A new report from the Organization for Economic Cooperation and Development (OECD) suggests that implementing a mixture of cost-effective policy interventions in human and animal health and food safety could keep the health, economic, and social consequences of antimicrobial resistance (AMR) in check.
But policy makers must act with urgency.
Based on a microsimulation model and machine learning analysis of AMR and antibiotic consumption data from OECD, European Union/European Economic Area (EU/EEA), and G20 nations, the report concludes that, unless governments implement a package of stronger One Health policies to reduce human and veterinary antibiotic use and prevent hospital and foodborne infections, AMR levels will remain high for the next 25 years, resulting in tens of thousands of deaths each year and healthcare costs that exceed those seen during the COVID-19 pandemic.
"The cost of inaction to tackle AMR is high," the report states. "Results from the OECD analysis demonstrate that policy action that is grounded in a One Health approach is urgently needed to tackle AMR."
Resistance will remain high under current trends
Based on 2000-2019 data and current trends, the report estimates that total human and animal antibiotic consumption in OECD, EU/EEA, and G20 countries will remain at current levels by 2035 if no a further action is taken, despite some small declines in human antibiotic consumption—and even larger reductions in antibiotic use in livestock and poultry—that have been observed in recent years.
That projection is based on the fact that while human antibiotic consumption is leveling off in many high-income countries, it's rising dramatically in low- and middle-income countries. In addition, use of last-resort antibiotics, like carbapenems, is projected to increase as the number of multidrug-resistant infections grows.
Similarly, the report projects that trends in resistance proportions (ie, the proportion of infections caused by resistant bacteria), averaged across 12 priority antibiotic-bacterium combinations, will also remain mostly flat if current AMR trends continue and no other policy actions are taken. But the average resistance proportions (20% in OECD countries, 22% in the EU/EEA, and 30% in the G20) are already concerning, and mask wide variations by country.
Results from the OECD analysis demonstrate that policy action that is grounded in a One Health approach is urgently needed to tackle AMR.
For example, while the average resistance proportions are 6% in Norway and Denmark, more than 44% of infections in Turkey and Greece are caused by antibiotic-resistant infections. And that gap will likely widen without efforts to reduce antibiotic consumption, meaning that countries with high average resistance proportions will be worse off by 2035.
"This indicates that countries on the higher end of the range need to do more to reverse current trends, or they will continue to face persistently high resistance," the report states.
In this scenario, the OECD projects that resistance to the last-resort antibiotics needed for multidrug-resistant infections could double by 2035. By 2050, the OECD estimates that resistant infections could claim the lives of 79,000 people each year in 34 OECD and EU/EEA countries, cost healthcare systems in those countries roughly $29 billion US annually combined, and cost the economy an estimated $36.9 billion US in lost workforce participation and productivity.
A mixed package of One Health policies
While many of the countries included in the analysis have implemented national AMR action plans, and some have advanced AMR agendas, implementation is limited to select localities, and compliance is not always guaranteed. Therefore, the report concludes, "it is paramount to continue to invest in policies to tackle AMR through multi-sectoral action."
Through a modeling analysis, the report identifies 11 One Health interventions that, if implemented, would not only mitigate the health impact of AMR but also generate economic gains.
Although all 11 modeled interventions are estimated to reduce infections and deaths, three interventions in human healthcare settings—antimicrobial stewardship programs (ASPs), improved hand hygiene, and improved environmental cleaning practices—would yield the greatest health benefit, with ASPs having the most impact on resistant infections and AMR-related deaths. The model estimates that implementation of ASPs could help avoid 298,000 resistant infections and prevent from more than 3,200 to 10,000 AMR-related deaths each year across the 34 countries analyzed.
Outside of the human health sector, the OECD model estimates that scaling up enhanced farm hygiene measures (like use of personal protective equipment) and enhanced hygiene in food handling could be effective ways of reducing foodborne bacterial infections and limiting the impact of AMR.
If the 34 countries were to implement a mixed package of these policies across the human and non-human health sectors, as opposed to implementing them in isolation, the model estimates that 1.6 million resistant infections and 17,000 deaths could be averted. And with the resulting reduction in healthcare expenditures and increase in workforce participation and productivity, the model estimates the average annual cost of implementing these interventions would be five times lower than the projected economic benefits.
"Scaling up investments in One Health packages of actions against AMR is affordable, with a return on investment significantly greater than implementation costs," the report concludes. "The health and economic benefits of implementing One Health policies as policy packages far exceed the benefits accrued by implementing these policies in isolation."