GARDP welcomes the publication of the latest study of the Global Research on Antimicrobial Resistance (GRAM) Project published in The Lancet.

This study suggests that we may have reached an alarming tipping point with antimicrobial resistance (AMR). Existing counter-measures to treat or prevent bacterial infections, like antibiotics and vaccination, may have helped to keep drug-resistance at bay in recent decades, but it is now clear from this study that the greatest gains have already been made. Such interventions can continue to have an impact, but diminishing returns should now be expected unless there is significant investment towards improving global access to antibiotics that remain effective and in the development of new antibiotics to replace those lost to resistance, particularly ones that target difficult-to-treat Gram-negative infections. We cannot continue to deal with these kinds of infections with the antibiotics we have today.

As Gram-negative infections continue to make up an increasing proportion of deaths associated with drug-resistance, this will place everyone more at risk, but particularly vulnerable people, with the number of AMR deaths among people over 70 likely to more than double by 2050. While this is a worrying trend it is to be expected, because people are living longer and old age is already recognized as a risk factor for death by bacterial infections. Similarly the fall in recent decades of under-five AMR mortality was anticipated, reflecting the broader global trend of increases in child survival, thanks largely to improved access to childhood immunization. But we should not lose sight of newborns, who continue to be one of the most at-risk groups. Mortality reduction has been much slower for newborns than for under-fives, and given that they are too young to receive most vaccines, they remain one of the most vulnerable populations and are expected to make up a significant proportion of AMR-related deaths.

With AMR mortality predicted to increase by 70% by 2050, the findings of this study show that the most impactful way to prevent this is through improved access to effective antibiotics, particularly in low- and middle-income countries (LMICs) where the burden of disease continues to be the greatest. According to this study improved global access could potentially avert more than 50 million deaths by 2050. However, for that a radical shift is needed. For decades the emphasis has been on restricting the use of antibiotics. But, while their careful stewardship remains essential, increasing access now has to become the priority. We also need a shift in the way that antibiotics are developed, one that supports research and development that is driven by public health needs and which integrates access, including for LMICs into the entire R&D process, because otherwise we won’t necessarily get the antibiotics we need. Public-private and product development partnerships are a good way to ensure this.