A complex global challenge

The world has not yet been able to find ways to collectively manage and control antibiotic resistance. The problem is multi-sectorial and involves many complex challenges. Apart from the medical components, it has economic, ecologic, sociological and developmental dimensions. Below is an outline of some of the contributing factors.

A threat to the world’s sustainable development

The 2015 resolution ‘Transforming our world: the 2030 Agenda for Sustainable Development’ highlighted the need to address growing antimicrobial resistance. In fact, several of the United Nations Sustainable Development Goals (SDGs) will be difficult to achieve without effective antibiotics.

HUMAN AND NON HUMAN USE OF ANTIBIOTICs must decrease

Overuse of antibiotics

The unpleasant truth is that our use and misuse of antibiotics has eroded their efficiency and fueled the spread of antibiotic resistance. Poor water and sanitation standards together with a lack of hygiene and infection control have further worsened the situation. All antibiotic use, whether appropriate or not, contributes to the development and spread of resistant bacteria. Worldwide, antibiotics are used in massive amounts within the health care, veterinary and agricultural sectors. Antibiotics can be life-saving when treating bacterial infections in humans and animals, but are often used when not needed or in the wrong way. There is a large variation in antibiotic consumption between countries. Reasons for this include socioeconomic factors, cultural differences, financial incentives, fear of lawsuits and lack of treatment guidelines.

• Antibiotic consumption for human health increased by 36% globally between 2000 and 2010, and the demand for antibiotics keeps increasing.
• Antibiotics used in production of food animals was estimated at >63,000 tons in 2010. Without major policy changes, consumption in the livestock sector is projected to rise by more than 60% by 2030.
• Studies show that up to 75% of patients with colds are inappropriately given antibiotics. Antibiotics have no effect at all on colds.

Lack of access to effective antibiotics

While excessive use of antibiotics remains a major problem, in the poorer parts of the world there is lack of access to antibiotics. Weak health systems and unstable central drug distribution systems contribute to shortage of essential medicines. Increasing resistance levels also result in older, cheaper antibiotics losing their efficacy, while newer drugs are unavailable due to high costs.

• Targeted access to antibiotics could avert approximately 445 000 community-acquired pneumonia deaths in children aged younger than 5 years.

Not all bacteria are bad

The vast majority of bacteria are essential for the life and health of humans, animals and the ecosystem. Only a small percentage actually causes disease. Thus, treatment of diseases must be optimized to minimize the ecological impact.

Running out of antibiotics – antibiotic development is no easy task

Antibiotic resistance has been a problem since the introduction of antibiotics, but we always had new antibiotics to replace the ones that stopped working. Now, the antibiotic development pipeline has run dry. We have reached the tipping point where antibiotic resistant bacteria are spreading faster than we can develop new antibiotic medicines.

Developing new antibiotics is both a great scientific challenge and highly resource intensive.

• Scientists have not discovered a new antibiotic class since 1987 that has reached the market.
• Today, there are very few novel antibiotics in advanced stages of drug development, especially against the most troublesome pathogens (resistant Gram-negative bacteria).
• In the current situation, it is expensive and often takes 10 years or more to develop an antibiotic.
• No single antibiotic will be the solution – different bacterial infections require different antibiotics, and resistance development makes constant innovation necessary.

The absence of efficient and low-cost rapid diagnostics is also an obstacle as uncertainty about the cause of infection drives inappropriate use of antibiotics.

Learn more in the ReAct Toolbox

UNDERSTAND: Few antibiotics under development

Lack of public awareness

Antibiotic resistance is not a disease in itself, but instead hampers our ability to treat many different diseases. This makes its individual and societal consequences difficult to visualize or articulate to a general audience.

Despite increased attention and publicity in recent years, awareness and understanding of the issue is low. By tradition, antibiotics are considered to be safe medicines that can be used without consequences. To reach sustainable solutions, a fundamental change in people’s behaviors and attitudes is needed.

Our globalized world

Resistant bacteria do not respect borders and their spread is the stark reality of our interconnected world of trade and travel. Resistance originating in one place can spread rapidly worldwide, in some cases in a matter of weeks. This means that misuse of antibiotics anywhere in the world is enough to overturn achievements in containing resistance elsewhere.

For long, there has been a lot of denial about the gravity of the situation – now we need concrete action!

Learn what ReAct thinks needs to be done in “What do we need?”