Our growing resistance to antibiotics is a “looming crisis” that could kill millions of people and make many surgeries too risky and eventually impossible, experts say.
— killed more than a million people globally every year between 1990 and 2021, according to a study published in The Lancet this week.
This research is the first to track the global impact of superbugs over time and estimate what could happen next.
Based on researchers’ modelling, superbugs could kill two million people annually by 2050 and contribute to a further 8.2 million deaths each year due to our inability to fight infections.
This means antimicrobial resistance (AMR) could directly kill 39 million people over the next 25 years and contribute to a total of 169 million deaths.
Deaths from infections of Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph bacteria that has become resistant to many antibiotics, doubled to 130,000 in 2021 from three decades earlier, the study found.
Professor Branwen Morgan, lead of minimising antimicrobial resistance at CSIRO, said no one is immune to the problem.
“People think, ‘If I don’t take antibiotics, then when I really need them, they’re going to work’. That’s not how it works,” she told SBS News.
“You can pick up a drug-resistant infection anywhere, anytime. It doesn’t matter if you’ve been really judicious in your whole life.
So what does this really mean? How will AMR impact us in the future? And why isn’t more being done to prevent the escalating danger of superbugs?
Why is antimicrobial resistance growing?
made worse by the overuse and misuse of antibiotics in humans, animals and plants.
It’s nothing new. When Scottish microbiologist Alexander Fleming discovered penicillin in 1928, he also warned that resistance to the antibiotic was developing rapidly.
Pharmaceutical companies have pulled away from antibiotic development because of the poor financial return on investment. Source: Getty / Tanja Ivanova
For a while, medical research was winning the battle, said professor Mark Blaskovich, an antibiotic hunter at the Institute for Molecular Bioscience at The University of Queensland.
“Until a couple of decades ago, we were producing new antibiotics fast enough to stay ahead of bacteria developing resistance,” he told SBS News.
Then we began to fall behind.
Major pharmaceutical companies stopped investing in new antibiotic development. And at the same time, humans were taking way too many of them.
“Bacteria reproduce incredibly quickly; within a day, millions of generations can occur. Any small mutation in response to antibiotic exposure can rapidly become the dominant population,” Blaskovich explained.
“As a result, AMR is now an ongoing looming crisis, and more figures are coming out to support that prediction.”
Who’s most at risk?
Countries where antibiotics can be bought over the counter, like India or South Africa, have the highest levels of resistance, Blaskovich said.
“This highlights that inappropriate use of antibiotics is a key driver of resistance development.”
Countries where antibiotics can be bought over the counter, like India or South Africa, have the highest levels of resistance. Source: Getty / Carlos Duarte
In Australia, while resistance rates are relatively low, associate professor Norelle Sherry from the Peter Doherty Institute for Infection and Immunity warns that “the relentless rise of resistance is alarming”.
“We are seeing people in hospitals with near-untreatable infections and community members with infections, like urinary tract infections, that require intravenous antibiotics — sometimes even in children,” she told SBS News.
A Lancet report from October 2022 revealed that in 2020, 1,031 deaths in Australia were linked to five resistant hospital-associated infections, with respiratory and bloodstream infections recording the highest mortality rates.
“This is a significant threat, particularly for the most vulnerable members of society like the very young and the very old,” Morgan at CSIRO said.
Morgan said Indigenous populations are more susceptible to certain infections, resulting in much higher resistance to antibiotics like methicillin compared to Australians in metropolitan areas.
AMR is also a significant economic burden, Sherry said.
“We know that patients with superbugs face higher morbidity and mortality from these infections and often need to stay in hospital for longer, creating more stress on the health system.”
What happens if we can’t fight bacteria and pathogens?
Eventually, surgeries will become too risky due to the heightened threat of infection.
“If we don’t have effective antibiotics anymore, treatments like hip and joint replacements and C-Sections will become life-threatening and therefore untenable,” Blaskovich said.
“This is already happening in some low and middle-income countries like India, where there are no antibiotics left to treat certain infections, resulting in tens of thousands of deaths annually.”
If antibiotics are no longer effective, operations like hip and joint replacements could become life-threatening. Source: Getty / Pyrosky
Blaskovich also warns that travellers can easily bring resistant bacteria back to Australia.
“Most of the time, this bacteria will live in your body for a while before being overtaken by other populations. But if you have an accident or need surgery, that bacteria could infect a part of your body where it would be very difficult to treat.”
So why aren’t we developing more antibiotics?
The pipeline of new antibiotic drugs is alarmingly thin.
“There are around 60 new antibiotics in globally, but only a small fraction will likely be approved. In contrast, nearly 1,500 oncology drugs are in clinical development,” Blaskovich said.
“So while AMR resistance will kill more people than cancer in 20 years time, the number of drugs being developed is less than a tenth of the number being developed for cancer.”
Developing a new antibiotic can cost between one and two billion dollars.
Pharmaceutical companies struggle to recoup these costs since antibiotics are sold cheaply and are taken only temporarily.
Furthermore, clinical trials are challenging because they require people with very specific infections.
To make matters worse, AMR deaths are underreported because it’s hard to determine whether a person dies with the infection or because of the infection.
So what’s the solution?
Global leaders will meet in New York this month during the United Nations General Assembly to discuss AMR. They are expected to reaffirm a political declaration to step up action against it, with hopes to include a target to reduce AMR deaths by 10 per cent by 2030.
Research from The Lancet suggests that improving care for severe infections and access to antimicrobial drugs could save 92 million lives by 2050.
To make progress, experts say we need greater public awareness and better incentives for antibiotic research and development.
We also need to stop taking so many antibiotics.
“Don’t take antibiotics when you don’t need them, such as for colds, which are caused by viruses, so don’t respond to antibiotics. And only take antibiotics as prescribed — don’t share them with family or use antibiotics prescribed from a previous infection,” Sherry said.
Morgan said the impacts of drug-resistant infections extend beyond death.
“If you’ve had a drug-resistant wound because you’re diabetic and needed an amputation, that’s living your life as an amputee.
“We shouldn’t forget about AMR survivors, and we also need to start counting them.”
