Embargoed access to the paper and contact details for authors are available in Notes to Editors at the end of the release.
The Lancet: More than 39 million deaths from antibiotic-resistant infections estimated between now and 2050, suggests first global analysis
- First in-depth analysis of global health impacts of antimicrobial resistance (AMR) over time reveals trends from 1990 to 2021 and estimates potential impacts to 2050 for 204 countries and territories.
- More than one million people died from AMR globally each year between 1990 and 2021. Over the period, AMR deaths among children aged under five declined by 50% while those among people aged 70 and older increased by more than 80%.
- Future forecasts indicate AMR deaths will rise steadily in the coming decades, increasing by almost 70% by 2050 compared to 2022, continuing to more greatly impact older people.
- Estimates suggest improved access to health care and antibiotics could save a total of 92 million lives between 2025 and 2050.
- The findings highlight the need for decisive actions – including improved healthcare, expanded prevention and control measures, and new antibiotics – to protect people from the threat of AMR.
**For access to regional-level data tables and information on country-level data availability, see Notes to Editors**
More than 39 million people around the world could die from antibiotic-resistant infections over the next 25 years, according to a study published in The Lancet.
The new study by the Global Research on Antimicrobial Resistance (GRAM) Project is the first global analysis of antimicrobial resistance (AMR) trends over time.
It reveals that more than one million people died each year as a result of AMR between 1990 and 2021. The study also estimates 1.91 million people could potentially die as a direct result of AMR in 2050, an increase of almost 70% per year compared to 2022. Over the same period, the number of deaths in which AMR bacteria play a role will increase by almost 75% from 4.71 million to 8.22 million per year.
Between 1990 and 2021, AMR deaths among children under five years old declined by 50%, while those among people aged 70 years and older increased by more than 80%. These trends are predicted to continue in the coming decades, with AMR deaths among children under five projected to halve by 2050 globally, as deaths among people 70 years and older more than double.
The findings highlight a vital need for interventions that incorporate infection prevention, vaccination, minimising inappropriate antibiotic use, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.
“Antimicrobial medicines are one of the cornerstones of modern healthcare, and increasing resistance to them is a major cause for concern. 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,” said study author Dr Mohsen Naghavi, Team Leader of the AMR Research Team at the Institute of Health Metrics (IHME), University of Washington, USA.
Already widely recognised as a major global health challenge, AMR – which occurs when bacteria or other pathogens change in ways that make them evolve to no longer respond to antimicrobials – is anticipated to worsen in the coming decades. However, until now, no studies have assessed historical trends of AMR and provided in-depth forecasts of future global impacts.
The first GRAM study, published in 2022, revealed the true scale of AMR for the first time. It found that global AMR-related deaths in 2019 were higher than those from HIV/AIDS or malaria, leading directly to 1.2 million deaths and playing a role in a further 4.95 million deaths. [1]
Estimates for the new GRAM study were produced for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes (including meningitis, bloodstream infections, and other infections) among people of all ages in 204 countries and territories. The estimates were based on 520 million individual records from a wide range of sources, including hospital data, death records, and antibiotic use data.
Statistical modelling was used to produce estimates of deaths directly from AMR and those in which AMR played a role. Based on the historical trends calculated, the authors estimate the most likely global and regional health impacts of AMR from 2022 until 2050. Estimates were also produced for scenarios in which healthcare quality and access to antibiotics improve in the future and drug development targets Gram-negative bacteria.
Shifting global trends
Their findings reveal that more than one million lives were lost each year from 1990 to 2021 as a direct result of AMR. In 1990, there were 1.06 million deaths directly due to AMR of a broader 4.78 million associated deaths. In 2021, AMR led directly to 1.14 million deaths and was associated of a broader 4.71 million deaths. AMR deaths in 2021 were lower than in 2019 (1.27 million direct AMR deaths; 4.95 million associated deaths) due to reductions in the burden of non-COVID lower respiratory infections, likely caused by social distancing and other disease control measures in place during the COVID-19 pandemic. The team’s analysis suggests this decline in AMR deaths was only temporary.
Over the three decades, trends in AMR deaths underwent a major age-related shift, with those among children under five years old decreasing by more than 50% (59.8% reduction in direct AMR deaths, 488,000 to 193,000 deaths; 62.9% reduction in deaths linked to AMR, 2.29 million to 840,00 deaths). This decline coincided with major improvements in the delivery of infection prevention and control measures – such as vaccination programmes – among infants and young children. However, the proportion of infectious deaths caused directly by AMR increased by a relative 13.6% – to a total of 7.2% in 2021 – among children under five years between 1990 and 2021.
Over the same period, AMR deaths among adults 70 years or older increased by more than 80% (89.7% increase in direct AMR deaths, 519,000 in 2021; 81.4% increase in deaths linked to AMR, 2.16 million in 2021), due to rapidly ageing populations and older people’s greater vulnerability to infection.
Deaths directly from AMR increased most in five global regions, where annual deaths rose by more than 10,000 between 1990 and 2021: western sub-Saharan Africa, Tropical Latin America, high-income North America, Southeast Asia, and South Asia.
“The fall in deaths from sepsis and AMR among young children over the past three decades is an incredible achievement. However, these findings show that while infections have become less common in young children, they have become harder to treat when they occur. Further, the threat to older people from AMR will only increase as populations age. Now is the time to act to protect people around the world from the threat posed by AMR,” said study author Dr Kevin Ikuta of the University of California Los Angeles (UCLA) and affiliate professor at IHME.
Different pathogens
The findings reveal increasing resistance to critically important antimicrobials, with all but one of seven key pathogens rated by the WHO as the most difficult to treat leading to more deaths in 2022 compared to 1990.
Deaths due to methicillin-resistant S. aureus (MRSA) increased the most globally, leading directly to 130,000 deaths in 2021 – more than doubling from 57,200 in 1990. Among Gram-negative bacteria –some of the most resistant to antimicrobial drugs – resistance to carbapenems increased more than any other type of antibiotic, from 127,000 in 1990 to 216,000 in 2021.
Future projections – worst can be averted by action now
The authors estimate that AMR deaths will increase steadily in the coming decades based on current trends, with 1.91 million annual deaths directly due to AMR projected by 2050 – a 67.5% increase on the 1.14 million deaths in 2021. By the middle of the century, AMR is also projected to play a role in a broader 8.22 million deaths – an increase of 74.5% on the 4.71 million associated deaths in 2021.
In total, between 2025 and 2050 it is estimated AMR will lead directly to more than 39 million deaths and be associated with a broader 169 million deaths.
Deaths among children under five years old will continue to decline, halving in 2050 compared to 2022 (49.6% decline, 204,000 to 103,000 deaths), but these will be outpaced by increases in other age groups, particularly those aged 70 years and older (146% increase by 2050, from 512,353 to 1,259,409). There will be considerable differences globally, with a 72% increase in deaths among people 70 years and older in high-income countries compared to a 234% increase in North Africa and the Middle East.
Future deaths from AMR will be highest in South Asia – which includes countries such as India, Pakistan, and Bangladesh – where a total of 11.8 million deaths directly due to AMR are forecast between 2025 and 2050. Deaths from AMR will also be high in other parts of southern and eastern Asia and sub-Saharan Africa. (In-depth figures for specific regions are available in Table S17 in Appendix 1).
The team’s modelling of alternative future scenarios reveals improving overall infection care and access to antibiotics could prevent 92 million deaths between 2025 and 2050 (see Appendix 1, pages 77 and 116–117). The greatest benefits would be in South Asia, sub-Saharan Africa, and parts of Southeast Asia, East Asia, and Oceania, with 31.7 million, 25.2 million, and 18.7 million deaths averted, respectively. Under the scenario in which new antibiotics targeting Gram-negative bacteria were developed, estimates indicate 11.08 million AMR-attributable deaths could be averted globally over the same period.
“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. 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,” said study author Dr Stein Emil Vollset of the Norwegian Institute of Public Health and affiliate professor at IHME.
The authors acknowledge some limitations to their study. A lack of data for some LMICs highlights a need for improved data collection – which requires investment in infrastructure – to strengthen estimates for these countries and improve the accuracy of future AMR forecasts. Some of the 520 million individual records used to produce the estimates may contain errors or biases. There was also limited reporting of AMR data before 2000, which may affect the strength of historical estimates in the 1990s.
Writing in a linked Comment, Professor Samuel Kariuki, of the Kenya Medical Research Institute, who was not involved in the study, said: “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.” Professor Kariuki concludes, adding: “These data should drive investments and targeted action towards addressing the growing challenge of AMR in all regions.”
NOTES TO EDITORS
This study was funded by the Wellcome Trust and the UK Department of Health and Social Care. It was conducted by researchers from the GBD 2021 Antimicrobial Resistance Collaborators (the full author list is available in the paper).
Quotes from Authors cannot be found in the text of the Article, but have been supplied for the press release. [The Comment quote is taken directly from the linked Comment.
[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0
The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com
Journal
The Lancet
Method of Research
Observational study
Subject of Research
People
Article Title
Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050
Article Publication Date
16-Sep-2024
COI Statement
U Abubaker reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the Early Career Pharmaceutical Group of the International Pharmaceutical Federation between January 2021 – December 2023, outside the submitted work. S Afzal reports payment or honoraria for educational events and Webinars with King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, and University of Massachusetts; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, and Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Pakistan Association of Medical Editors, Faculty of Public Health Royal Colleges UK (FFPH), with Society of Prevention, Advocacy And Research, King Edward Medical University. (SPARK), and the Pakistan Society of Infectious Diseases; other financial or non-financial interests as Dean of Public Health and Preventive Medicine King Edward Medical University, Chief Editor Annals of King Edward Medical University since 2014, Director Quality Enhancement Cell King Edward Medical University, and Member Research and Publications Higher Education Commission Pakistan; all outside the submitted work. R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Laropharm, Reckitt, and Merck Romania; support for attending meetings and/or travel from Merck Romania; all outside the submitted work. J R Andrews reports support for the present manuscript from Bill and Melinda Gates Foundation (funding for the Surveillance for Enteric Fever in Asia Project Study); grants or contracts from NIH for typhoid and tuberculosis studies; royalties from UpToDate on typhoid clinical management; outside the submitted work. D T Araki reports support for their participation in the present manuscript through their employment at the Institute for Health Metrics and Evaluation (IHME), and support for attending meetings and/or travel from IHME outside the submitted work. A Beloukas reports grants or contracts from Gilead and GSK/ViiV through their institution; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead and GSK/ViiV through their institution; support for attending meetings and/or travel from Gilead and GSK/ViiV through their institution; Receipt of FOC reagents from Cepehid; all outside the submitted work. J A Berkley reports support for the present manuscript from the Bill & Melinda Gates Foundation through payments to their university. S Bhaskar reports grants or contracts from Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Grant-inAid for Scientific Research (KAKENHI) (P23712), JSPS and the Australian Academy of Science, and JSPS International Fellowship (P23712); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Rotary District 9675, Sydney, Australia, Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany, PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research & BMC Medical Research Methodology, College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada, World Headache Society, Bengaluru, India, Cariplo Foundation, Milan, Italy, National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Osaka, Japan, and Cardiff University Biobank, Cardiff, UK; all outside the submitted work. C S Brown reports other financial or non-financial interests through participation in shortterm, anonymous, and indirect market research with companies Sermo, Atheneum, and M3, all outside the submitted work. E Chung reports support for the present manuscript in part by the National Institutes of Health (NICHD T32HD007233 to EC). S J Dunachie reports support for the present manuscript from UK Fleming Fund at Department of Health and Social Care, Bill & Melinda Gates Foundation, and Wellcome Trust through their employment, and from the UK National Institute of Health and Care Research through a Global Research Professorship (NIHR300791); grants or contracts from UKRI (MR/W02067X/1 and MR/W020653/1), US Defense Threat Reduction Agency, Wellcome Drug Resistant Infections Discretionary Award, and the UK Dept of Health & Social Care; consulting fees from the Scottish Parliament and Wellcome; participation on the Data Monitoring Committee for UK STABILISE study of BCG vaccine in COPD; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), Chair of Wellcome SEDRIC subgroup on data standards and harmonisation in antimicrobial resistance, UK, member of Variant Technical Group for SARS-CoV-2 for UK Health Security Agency, UK, Expert advisor to WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), Geneva, Switzerland, and a Member of World Health Organization Guidelines Development Group on Treatment of Ebola, Geneva, Switzerland; all outside the submitted work. T Eckmanns leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with a speaker working group infection control German society of infection control and microbiology. N A Feasey reports grants from Wellcome Programme Grant: ACORN, and Wellcome Programme Grant: ADILA through payments to their institute, outside the submitted work. I M Ilic reports support for their participation in the current manuscript from Ministry of Education, Science and Technological development, Republic of Serbia, project No 175042, 2011-2023. N E Ismail reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, as Bursar and Council Member of the Malaysian Academy of Pharmacy and as a Committee Member of Education Chapter, Malaysian Pharmacists Society; all outside the submitted work. T Joo reports support for their participation in the current manuscript from EU under EU4HEALTH programme (AMR-EDUcare – EduCation on Antimicrobial REsistance for the health workforce). M Lee reports support for their participation in the current manuscript from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298). L Monasta reports support for their participation in the current manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017) through payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. C E Moore reports participation on a Data Safety Monitoring Board orAdvisory Board as a Member of Advisory board for MRC grant, Advisory group for WHO Medically Important Antimicrobial List, Member of the Steering group for the REVIVE study , Member of Advisory board for CABBAG, and as a Member of Advisory board for RADAAR; Leadership or fiduciary role, unpaid, in a microbiology society as Co-chair of Impact and Influence group of Knocking Out AMR project; all outside the submitted work. A J Pollard reports grants or contracts from Gates Foundation, Wellcome, Cepi, MRC, NIHR, AstraZeneca, EC, and the Serum Institute of India, all as payments to their institution; royalties or licenses with AstraZeneca through their institution; consulting fees from Shionogi; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, as Chair of DHSC’s Joint Committee on Vaccination and Immunisation, a Member of WHOs SAGE until 2022, and Chair of WHOs Salmonella TAG; receipt of equipment, materials, drugs, medical writing, gifts or other services from Moderna; all outside the submitted work. L F Reyes reports grants or contracts from GSK, MSD, and Pfizer; consulting fees from GSK, MSD, and Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GSK, MSD, and Pfizer; payment for expert testimony from GSK, MSD, and Pfizer; support for attending meetings and/or travel from GSK and Pfizer; stock or stock options in GSK; all outside the submitted work. Y L Samodra reports grants or contracts from Taipei Medical University; a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the Benang Merah Research Center, Indonesia; and other financial or non-financial interests in bertakon.com as founder; all outside the submitted work. E A F Simões reports grants or contracts from Astra Zeneca Inc, Merck & Co., Pfizer Inc, Icosavax Inc, Johnson and Johnson, and Enanta Pharmaceuticals; consulting fees from Merck & Co., Pfizer Inc, Sanofi Pasteur, Cidara Therapeutics, Icosavax Inc, Nuance Pharmaceuticals, GSK, Enanta, and Gilead; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pfizer Inc and Astra Zeneca; support for attending meetings and/or travel from Astra Zeneca, Sanofi, and Pfizer Inc; participation on a Data Safety Monitoring Board or Advisory Board with AbbVie Inc, GlaxoSmithKline plc, and Moderna Inc; all through their institution and outside the submitted work. P Turner reports grants or contracts from the Wellcome Trust through the ACORN AMR surveillance network project (University of Oxford); support for attending meetings and/or travel from the World Health Organization for attendance at the AMR Diagnostic Initiative Meeting (July 2023); all outside the submitted work. P C M Williams reports grants or contracts from National Health and Medical Research Council administered by the University of Sydney; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events ECCMID & WSPID for conferences between 2022 and 2024; support for attending meetings and/or travel from ECCMID & WSPID; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the World Society of Paediatric Infectious Diseases and the Australasian and New Zealand Paediatric Infectious Diseases Society; all outside the submitted work. G Zamagni reports support for their participation in the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. M Zielińska other financial or non-financial interests in AstraZeneca as an employee, outside the submitted work. A Zumla reports support for their participation in the current manuscript from the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the EDCTP - the EU Horizon 2020 Framework Programme, the UK NIHR, a Mahathir Science Award, and EU-EDCTP Pascoal Mocumbi Prize; participation on a Data Safety Monitoring Board or Advisory Board, unpaid, with the WHO Infection Prevention and Control Committee; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the University of Bolton School of Medicine; outside the submitted work.