What is antibiotic resistance and how we can tackle it

Representational image: Flickr

• In the space of a century we have gone from discovering antibiotics to many of them significantly losing their effectiveness as antimicrobial resistance (AMR) grows around the world.
• AMR occurs when strains of microbes develop resistance to drugs and this resistance is spread to future generations.
• By 2050, the global death toll as a result of AMR could reach 10 million deaths annually.
• Overuse and misuse of antibiotics is a significant factor in the spread of superbugs, but pollution and climate change also play a role.

In 1928, Alexander Fleming discovered the first antibiotic, penicillin, and by the 1930s the first antibiotics had become commercially available.

Now, less than 100 years later, we are facing a health crisis as many drugs we have commonly used are no longer effective and we struggle to find new treatments to combat infections.

Antimicrobial resistance (AMR) has been described as “one of the biggest threats to global health, food security, and development today”, but what exactly is it, and why does it pose such a problem?

What is antimicrobial resistance?

Antimicrobial resistance (AMR) occurs when microbes – bacteria, fungi, parasites and viruses – evolve over time so that antimicrobial drugs that previously worked against them are no longer effective. As a result of this drug resistance, infections spread and become harder to treat.

Some strains of bacteria have become “superbugs”, developing resistance to multiple forms of treatment. These include MRSA (methicillin-resistant Staphylococcus aureus), Clostridium difficile (C. diff) and the bacteria that cause multi-drug-resistant tuberculosis.

AMR affects all countries, although some are feeling the impact more than others. In particular, Sub-Saharan Africa may bear a particularly heavy burden. In addition, recent research demonstrates there is little high-quality data available about AMR and infectious diseases in low-income settings, which hampers our understanding.

We are urgently in need of more innovative, high-quality antimicrobials as resistance spreads and drugs such as antibiotics become less effective.

Why is AMR such a problem?

AMR directly caused 1.27 million deaths globally in 2019 and contributed to an additional 4.95 million deaths. This makes it a bigger killer than HIV/AIDS or malaria. By 2050, this death toll could climb to 10 million deaths annually.

The impacts aren’t limited to health alone, says the World Health Organization (WHO). The global economy will also be affected by increased healthcare costs, reduced productivity and increase in poverty as a result of antimicrobial resistance. Without action it could reduce global GDP by $3.4 trillion and drive an additional 24 million people into extreme poverty, it warns.

How does resistance arise?

Natural variations in the genetic makeup of microbes cause resistance to develop over time as they reproduce. For example, alterations in their DNA could mean antimicrobials are no longer able to reach the microbe cell, or make microbes capable of creating enzymes which destroy the antimicrobial. Through natural selection these microbes with advantageous traits will proliferate over less-resistant strains, spreading the genetic advantage more widely.

Microbes like bacteria are also able to directly transfer genetic material to each other in various ways other than reproduction.

Although both of these ways of transferring genetic material occur naturally, poor use of antimicrobials, among other things, can speed up resistance developing and spreading. For example, if an antibiotic course does not totally kill off an infection, we leave behind the microbes best able to fight against the drug. These will then multiply and pass on their survival traits.

How does antibiotic use affect resistance?

Excessive antibiotic use is a significant driver of resistance. If the treatment is too short, or weak, or incorrect for the infection, we risk leaving behind resistant microbes. The more we expose microbes to antimicrobials and/or other resistant microbes the more opportunities we create for resistance to develop and multiply.

And it’s not just prescribing to humans that is a problem – two-thirds of the antibiotics used globally are used in farming. Low-level antibiotics are routinely used for prolonged periods of time even in healthy animals to stave off disease and promote livestock growth. In recent years, antibiotic use in agriculture in Europe has fallen dramatically. But they continue to be widely used elsewhere, particularly in Brazil, China and other emerging countries, because of their impact on profit margins and a lack of viable and affordable alternatives.

Shyam Bishen, Head, Shaping the Future of Health and Healthcare, Member of Executive Committee, World Economic Forum.

This article was originally published in the World Economic Forum.