Josep Figueras and Anna Sagan from the European Observatory on Health Systems and Policies focus here on antimicrobial resistance and ponder whether or not this could be the next big pandemic

The sudden emergence of the COVID-19 pandemic brought the world to its knees in 2020. To date, over 800,000 people across the globe have succumbed to the deadly virus and, sadly, the count keeps on rising. With national economies plunging into contractions following many weeks of lockdowns, the full societal cost of the pandemic is yet to unravel.

Despite the existence of International Health Regulations (IHRs), national pandemic preparedness plans, and some high-profile warnings in recent years, COVID-19 has caught us all largely off guard.

After over nine months since the first case was reported, the virus remains present in most countries around the world and uncontrollable in some. With children back at schools and with health systems in the northern hemisphere preparing for the winter influenza season, it is unsurprising that COVID-19 continues to captivate the attention of the general public and public decision-makers alike.

The danger of antimicrobial resistance

Yet, there are other challenges that we must not forget about. Antimicrobial resistance (AMR) is one of the urgent global health challenges of our times. AMR is the natural ability of microorganisms such as bacteria to become resistant to antimicrobial medicines. This Darwinian ability has always been present, and, in the past, we have responded to it by developing novel antibiotics and other antimicrobials. However, as global consumption of antibiotics in both humans and animals has increased and the antibiotic pipeline has dried up, AMR has increasingly put modern medicine under threat. In the relatively near future, AMR may render operations as easy as a wisdom tooth extraction, let alone hip replacement, organ transplant or cancer chemotherapy, impossible. The consequences of this may potentially be more severe and more difficult to contain than that of COVID-19.

Can AMR be mitigated?

Drug-resistant diseases already claim at least 700,000 lives globally and this number is estimated to rise to 10 million deaths each year by 2050 if no action is taken. In the EU alone, AMR causes the estimated death of 33,000 individuals every year and costs the bloc about €1.5 billion per annum in healthcare costs and productivity losses.

However, this burden can be reduced significantly by implementing effective intersectoral policies. A recent report by the Organisation for Economic Co-operation and Development (OECD) and the European Centre for Disease Prevention and Control (ECDC) review policies that are currently in place and show how this can be achieved affordably and cost-effectively. AMR is a threat we know and can mitigate.

But unlike COVID-19, the danger of AMR has been creeping up on us silently and gradually and it has taken time for the seriousness of this threat to trickle down to the public consciousness. Further, the complexity of the problem and the need for an integrated response across human, animal and environmental sectors can prove challenging. In many countries, AMR is still perceived more as a human health problem and there is insufficient coordination across sectors. Yet, international and national efforts to combat AMR have increased substantially over the past two decades, and a number of important positive developments can be noted.