The economic impact of Antimicrobial Resistance

The World Organisation for Animal Health and the World Bank have recently published the report “Forecasting the Fallout from AMR: Economic Impacts of Antimicrobial Resistance in Humans”.

The document, released in September 2024, provides a detailed and alarming analysis of how antimicrobial resistance (AMR) could shape global health outcomes and economic trajectories if left unchecked. The report uses projections from the Institute for Health Metrics and Evaluation (IHME) and combines them with economic modelling to provide a rigorous look at the impact of AMR on health systems and economies around the world. 

This commentary summarizes key findings of the report, including its implications for low- and middle-income countries, the economic burden of AMR, possible intervention strategies, and the return on investment from tackling this public health crisis.

AMR: a global health and economic threat

At the heart of the report is a critical message: AMR is not just a medical problem, but a looming economic disaster that could destabilise healthcare systems and slow global economic growth, particularly in vulnerable regions. The report estimates that under a business-as-usual scenario, where resistance rates follow historical trends, the direct health costs of AMR will rise from $66 billion to $159 billion annually by 2050. Furthermore, if resistance rates increase at the rate of the bottom 15% of countries, healthcare costs could rise to $325 billion and the global economy could shrink by $1.7 trillion by mid-century.

These figures underscore the profound economic and social impact of AMR. Beyond direct healthcare costs, AMR affects labour force participation, tourism and overall economic resilience, with low-income countries bearing the heaviest burden. The report highlights that AMR is likely to have a disproportionate impact on low- and lower-middle-income countries, where health systems are already strained and access to advanced treatments is limited. 

The human cost of AMR

In addition to the economic impact, the report paints a grim picture of the human toll of AMR. Under a business-as-usual scenario, AMR could lead to 38.5 million deaths between 2025 and 2050. However, if resistance increases at the rates observed in the most affected countries, this figure could rise dramatically. On the other hand, comprehensive intervention strategies that improve treatment, increase access to antibiotics and encourage innovation in new drug development could avert up to 110 million deaths over the same period.

This contrast between potential scenarios highlights that the trajectory of AMR is not predetermined. Coordinated global action, including increased investment in antibiotic research and development, improved access to healthcare, and better hygiene and vaccination programmes, can dramatically reduce the number of deaths from AMR. In particular, the report’s Scenario 4, which includes a combination of better treatment, increased innovation and improved sanitation, offers the greatest health gains, highlighting the importance of a multi-pronged approach to AMR.

Economic impact: Rising costs and lost productivity

The report emphasises that the economic impact of AMR goes beyond direct healthcare costs. The projected loss of global economic output due to AMR is staggering, with a worst-case scenario of the global economy being US$1.7 trillion smaller by 2050. These losses stem not only from increased healthcare spending, but also from reduced labour force participation, lower productivity, and a decline in tourism and hospitality – industries that are particularly vulnerable to health crises.

Experts consulted for the report agreed that countries with robust health systems and higher GDPs are more resilient to the economic impact of AMR, while poorer countries are particularly vulnerable. This creates a vicious circle: low-income countries, already facing significant public health challenges, will struggle even more as AMR strains their economies, limiting their ability to invest in the infrastructure and innovation needed to tackle the problem. This dynamic underscores the importance of global cooperation and support to ensure that all countries, especially those with fewer resources, can tackle AMR effectively.

The cost of inaction vs. intervention: An economic and moral imperative

One of the most striking findings of the report is the clear economic case for immediate and decisive action against AMR. While the cost of interventions, including improving access to antibiotics and developing new drugs, is not insignificant, the return on investment is immense. The report estimates that improving innovation and access to high-quality treatment for bacterial infections would cost about $63 billion a year, but the return on investment is calculated at 28:1, with a global economic benefit of $990 billion by 2050. 

This underlines the urgency of action. Failure to invest in the fight against AMR will result in skyrocketing healthcare costs and severe economic losses, while proactive measures offer a highly favourable cost-benefit ratio. For example, increased innovation in Gram-negative antibiotics alone could save US$84 billion annually in healthcare costs and add US$740 billion to global GDP by 2050. This shows that the financial case for tackling AMR is as compelling as the moral case: investing in public health now will save lives and money in the future.

Innovation as a key to tackling AMR

The report emphasises that innovation is critical to the global response to AMR. Gram-negative bacteria, which account for two-thirds of the global bacterial burden, are particularly difficult to treat and new antibiotics targeting these pathogens are urgently needed. However, the pipeline for new antibiotics has been alarmingly slow, with fewer drugs reaching the market in recent decades. The report estimates that around ten new antibiotics per decade are needed to keep pace with rising levels of resistance, with a focus on treatments for Gram-negative infections.

Meeting this need will require substantial investment in antibiotic research and development. The report estimates the cost of R&D at US$2.2 billion per year, which, when distributed among high-income countries, represents a modest 0.0036% of their GDP. This is a small price to pay for developing life-saving treatments that could prevent millions of deaths and reduce the economic burden of AMR.

A call for coordinated global action

The report makes clear that AMR is both a public health emergency and an economic threat that requires urgent global attention. While the challenge is daunting, the report offers hope: with coordinated global action, it is possible to mitigate the worst effects of AMR, saving millions of lives and preventing trillions of dollars in economic losses. The key to success is a multifaceted approach that includes improving access to existing treatments, fostering innovation in new antibiotics, and addressing the underlying social and environmental drivers of resistance, such as poor sanitation and inadequate vaccination coverage.

The stakes could not be higher. As the report concludes, the cost of inaction is far greater than the cost of intervention. Policymakers, healthcare providers and international organisations must act now to avert the devastating consequences of AMR and ensure a healthier, more prosperous future for all.