We must tackle antimicrobial resistance before it’s too late

Everyone knows about penicillin. It is one of the most widely prescribed drugs in the world. And herein lies the problem.

Penicillin was the first antibiotic, discovered in 1928. It revolutionised healthcare. No longer did patients have to die or have their limbs amputated because of minor bacterial infections.

Millions of lives have been saved, and dozens of other antibiotic medicines have been developed since.

But we are now at a turning point. These “minor” infections are becoming life-threatening again. Many infections are becoming harder to treat, while medical procedures — such as surgery and chemotherapy — have become much riskier.

How did we get here?

Over the past decades, many bacteria have evolved to develop resistance to antibiotics. This is a natural process that occurs over time through genetic changes in the bacteria.

However, the process is accelerated by humans through inappropriate use — like when you stop antibiotic treatment before finishing the prescribed course — and incorrect diagnosis, eg when your doctor prescribes antibiotics for a viral infection on which antibiotics have no effect.

This is called antimicrobial resistance (AMR) and it’s one of the greatest threats to public health in the world today.

Medical breakthroughs made over the past century are being reversed right before our eyes, but still, this “silent pandemic” gets very little attention outside the public health realm.

We already know that AMR is directly responsible for over 1 million deaths annually and indirectly linked to 5 million deaths globally. To put this into perspective, the health burden of antibiotic resistance is comparable to that of influenza, tuberculosis and HIV/AIDS combined.

In the WHO European Region, covering 53 member states across Europe and Central Asia, AMR is already directly responsible for 133,000 deaths each year and indirectly linked to 541,000 deaths. And these numbers are only going up.

At this rate, if nothing is changed, by 2050 over 10 million people will die from AMR globally each year.

We have a plan on how to tackle this

Even as the AMR crisis is rapidly unfolding, we know what we need to do to stop it. Last year the 53 WHO/Europe member states agreed on the AMR Roadmap 2023-2030 prioritising action in the region. Our roadmap has gathered available evidence around the effective tools to address AMR.

First, we need to reduce the number of infections that need to be treated with antibiotics.

This means preventing infection in the first place through appropriate infection control measures. It also means ensuring routine vaccinations, as well as good water, sanitation and hygiene practices, particularly in hospitals and other health services.

Second, we need to reduce the use of antibiotics in humans, animals and agriculture.

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As part of a comprehensive stewardship programme, we need more diagnostic testing to ensure targeted treatment. Health care professionals need relevant training and support to follow evidence-based guidelines for prescribing antibiotics.

Antibiotics that are critical to human medicine need to be used prudently in veterinary and agricultural sectors, recognising that human, animal, and environmental health are closely linked — a “One Health” approach.

Third, we need to hold each other accountable using clear targets.

Measurable targets allow us to focus our efforts and resources on key areas, motivating governments, healthcare providers, and organisations to act.

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The WHO Regional Office for Europe, together with the London School of Economics, is currently developing the first AMR Accountability Index for Europe and Central Asia , which already has broad support from our 53 member states through the adoption of the AMR Roadmap last year. WHO/Europe plans to launch the Index in 2025, benchmarking progress on AMR and supporting member states in their response efforts.

Fourth, we need partnerships — with governments, pharmaceutical, agricultural and food industries, academia, and civil society.

Most large pharmaceutical companies have withdrawn from antibiotic research and development, as antibiotics are often less profitable than other drugs. But new antibiotics are desperately needed to curb the “catastrophic threat” of growing AMR.

However, subsidising research alone will not solve the AMR problem. We will also need to strengthen community engagement and public awareness.

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What will we choose to do?

As we head into a high-level meeting on AMR this month on the sidelines of the 79th session of the UN General Assembly, I call for increased global leadership, commitment, action, and solidarity.

We have a choice: to be the generation that takes definitive action against AMR, safeguarding our health and the health of future generations.

Or to be the generation that squandered the opportunity before us, potentially jeopardising modern medicine as we know it.

The choice is obvious.

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Dr Hans Henri P Kluge has been the World Health Organisation’s Regional Director for Europe since 2020.

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