As Deaths From ‘Superbugs’ Rise, Health Authorities Float Multiple Strategies
Antibiotics are among the greatest medical advances of the 20th century. Their widespread use has revolutionized healthcare, increased life expectancy worldwide, and saved countless lives by effectively treating bacterial infections that were once fatal.
However, this progress is threatened by the rise of “superbugs”—antibiotic-resistant bacteria, and, more broadly, antimicrobial resistance (AMR) among various microscopic pathogens, including viruses and fungi.
As a result, medical researchers, drug developers, and pharmaceutical companies are joining with health authorities and NGOs to find effective approaches for controlling AMR. Their strategies include developing new treatments, encouraging the prudent use of antibiotics, and finding ways to stop the spread of resistant pathogens.
History of Antibiotics
For millennia, diseases and life-threatening conditions caused by bacterial infection, such as pneumonia, tuberculosis, sepsis, and meningitis, were often deadly. In the mid-1300s, bubonic plague caused by the bacterium, Yersinia pestis, led to the Black Death, a pandemic that killed 75 million to 200 million people worldwide.
But in the 20th century, these lethal diseases were turned into treatable conditions. The modern era of antibiotics began in 1928 with the discovery of penicillin by Alexander Fleming. This event marked the beginning of a new class of drugs capable of effectively and selectively killing bacteria or inhibiting their growth.
By the 1940s, antibiotics had become widely available. Penicillin dramatically reduced mortality rates from wound infections during World War II and successfully treated the ancient disease of gonorrhea. In addition to curing existing infections, antibiotics enabled major medical advancements, such as safer surgeries and complex medical procedures, by greatly reducing the risk of post-surgical infections. Because of their remarkable effectiveness and cheap manufacturing costs, antibiotics have also become widely used in agriculture to improve animal health and productivity.
The World Health Organization (WHO) now lists germ resistance as one of the world’s leading health challenges, and millions of deaths are already attributed to microbial pathogens that do not respond to the classes of drugs that once destroyed them.
By the mid-20th century, antibiotics were hailed as miraculous wonder drugs. However, their overuse and misuse paved the way for the dangerous rise of antibiotic-resistant strains of bacteria or superbugs. The World Health Organization (WHO) now lists AMR as one of the world’s leading health challenges, and millions of deaths are already attributed to microbial pathogens that do not respond to the classes of drugs that once destroyed them.
Development of Antibiotic Resistance
The struggle over antibiotic resistance was not unexpected.
The first widely recognized instance of a superbug was the emergence of penicillin-resistant strains of the bacterium, Staphylococcus aureus, shortly after the mass use of penicillin during World War II. In 1959, a groundbreaking new antibiotic, methicillin, was developed to combat penicillin-resistant bacteria. But by 1961, strains of methicillin-resistant Staphylococcus aureus (MRSA) were already identified. These sobering developments demonstrated the uncanny ability of bacteria to rapidly adapt to antibiotics and highlighted the necessity of cautious use and continued development of new treatments.
Antibiotic resistance occurs when bacteria—through genetic mutation, natural selection, and transfer of genetic elements—develop mechanisms to survive the drugs designed to kill them. The more antibiotics are used, the greater the selective pressure on bacteria, thereby accelerating their ability to develop resistance.
Eventually, the antibiotic eliminates the original bacterial strain, but the mutant bacteria that are impervious to the antibiotic remain and continue to multiply uncontrollably. When that happens, the once-miraculous antibiotic is no longer effective. A harmful bacterium that becomes resistant to several antibiotics has become a superbug.
Looming Global Health Crisis
The increasing prevalence of AMR and superbugs poses a serious global health crisis because it could return humanity to a situation in which common infections could again be life-threatening.
According to a study published in 2022 in The Lancet and referenced in the CDC's 2019 Antibiotic Resistance Threats Report, bacterial AMR was estimated to have directly caused 1.27 million deaths globally in 2019. Another study published in The Lancet in 2024 found that, worldwide, an estimated “4.71 million deaths… were associated with bacterial AMR” in 2021 alone.
Although the 2024 study found that AMR-linked deaths fell by 50% among children under age 5 from 1990 to 2021, the death rate during the same period rose by more than 80% for adults 70 years and older.
Deaths from MRSA have doubled since 1990 to about 680,000 in 2021, the 2024 Lancet study said. “Resistance to carbapenems [broad-spectrum antibiotics] increased more than any other antibiotic class,” it added.
In 2016, the Review on Anti-Microbial Resistance projected that AMR deaths could surpass 10 million annually by 2050.
In 2016, the Review on Anti-Microbial Resistance projected that AMR deaths could surpass 10 million annually by 2050 if the threat is not fully addressed. In addition, the World Bank estimates that AMR could reduce the global GDP by nearly 3.8% by 2050.
Strategies to Deal with AMR
In response to the burgeoning threat to humanity posed by AMR, a concerted global effort is underway. Various strategies have been implemented to combat this crisis, ensuring the continued efficacy of antibiotics and preserving public health. These strategies include:
Antibiotic stewardship. Antibiotic use is optimal when prescribed only when necessary to treat a known infection. Education and training for healthcare professionals can counter attitudes about prescribing antibiotics unnecessarily and encourage patient follow-up to ensure dosage compliance and track treatment outcomes.
Surveillance and monitoring. Surveillance systems are necessary to track current antibiotic-resistant infections and to monitor trends over time. The WHO and the CDC have established extensive surveillance networks.
Development of new antibiotics. Given the rise in resistance, there's an urgent need for new classes of antibiotics. However, the pace of antibiotic discovery has slowed in recent decades, partly because antibiotics are less profitable for pharmaceutical companies compared to other drugs. Governments and health organizations need to incentivize antibiotic research and development through grants, subsidies, and public-private partnerships.
Research and development of novel therapies. Alternative treatments to fight bacterial infections are being explored. Some of these include antimicrobial peptides, immunotherapies, and phage therapy, in which key viruses are deployed to attack certain bacterial pathogens.
Reducing agricultural antibiotic use. Stricter regulations on the use of antibiotics in agriculture are essential. Policies should include improving animal welfare and hygiene to prevent infections and reduce the need for antibiotics.
Global collaboration. AMR is a global issue requiring international cooperation. Global efforts, like the WHO’s Global Action Plan on Antimicrobial Resistance, can help combat resistance on an international scale.
Global Efforts Underway
This year, the WHO designated a full week in November to AMR awareness and to sound warnings about the threat of AMR.
Meanwhile, other global gatherings have been convened this year to address the AMR threat:
United Nations General Assembly High-Level Meeting (HLM)
In September, the United Nations General Assembly held the second High-level Meeting (HLM) on Antimicrobial Resistance. Nations committed to reducing the global number of deaths associated with bacterial AMR (4.95 million deaths in 2019) by 10% by 2030. The main thrust of the HLM’s “political declaration” was to set targets, such as “strengthening governance mechanisms for the response to AMR, using a One Health approach, addressing AMR in human, animal and plant health.”
“There is a great appetite to address the slow global, regional and national response that needs to be accelerated to address AMR and its dire effects on the One Health ecosystem,” said Dr. Mirfin Mpundu, director of ReAct Africa, at a UN plenary meeting held in February.
“There is a great appetite to address the slow global, regional and national response that needs to be accelerated to address AMR and its dire effects on the One Health ecosystem.”
World AMR Congress
Also in September, the World AMR Congress was held in Philadelphia, with speakers from government, science, and industry addressing AMR mitigation strategies “from fundamental research to commercial production.” Speakers included representatives from the US Centers for Disease Control and Prevention and Department of Health and Human Services, as well as the AMR Action Fund, and CARB-X.
ReAct Africa Regional AMR Conference
In July, ReAct Africa co-hosted the 2024 regional AMR annual conference in Zambia, under the theme “Global Accountability for AMR response: Investing in priorities for Africa.” The conference, funded in part by Wellcome Trust and the Ministry of Health Zambia, facilitates cross-learning to strengthen “the development and implementation of AMR National Action Plans (NAPs)” in African nations.
BEAM Annual AMR Conference
In March, BEAM (Biotech companies in Europe combating Antimicrobial Resistance) held its 8th Annual AMR Conference 2024, calling its gathering “the one-stop shop to catch up with the latest trends in the development of AMR products, by covering scientific, regulatory, financial and policy topics.”
The BEAM conference typically brings together over 70 small to medium-sized European biotech and diagnostics companies that work to develop innovative products that fend off antibiotic-resistant pathogens. In addition, the BEAM Alliance supports “policies and incentives in antimicrobial research and development in Europe.”
Such international collaboration, exemplified by global action plans and high-level commitments, underscores the recognition of AMR as a shared health challenge that transcends national borders. With millions of lives already affected and projections warning of increasing AMR-associated mortality rates if left unchecked, the need for a unified global response is called for. By implementing prudent antibiotic stewardship, developing novel treatments, administering stricter agricultural policies, and fostering strong international cooperation, there is real hope that the AMR crisis can be effectively mitigated.
*Richard Park has 29 years of experience as an infectious disease scientist in academia and the biotechnology industry. He received his Ph.D. in Biology from Johns Hopkins University, and has held academic positions at Johns Hopkins University, Cornell University, and Yale University. Dr. Park was also Director of Research at Nuclixbio, Inc. He is currently a junior research faculty member at Yale University.
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