#AMRSOS! AMR could worsen, killing 39m during 2025-2050

Key messages are:

• Globally, AMR-attributable mortality will increase if we do not take action.
  • The rate of increase is uneven!
  • Mortality is decreasing in children under 5 (yes, decreasing)
  • But mortality is increasing in the older population, with an 80% increase forecast in those over age 70!
  • This follows from the huge impact of vaccination and WASH (Water, Sanitation, and Hygiene) on infection rates in children vs. the increasing complexity of a growing older population.
• The net effect is “increasing burden from AMR in the coming decades, with an estimated 69·6% increase in global deaths attributable to AMR and 67·0% increase in deaths associated with AMR between 2022 and 2050.“
• Sadly, this paper concludes “that without additional measures we will fail to hit the 10% reduction in AMR mortality proposed in the 10-20-30 by 2030 target.”
  • This is reference to the 10-20-30 target proposed in May of this year … see the superb series of papers discussed in 23 May 2024 newsletter entitled “Lancet: 10-20-30 targets to address AMR by 2030“

Lest you think that you are safe because you might not currently be in one of the dark red countries on the map–think again. In our globally connected world, no one is safe until we all are safe. Sobering … but indeed exactly the kind of evidence that precipitates action! 

If you want to read a bit more deeply, look below my signature for an annotated version of the Findings from the abstract. Extraordinary stuff!

With thanks to the team behind the amazing Global Burden of Disease project and also with thanks to all of you are acting to avert this looming disaster, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

Annotated elements from the abstract of the paper:

Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021.

Findings

• “In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR.
  
  • “Trends in AMR mortality over the past 31 years varied substantially by age and location.
• “From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older.
  
  • “AMR mortality decreased for children younger than 5 years in all super-regions,
    • Why? From the body of the paper:
    • “Much of this reduction is due to a decrease in drug-resistant S pneumoniae and in pathogens commonly spread through faecal–oral transmission (eg, Salmonella, Shigella, and enteropathogenic or enterotoxigenic E coli).”
    • “This decline coincides with widespread vaccination efforts and improved access to WASH and serves as an important reminder to the global health community and policy makers that infection prevention might be a highly effective intervention in reducing AMR burden.”
  • … “whereas AMR mortality in people 5 years and older increased in all super-regions.
    • !!! Why is this? From the body of the paper:
    • “First, the rising AMR and sepsis mortality in older adults has been masked by traditional global health metrics.
    • “Second, interventions that are effective in younger age groups, such as vaccines, might be less effective in older adults.
    • “Third, older adults are more likely to have adverse effects from specific antimicrobials; as resistance increases, the use of more toxic second-line and third-line treatment options is necessitated, which might not be tolerated in older populations.
    • “Fourth, adults are more likely to have comorbidities that lead to immunodeficiencies and increase the risk of opportunistic infections.”
  • “For both deaths associated with and deaths attributable to AMR, methicillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021).
  • “Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021.
  • “There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021.
• Going forward: “Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050.
  
  • “Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean.
  • “Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050).
  • “In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050.
  • From the body of the paper: “Cumulatively from 2025 to 2050, our reference scenario forecasts 39·1 million (33·0–46·0) deaths attributable to AMR”
  • “Globally and in every super-region, AMR deaths in children younger than 5 years are decreasing, most pronounced in absolute numbers in sub-Saharan Africa and south Asia.
  • “For deaths of people 70 years and older, we forecasted an increase from 2022 to 2050 in every super-region.
• And if take action: “Under the better care scenario, across all age groups,
  
  • “92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and
  • … “under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths.