The silent pandemic – antimicrobial resistance

Abstract

EXECUTIVE SUMMARY Antimicrobial resistance is one of the most serious global One Health threats of the 21st century, linking the interests, concerns and efforts of human health, animal health, and environmental health. Documented in almost all regions of the world,1 antimicrobial resistance is considered by many as the silent global pandemic that will undermine healthcare systems and food safety and supply, and result in millions of deaths. The current estimated economic and human costs are large enough to justify major intervention, however this threat continues to go unnoticed by many. Studies suggest that resistant infections can add an additional AUD$10,000 to the cost of treatment,2 and that Australian hospitals spend an additional AUD$16.8 million per year treating common resistant hospital-associated infections.2 Antimicrobial resistance was associated with 4.95 million deaths in 2019,3 and over the next few decades it is predicted to become one of the leading causes of death, estimated to be responsible for 50 million deaths each year by 2050.4,5 While antimicrobial resistance is a natural phenomenon, the largely unrestrained use of antimicrobials in human and animal health and agriculture combined with several other complex factors is accelerating the emergence and spread of resistant pathogens. Of these factors, the failing market for antimicrobial development has meant that the breadth and novelty of the current pipeline of new antimicrobials is insufficient to meet the ongoing threat of antimicrobial resistance. Without new antimicrobials, the world may be on track to return to the medical ‘dark ages’, a time where a superficial scratch could be life threatening, and the procedures and treatments which we now rely on are considered too risky to perform, due to risk of untreatable infection. Antimicrobial resistance requires a global response, and one country’s actions will not have a significant impact if other nations continue to act independently of one another. As a wealthy, developed country with an advanced healthcare system, Australia is well placed to lead global efforts to control the growing threat of resistant infections and other health threats, particularly in the Asia-Pacific region. Australia however is lagging in several key areas, including public awareness and understanding of antimicrobial resistance; stewardship; coordination and incentives for research and development; and national One Health governance. To address this, the AMA has proposed several solutions that build on work the government is already doing to encourage behavioural change, incentivise antimicrobial research and development, and deliver a unified One Health approach to tackling antimicrobial resistance. These solutions include: • establishing a Centre for Disease Control (CDC) that is a recognised separate authority for the national scientific leadership and coordination of diseases and health threats, as well as several immediate priorities for government to ensure Australia’s response to antimicrobial resistance is effective, integrated, and aligned to One Health objectives • improving antimicrobial stewardship practices in Australia, by embedding stewardship practices, education and training, and clinical decision support tools into all sectors • improving the antimicrobial market through sovereign manufacturing of antimicrobials and implementing mechanisms to incentivise research and development. The need for efficient, effective, and sustainable mechanisms to prevent and treat infectious diseases was clearly demonstrated during the COVID-19 pandemic. These proposed solutions will position Australia as a global leader and support a coordinated, sustained, and unified One Health approach to addressing antimicrobial resistance and other health threats. Now is the time for strong and sustained action on antimicrobial resistance, as this may well be the cause of the next global pandemic.