Lancet Study: More than 39 million people worldwide could die from antibiotic-resistant infections over the next 25 years, a new study published in The Lancet has warned. This comprehensive analysis by the Global Research on Antimicrobial Resistance (GRAM) Project marks the first in-depth examination of antimicrobial resistance (AMR) trends from 1990 to 2021, offering an alarming outlook for the coming decades.


AMR occurs when bacteria or other pathogens evolve to become resistant to antimicrobial treatments. Already acknowledged as a significant global health issue, it is expected to intensify in the coming decades, the study notes.


The report also underscores a stark reality for South Asia, a region already grappling with high AMR burdens. Countries such as India, Pakistan, and Bangladesh are projected to experience significant increases in AMR-related deaths, with an estimated 11.8 million lives potentially lost between 2025 and 2050 due to resistance. 


The broader impact across Southern and Eastern Asia is similarly alarming, highlighting a critical need for urgent interventions.


“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern,” says Dr Mohsen Naghavi, Team Leader of the AMR Research Team at the Institute of Health Metrics (IHME), University of Washington, USA, who is among the authors of the study. "These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing. Understanding how trends in AMR deaths have changed over time, and how they are likely to shift in future, is vital to make informed decisions to help save lives." 


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How Deaths Are Rising And Trends Changing 


Between 1990 and 2021, AMR caused over 1 million deaths annually. While the number of deaths among children under five has seen a significant decline — 50% over the three decades — deaths among older adults have surged. Specifically, AMR deaths in individuals aged 70 and older increased by more than 80% during this period. The study projects that this trend will continue, with AMR deaths among older adults expected to more than double in another 25 years from now.


By 2050, the study's projections indicate, AMR could directly cause 1.91 million deaths annually and be associated with a broader 8.22 million deaths. 


For South Asia, this translates into a dire situation where the prevalence of AMR will likely remain high due to factors such as antibiotic overuse, inadequate healthcare infrastructure and regulation, limited access to advanced treatment options, and poor sanitation.


The region's struggle with AMR is reflected in the higher all-age death rates compared to other parts of the world. The study’s data reveal that South Asia, alongside sub-Saharan Africa, suffers from the highest rates of AMR-related deaths, driven by both the prevalence of resistant infections and the frequency of critical diseases.


In contrast, high-income regions will see relatively lower increases in AMR-related deaths, highlighting the disparities in healthcare resources and the effectiveness of existing interventions. The study also stresses the importance of region-specific responses, noting that while some areas may benefit from increased access to antibiotics, others, like South Asia, may need more stringent antibiotic stewardship programmes.


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Study Calls For Immediate Action


The report emphasises the need for substantial improvements in healthcare systems, including enhanced infection prevention measures, better access to effective antibiotics, and rigorous research into new drugs. It highlights that while progress has been made in reducing AMR-related deaths among young children, the growing threat to older populations necessitates a focused approach.


“There has been real progress in tackling AMR, particularly among young children, but our findings indicate more must be done to protect people from this growing global health threat. By 2050, resistant infections could be involved in some 8 million deaths each year, either as the direct cause of death or as a contributing factor,” says study author Dr Stein Emil Vollset from the Norwegian Institute of Public Health and affiliate professor at IHME. "To prevent this from becoming a deadly reality, we urgently need new strategies to decrease the risk of severe infections through vaccines, new drugs, improved healthcare, better access to existing antibiotics, and guidance on how to use them most effectively."  


The GRAM study suggests that improved healthcare access and the development of new antibiotics could prevent up to 92 million deaths globally between 2025 and 2050. In South Asia, effective intervention could avert 31.7 million deaths, underscoring the critical need for targetted strategies to combat AMR.


The authors of the study acknowledge certain limitations, which include the lack of data from some low- and middle-income countries that underscores the need for enhanced data collection and infrastructure investment to refine estimates and improve future AMR projections. Additionally, potential errors or biases in the 520 million records used, coupled with limited AMR data prior to 2000, may impact the reliability of historical estimates from the 1990s.


In a related commentary, Professor Samuel Kariuki from the Kenya Medical Research Institute, who was not involved in the study, remarks: “The model successfully evaluated the changing trends in AMR mortality across time and location that is necessary to understand how the burden of AMR is developing, and to provide evidence for action by all stakeholders to make informed decisions regarding interventions.” 


He adds: “These data should drive investments and targeted action towards addressing the growing challenge of AMR in all regions.”