Hidden health crisis: Why antimicrobial resistance is a global threat

It has been estimated that at least 200 million lives worldwide to date have been saved by the coincidental discovery of penicillin by Scottish bacteriologist Alexander Fleming in 1928. Since then, new antibiotics and other antimicrobial medicines have been developed to treat various infections and health conditions. Nevertheless, antimicrobial resistance is increasingly unfolding as an imminent health hazard around the world. It is therefore no wonder that the WHO has declared AMR as one of the top ten global public health threats facing humanity in the 21st century.

Why does antimicrobial resistance occur?
This natural adaptation occurs when pathogens – which include bacteria, fungi, parasites, and viruses – are no longer susceptible to the drugs that are used to prevent and treat the infectious diseases they cause in humans, animals, and plants. Statistics relating to AMR are very sparse, but the WHO estimates that bacterial resistance globally was directly responsible for nearly 1.3 million deaths and indirectly contributed to almost 5 million deaths (in combination with pre-existing diseases) in 2019.

Although resistance to antimicrobial drugs is a naturally occurring process in biology, a few factors can accelerate the spread of drug-resistant pathogens. These include poor hygiene, lack of clean water, and, particularly, the irrational overuse of antimicrobials in healthcare settings, agriculture, and livestock farming. A recent study published in the scientific journal ‘The Lancet’ has revealed a nearly 50% rise in global antibiotic consumption since the turn of the millennium.

The Covid-19 pandemic also revealed the economic hardships caused by infectious diseases, whether in the form of lengthier hospitalisation or a loss of employment opportunities, that lower-income households face in both poor and wealthy countries. Therefore, a concerted global emergency response to the crisis is indispensable if the warning by former Goldman Sachs economist Jim O’Neill is right: the projected annual death toll could reach 10 million by 2050 due to the infections caused by superbugs.

What is the financial cost of AMR?
In addition to the threat of mortality that AMR could present to humankind, drug-resistant diseases could also have adverse effects on the global economy. As the World Bank points out, if the optimistic scenario of a low-AMR impact materialises, uncontrolled AMR could cause the international gross domestic product (GDP) to decrease by 1.1% by 2050. In this case, the economic relevance of AMR appears to be insignificant, although it would likely entail significant social consequences.

However, in a pessimistic high-AMR scenario, the world’s economy is expected to decrease by almost 4% and could push 28 million more people into poverty by 2050. Poorer countries with an inadequate disease surveillance system are particularly vulnerable to the onslaught of AMR. For instance, in the worst-case scenario of higher infectious disease prevalence, low-income countries are likely to experience a decline in GDP growth of roughly 6%, versus 3% in high-income nations, due to lowered labour productivity and livestock product output. In other words, AMR is as much a global income equity challenge as an urgent public health threat.

What countries are affected by antimicrobial resistance?
Lower-income countries are more likely to bear a greater burden than their wealthier counterparts. Among the 1.3 million people worldwide whose death was directly caused by drug-resistant pathogens in 2019, approximately 400,000 people across South Asia lost their lives to the superbugs. By contrast, the number of direct casualties was over 250,000 each in Sub-Saharan Africa and the Asia-Pacific region and under 150,000 in high-income economies like Western Europe and North America, respectively.

The scale of the health challenge in absolute terms is further laid bare if the number of victims indirectly linked to AMR is taken into consideration. Among the 5 million AMR-related deaths globally that resulted from pre-existing diseases in 2019, 1.4 million were found in South Asia. This was followed by 1 million each in Sub-Saharan Africa and the Asia-Pacific region and 600,000 across high-income economies.

The rise of superbugs increasingly unaffected by the drugs used to treat communicable diseases poses a more severe challenge for low- and middle-income economies rather than their wealthier counterparts. This is partly due to a lack of effective regulations on the prescription of antibiotics in the former group of countries. A case in point: some studies have shown that more than 99% of children under the age of five worldwide who have died from AMR are found in low- or middle-income countries, and over half of them die in their first month of life, because their physicians tend to prescribe a large quantity of unnecessary antibiotics, in general.

While a great deal of focus is directed at the adverse impact of AMR on poorer countries, wealthier nations are also affected by the creeping health crisis. In the case of Europe, for instance, the European Council estimates that AMR may constitute just under 1% of total healthcare expenditures every year. When an infection does not respond to a first-line antimicrobial treatment, which is often the safest option for the patient, healthcare professionals may be compelled to turn to more potent alternatives, like the second- and third-line drugs. Costs may escalate further should patients require longer hospital stays due to a lengthier duration of the disease or treatment. Beyond the aspect of money, drug-resistant infections affect 800,000 people and kill 35,000 in Europe every year.

What does this mean for investors?
A new business model is needed AMR is one of the most pressing global public health threats facing humanity in the 21st century. The global community must therefore urgently address the challenges associated with the waning efficacy of antimicrobial medicine against ever-evolving pathogens, which can cause serious illness to their hosts in a variety of ways. However, there are several hurdles that prevent key industry players like pharmaceutical companies from bringing novel antimicrobial medicine to the market.

Firstly, drug manufacturers may be faced with the high costs associated with R&D and the commercialisation of new antimicrobial medicine. As a result, revenues may become unsustainable for them.

Furthermore, wealthy economies tend to shoulder a greater bulk of the R&D expenses relating to innovative antibiotics, which lower-income countries tend to need urgently. As a consequence, some companies have preferred to pursue other more profitable therapeutic areas like oncology. This has the effect of curtailing the antimicrobial resistance pipeline.

Moreover, new antibiotics are kept in reserve and are only used as a last resort against lethal infections in order to limit the development of resistance. They are therefore not sold in large volumes. This is one of the key reasons why scientists have only recently discovered an entirely new class of antibiotics, something last achieved in the 1980s.

AMR is not an economic issue but rather a social one that requires the collaboration of different stakeholders along the value chain.


Dr Damien Ng, Next Generation Research Analyst

It is therefore understandable that the antimicrobial industry must reform their business model for all the key stakeholders involved along the value chain. This includes the fostering of scientific R&D for long-term, novel solutions like new antibiotics, bacteriophages, and vaccines for future health security. The world will also be better served through the fostering of an ecosystem that includes different AMR stakeholders in the private and public sectors.

Thus, from a stock market perspective, we do not see interesting investment opportunities related to the AMR space yet. This is due to the high risks facing the sector in terms of a lack of profitability, the limited growth potential, and the extremely small market capitalisation of AMR companies. As highlighted, AMR is not an economic issue but rather a social one that requires the collaboration of different stakeholders along the value chain. It is some of the world’s poorest countries that are confronted with a high burden of drug-resistant infections.

Investors could also consider the following health-related investment subthemes that underpin the ‘Shifting Lifestyles’ Next Generation theme if they wish to gain exposure to the space.

--- END press release Hidden health crisis: Why antimicrobial resistance is a global threat ---

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  Die verborgene Gesundheitskrise: Warum antimikrobielle Resistenzen eine globale Bedrohung darstellen (news article in german on swiss-press.com)