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Antimicrobial resistance (AMR) is responsible for at least 1.27 million deaths per year — with over 97,000 deaths in 2019 in SE Asia alone, according to a study published in The Lancet by the Global Research on AntiMicrobial resistance (GRAM) project, who urged urgent action from policymakers and health communities to avoid further preventable deaths.

World map of global burden of bacterial antimicrobial resistance, colour-coded by country, showing the percentage of isolates with resistance
Fluoroquinolone-resistant Escherichia coli (2019) (Source: Lancet)

20 January 2021 – Antimicrobial Resistance (AMR) is a leading cause of death globally, higher than HIV/AIDS or Malaria, according to a paper published today in The Lancet. In Southeast Asia alone, researchers estimate that over 97,000 people died as a direct result of AMR in 2019. Globally, they estimate that AMR is responsible for at least 1.27 million deaths per year — one in 5 of them occurring in children under the age of 5.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.

The paper by the Global Research on AntiMicrobial resistance (GRAM) project found that there are worryingly high rates of AMR across Southeast Asia. In 2019, leading pathogens were E. coli, K. pneumoniae, A. baumannii, S. aureus, and S. pneumoniae.

This paints a concerning picture for tackling AMR in the region. And with high levels of hospitalisations from COVID-19, there is a risk that the burden of AMR has already accelerated due to increased use of antibiotics.

Although a number of countries in the region, including Thailand, have developed National Action Plans to respond to AMR, challenges such as a lack of enforcement and regulation as well as a lack of AMR epidemiologists have hampered implementation efforts.

Health systems in Southeast Asia and around the world depend on effective antibiotics. AMR is threatening the ability of hospitals to keep patients safe from infections and undermining the ability of doctors to carry out essential medical practice safely, including surgery, childbirth and cancer treatment since infection is a risk following these procedures.


“The new data in the GRAM paper confirms the scale of antimicrobial resistance and the threat it poses for health systems in Southeast Asia, and worldwide. We now need to develop effective and comprehensive policies to respond to this threat,”
Professor Direk Limmathurotsakul, Head of Microbiology at Mahidol-Oxford Tropical Medicine Research Unit (MORU), in Bangkok.

Published in The Lancet, and based on estimates across 204 countries and territories, the paper, Global burden of bacterial antimicrobial resistance in 204 countries and territories in 2019, provides the most comprehensive estimate of the global impact of antibiotic resistance to date. It reveals that AMR has now become a leading cause of death globally. The paper also highlights specific areas of concern and equips governments and health communities with the information they need to act quickly and develop a proportionate response.

Common infections such as lower respiratory tract infections, bloodstream infections, and intra-abdominal infections are now killing hundreds of thousands of people every year because bacteria have become resistant to treatment​. This includes historically treatable illnesses, such as pneumonia, hospital-acquired infections, and food-borne ailments.

An estimated 4.95 million people who died in 2019 suffered from at least one drug-resistant infection and AMR directly caused 1.27 million of those deaths. The data shows that in 2019, one in five deaths attributable to AMR occurred in children under the age of five – often from previously treatable infections.

Current action plans on AMR are not ambitious or fast enough to control this threat.

Previous estimates had predicted as many as 10 million annual deaths from AMR by 2050. In 2022, as we now have access to these robust estimates, we now know that we are already far closer to this figure than expected.

We are not innovating fast enough to develop effective vaccines, medicines and treatments:

  • Between 1980 and 2000, 63 new antibiotics were approved for clinical use. Between 2000 and 2018, just 15 additional antibiotics were approved.  
  • Out of the seven deadliest drug-resistant bacteria, vaccines are only available for two (Streptococcus pneumoniae and Mycobacterium tuberculosis).​
  • Whilst all seven of the leading bacteria have been identified as ‘priority pathogens’ by the World Health Organization (WHO) only two have been a focus of major global health intervention programmes – S. pneumoniae (primarily through pneumococcal vaccination) and M. tuberculosis.  

Discussing the importance of the new estimates to direct urgent action, Director of the Institute for Health Metrics and Evaluation, Professor Chris Murray, said:

“This paper is a critical step that allows us to see the full scale of the challenge. We now need to leverage these estimates to course-correct action and drive innovation so we can control the threat and avoid further preventable deaths."

There are immediate actions that can help countries around the world protect their health systems against the threat of AMR:

  1. We need to take greater action to monitor and control infections, globally, nationally and within individual hospitals.
  2. We must accelerate our support for infection prevention and control, as well as expand access to vaccines and clean water and sanitation.
  3. We must optimise our use of antibiotics unrelated to treating human disease, such as in food and animal production, taking a One Health approach and recognising the interconnection between human and animal health.
  4. It’s time to be more thoughtful about our use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed, minimising use where they are not necessary to improve human health, and acting according to WHO Global Action Plan and AWaRe guidelines.
  5. We must increase funding at every stage of the development pipeline for new antimicrobials targeting priority pathogens - from research for high priority bacteria, such as K. pneumoniae and E. coli, to securing access through innovative market solutions.

The GRAM leadership team at the University of Oxford, Prof Christiane Dolecek, Dr Catrin Moore, and Prof Benn Sartorius, also commented:

“Being able to measure AMR, and compare it with other major health threats, is essential to addressing its serious consequences. This work incorporates the best available data and provides reliable evidence describing the substantial mortality and morbidity caused by AMR globally. We anticipate that policymakers will use these results as we intended them, to drive action.”

Authors of the paper are hopeful that, with this new data, the world is better equipped than ever to correct the trajectory. COVID-19 has demonstrated the importance of global commitments to infection and control measures, such as hand washing and surveillance, and rapid investments in treatments.


“The COVID-19 pandemic has highlighted the importance of global collaboration: political leaders, the healthcare community, the private sector and the public working together to tackle a global health threat. Like COVID-19, we know what needs to be done to address AMR, but we must now come together with a sense of urgency and global solidarity if we are to be successful,”
Tim Jinks, Head of Intervention, Infectious Disease at Wellcome Trust.

ABOUT THE GLOBAL RESEARCH on antimicrobial resistance paper

The paper was authored by the Global Research on Antimicrobial Resistance (GRAM) Project, a partnership between the Institute for Health Metrics and Evaluation (IHME) and the University of Oxford. GRAM was launched with support from the Fleming Fund, the Wellcome Trust, and the Bill & Melinda Gates Foundation. The Gates Foundation’s cross-cutting Antimicrobial Resistance (AMR) strategy is focused on preventing drug resistant infections and related mortality in the most vulnerable populations in low and middle-income countries.

The paper is based on 471 million actual individual records or isolates (not projections) from 7,585 study-location-years, with modeling that allows for comparable final estimates across all 204 countries and territories. No paper on AMR has ever been this comprehensive and covered as many countries and data sources. Accurate and timely estimates of AMR burden can be used to inform treatment guidelines and agendas for research and policymaking, to detect emerging problems, and to promote solutions.

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