Tackling a silent killer: why antimicrobial resistance matters

Antimicrobials, natural or manufactured substances that can resist and prevent the growth of microbes such as bacteria, viruses, fungi and parasites, are essential for the health and welfare of both animals and humans.

Unfortunately, antimicrobials are becoming less effective. Antimicrobial Resistance (AMR) occurs when microbes evolve, adapt and resist to medicine. This phenomenon is amplified when antimicrobials are misused—sometimes in too small quantities, sometimes in excess, and often for the wrong purpose. This poses grave consequences for the world’s population and is a particular threat to vulnerable groups who lack access to both old and new medicine.

One of the biggest killers

According to a recent study by the Institute of Health Metrics, 39 million people could die from AMR between now and 2050 AMR’s economic impacts by 2050 also stand to be significant: annual global GDP losses could reach US$ 1.7 trillion. In addition, resistant pathogens spreading from livestock to humans could cost up to US$5.2 trillion, and production losses in the livestock sector could be as great as the needs of more than two billion people. In short, tackling antimicrobial resistance could improve food security, save millions of lives, boost productivity, build more resilient societies, and support progress on a wide range of development priorities.

To support governments in the fight against AMR, in May 2024, the World Bank launched Stopping the Grand Pandemic: A Framework for Action to Address AMR through World Bank Operations. This Framework highlights 20 areas for government to address AMR, which can be financed by the World Bank. It is intended to be a starting point for mitigating the negative impacts of AMR. From hand washing to infection prevention and control, much can be done to stop the emergence and spread of resistance.

Antimicrobials, humans and animals

The livestock industry is one area with significant potential for impactful action. The livestock industry has a role to play. For instance, the World Organisation for Animal Health (WOAH) reveals that countries reported a global 2% increase in antimicrobial use per kilo of meat between 2019 and 2021, following a period of significant decrease. Further, almost 20% of its member countries reported using antimicrobials as a growth promoter, including 11% using antimicrobials commonly used for human medicine.

In this context, increased veterinary oversight, and improving animal husbandry practices and biosecurity have an important role to play. However, implementing these interventions requires access to data on antimicrobial use in food-producing animals, along with investments in monitoring, surveillance, and the expansion of veterinary laboratory capacity and diagnostic services.

A Danish success story

Denmark has had substantial success in addressing AMR in its livestock and agricultural sector, thanks to a strong focus on registration, advisory services, management of livestock in stables and educational programming the livestock sector have contributed to a 12% reduction in sales of antibiotics.

Since 1992, Denmark has registered all production animals such as cattle, pigs, and poultry in the Central Husbandry Register, a database owned by the Ministry of Food, Agriculture and Fisheries.

Since 2000, Denmark's VetStat system, managed by the Danish Veterinary and Food Administration, has collected detailed data on all prescribed animal drugs, with a focus on production animals. Both systems have led to greater transparency and a national action plan that has restricted the use of antibiotics, and continues to issue guidance for the industry.

Lessons from Southern Africa

A major World Bank-financed loan to fight tuberculosis and strengthen health systems in Lesotho, Malawi, Mozambique and Zambia has resulted in the creation of 155 cutting-edge laboratories to tackle antimicrobial resistance in humans. The program supplies equipment and infrastructure, standardizes procedures for monitoring multi-drug-resistant tuberculosis variants, and strengthens technical cooperation among key partners, including the African Union and the East, Central, and Southern Africa Health Community.

What’s next?

In September 2024, decision-makers from around the world gathered at the United Nations General Assembly in New York to adopt a landmark declaration that marked an important and much-anticipated milestone in addressing AMR. Crucially, the declaration emphasized the importance of multi-sectoral collaboration, including from governments, international organizations, and the private sector, to ensure sustainable and equitable progress in tackling AMR worldwide.

Currently, the World Bank channels approximately $2.6 billion in financing to address AMR across 40 countries through 47 projects. Building on this foundation, the World Bank will continue to prioritize AMR through expanding surveillance and data collection, strengthening registration systems, and improving livestock management around the world.

Learning from both successful and challenging experiences—from Denmark to Southern Africa—will be a critical way to achieve more effective, resilient approaches to combating antimicrobial resistance globally.