One of the huge fears of researchers and health professionals alike has been the spread of antibiotic-resistant infections, called "superbugs." A novel study recently gracing the pages of The Lancet incorporates data suggesting that unless appropriate timely measures are taken, antimicrobial resistance could claim more than 39 million lives by 2050.
This projection highlights the critical nature of antimicrobial resistance (AMR), a process in which bacteria evolve to resist the effects of conventional antibiotics, rendering treatments ineffective. As a result, vulnerable segments of the population become even more susceptible to harm, exacerbating health disparities.
An Increasing Global Threat
The Global Research on Antimicrobial Resistance (GRAM) Project, which led this comprehensive review, puts the size of the threat into perspective. The study draws on data from 204 countries and territories, covering the period from 1990 to 2021, with projections extending to 2050. In 2021, AMR was directly responsible for 1.14 million deaths, a figure projected to rise to 1.91 million by mid-century. More concerning is the broader impact of AMR, which accounted for 4.71 million deaths in 2021 and is expected to increase to 8.2 million annually by 2050.
Although improvements in hygiene, vaccinations, and access to healthcare have substantially lowered the rates of deaths involving AMR among children under the age of five, the same cannot be said about adults. People aged over 70 years are at high risk of acquiring infection due to drug resistance. Deaths within this age group have increased by 80% over the past three decades, with AMR-related fatalities expected to rise by an estimated 146% by 2050.
This provides a clear view of the global distribution of AMR-related deaths, with the highest burdens projected in regions like South Asia and sub-Saharan Africa. These areas have also experienced the most rapid growth in AMR-related fatalities, driven in part by limited healthcare access, antibiotic overuse, and inadequate infection prevention measures. However, they stand to gain the most from improvements in health infrastructure and increased access to appropriate antibiotics.
Poor infection management and the lack of wide-range antibiotic regulation place countries like India, Pakistan, and Bangladesh at particular risk. Specific breeding grounds for AMR are pinpointed as hospitals where the infections are common amongst the aging populations, further deteriorating the crisis.
Among these pathogens propagating this surge in resistance, methicillin-resistant Staphylococcus aureus or MRSA stands out. This bacterium has developed resistance to various antibiotics, particularly to methicillin. MRSA increased its atrocity death toll from 57,200 deaths in 1990 to 130,000 deaths in 2021. Equally concerning is the sharp increase in resistance among Gram-negative bacteria to carbapenems—antibiotics typically reserved as a last-line treatment. The growing resistance to these critical drugs poses serious challenges for healthcare systems globally, underscoring the urgency of addressing AMR.
What Can Be Done?
Dr. Mohsen Naghavi, from the University of Washington's Institute for Health Metrics and Evaluation, IHME, the leader of the study said: "Antimicrobial medicines are one of the cornerstones of modern health care, and rising resistance to them is a major cause for concern.”
Its findings have spurred calls for global response. Heads of state will convene this month in New York at the United Nations General Assembly to act on the AMR crisis. Advocates are hopeful that concrete political declaration with bold commitments, such as reducing the number of deaths caused by AMR by 10% by 2030 will emerge from these deliberations.
The solutions, according to the researchers, are manifold. Better infection prevention, improving healthcare access, and putting antibiotics to better use-the judicious use, in other terms-is basic. Development of new antibiotics and treatment forms the core in this war against an ever-threatening resistant bacteria. These measures will save millions of lives, particularly in the improvement of care for severe infections and the extension of antibiotic access.
The Future of AMR
In the future, the fight against AMR must adopt a One Health approach, addressing the interconnected health of humans, animals, and the environment, and be sustained through coordinated global efforts. Without intervention, AMR-related deaths are projected to increase by nearly 70% by 2050.
On the other hand, this battle can be won with a better health care system, more control over infection practices, and the development of new antibiotics. The number of deaths that might be prevented from 2025 to 2050 could, at its best estimate, reach a high of 92 million.
With the rise in the aging population around the world and with the evidence of pathogens gaining resistance, little can be left to assumption about the increasing trend of AMR. Superbugs will continue to evolve unless firmly acted upon, thus putting millions of lives at risk and undermining the effectiveness of modern medicine.
Edited by: Derya Selin Yener & Yağmur Ece Nisanoğlu