THE "SILENT PANDEMIC" IN NUMBERS
Defined as the ability of microbes to resist antimicrobial agents, Anti Microbial Resistance (AMR) is considered as one of the most pressing public health challenges facing the global community. Despite the endorsement of the Global Action Plan of AMR 8 years ago by 194 countries, much remains to be done against the rampant « silent pandemic ». Illustrated by data and evidence from OECD, EU/EEA and G20 countries, the 2023 OECD report on AMR shows that average sales in antibiotics rose by almost 2% since 2000 despite all optimisation politics. Today, the trend for antibiotic consumption in animals and well as humans still keeps increasing, thus raising the risk of untreatable infections. As a result, more than one third of OECD countries do not meet the set WHO criteria for first line (Access) antibiotics.
As OECD members are exhausting the existing antibiotic arsenal, the resistance to last resort antibiotics has doubled since 2005. One in 5 infections in OECD countries are resistant to antibiotic treatment. According to data gathered in 2019, the share of resistant infections even reached more than 35% in Italy, and 25% in the United States. Some countries included in the study, such as Greece, Türkiye and India, are especially affected by this phenomenon. By 2035, antibiotic consumption is expected to settle at current levels for humans, and to decline slightly for animals. But, despite a stagnation of general antibiotic consumptions, AMR will likely keep increasing. Moreover, the 2023 report includes little information from developing countries, yet the majority of antimicrobial sales for animals takes place outside OECD countries. The sale of antimicrobials for animal use in G20 countries is expected to reach nearly twice the OECD average by 2035. Health being a global issue, taking action has become urgent.
OECD RECOMMENDATIONS TO AVOID HEAVIER CONSEQUENCES
The report shows that countries are already paying the price of inaction. AMR indeed leads to extra health expenditures due to longer hospitalisation periods, and causes loss in productivity, defined as the reduction in participation in the labour market and reduced productivity. The most striking example is the United States, where the consequential impact of AMR on workforce participation and productivity is already estimated to be equivalent to USD 36.9 billion, roughly representing one fifth of the gross domestic product in Portugal in 2020. By 2050, OECD and EU/EEA countries are expected to suffer further economic losses, « with costs exceeding the healthcare expenditure on the COVID-19 pandemic ». Furthermore, AMR does not only causes damage to the economies. Resistant infections cause 79 000 deaths every year, only in the studied countries only. Healthcare acquired resistant infection accounts for over 60% AMR-related deaths. Babies as well as people above 65 years of age especially vulnerable.
To limit consequences, the OECD recommends the adoption of a One Health framework of action. The only viable response to AMR is indeed defined as multidisciplinary and multisectoral, targeting people, animals, agri-food systems as well as the environment. The 2023 report identifies 11 One Health “best buys” that, if implemented systematically, would improve population health, reduce health expenditure and generate positive returns for the economy. The priority should be given to policies such as infection prevention and control supporting optimal use and the optimisation of use of antimicrobials, compliance with regulations, promotion of optimal use of antimicrobials in animals, strengthened surveillance systems for both AMR and antimicrobial use, and finally investment in R&D. With 1,6 million infections avoided in OECD countries, such policies could save a total of 9,4 billion of USD PPP in health expenditure, and help gain 13,8 billion worth of US PPP in workforce productivity.
Embracing a One Health Framework to Fight Antimicrobial Resistance
OECD (2023), Embracing a One Health Framework to Fight Antimicrobial Resistance, OECD Health Policy Studies, OECD Editions, Paris
Article écrit par Marie-Laure Privat