should not be delayed. Policies need to address three issues: First, emerging economies must implement effective policy measures to combat resistance. Second, public funding is required to remedy market failure. Third, international cooperation, particularly in research on diagnostics and prevalence as well as interventions, is necessary to better assess the societal impact of antimicrobial resistance and identify efficient ways to actively address the problem.