Antimicrobial resistance in low- and middle-income countries: a report from the Global Fund for Disease Prevention and Control (GEMS 2018)

One of the main factors driving the global rise of AMR is the use of inappropriate or substandard antibiotics. People living in low- and middle-income countries are more likely to die of infections that are resistant to antibiotics than their counterparts in high-income countries. A modelling study I was involved in showed that even a modest global investment, in the range of hundreds of millions of dollars, would be enough to avert millions of deaths. Lancet 403, 2439–2454; 2024).

The report estimates that by the year 2050, 1.91 million deaths could be caused by antimicrobial resistance and 8.22 million could die from illnesses associated with it. The majority of deaths attributed to AMR will be among people over the age of 70.

This is the second high-level meeting that AMR has been seen at. The first one, in 2016, highlighted the importance of the problem, which is associated with nearly five million deaths each year worldwide. In the past eight years, there have been some improvements, but the pace of change has been slow. I am presenting at the upcoming meeting, and I hope to convince attendees that the next eight years could look very different.

International funders, such as the Global Fund, must step up. People with HIV have a high risk of developing bacterial, viral, fungal and protozoal infections. Providing people with access to effective diagnostics and antibiotics targeting bacterial infections more broadly would be a natural extension of the Global Fund’s existing mandate.

Prevention strategies need support from organizations such as the Vaccine Alliance and the United States Agency for International Development, as well as through bilateral donors. In low- and middle-income countries, budgets need to be prioritized for them.

The talk at the General Assembly this year should lead to global action to tackle the disease, because of the investment from global funders, targets and accountability that can be found through an independent panel.

The authors hope the report will “guide information on how to develop new drugs, which new drugs to focus on, what new vaccines to focus on”, says co-author Eve Wool, a research manager at the Institute for Health Metrics and Evaluation in Seattle, Washington.

Policymakers should also address the overuse of antibiotics in farming, which speeds up bacterial resistance, and invest in research for innovative antibiotic drugs, Walsh says.

Regions with the highest predicted mortality rates include south Asia, Latin America and the Caribbean, and researchers emphasize that any strategies to tackle drug resistance must prioritize low- and middle-income countries.

A new study shows we have a problem in health-system quality, according to the co-author.

Many of the infections that resulted in deaths between 1990 and 2016 were caused by gram-negative germs. Acinetobacter annii is one of the pathogens associated with hospital-acquired infections.

Their findings shows that the number of children dying from infections that are resistant to drugs has fallen by more than half over the past 3 decades, but mortality rates have increased for older people.

“This is an important contribution for understanding how we’ve gotten where we are, and for giving a rational expectation of the future burden of [resistance] in order to inform next steps that can be undertaken,” says Joseph Lewnard, an epidemiologist at the University of California, Berkeley.