Antimicrobial resistance

AMR is one of the top ten threats to global public health.

In 2019, more people died from AMR than from AIDS or malaria, as an estimated 1.2 million deaths were directly attributable to drug-resistant strains of common bacterial infections. This number is expected to increase to 10 million deaths per year by 2050. The highest burden of AMR is in low- and middle-income countries, and the growth of AMR is projected to result in a 25% increase in healthcare costs in low-income countries by 2050, compared with a 6% increase in high-income countries.

Testing plays a key role in reducing AMR by improving diagnosis of infections to prevent unwarranted use of antibiotics that can allow drug resistance to develop, and to rapidly detect and contain resistant infections.

Some pathogens are particularly adept at developing drug resistance. In gonorrhoea, AMR emerged almost as soon as antimicrobial medicines began to be used, and has continued to expand for more than 80 years. In the absence of a diagnostic test, gonorrhoea is indistinguishable from chlamydia, making it challenging to treat correctly. With over 82 million new cases of gonorrhoea occurring in 2020, extensively drug-resistant “super gonorrhoea” is now a major concern.

The COVID-19 pandemic caused significant setbacks in the fight against AMR. Many people with COVID-19 were prescribed inappropriate antibiotics, which may have fuelled an increase in other drug-resistant infections.

Tackling AMR also goes beyond human health, as interventions must be aligned with antimicrobial control in animal health and environmental measures – this integration is known as the ‘One Health’ approach. By linking humans, animals and the environment, One Health can help to address the full spectrum of disease control – from prevention to detection, preparedness, response and management – and contribute to global health security.

Our AMR strategy focuses on preventing further development of AMR by increasing access to testing for infections associated with AMR at the primary care level. We are working to reduce AMR deaths by improving diagnosis in hospitals for severe blood stream infections, including neonatal sepsis. We are also supporting the development of digital tools to strengthen AMR surveillance and antimicrobial stewardship, in line with the One Health approach.

Working with partners we will deliver:

• 1–2 affordable point-of-care tests for gonorrhoea and chlamydia
• 1–2 field evaluation studies to inform WHO Prequalification on gonorrhoea and chlamydia point-of-care tests
• Demonstration studies for gonorrhoea and chlamydia point-of-care tests
• Digital decision support and data collection tools to support antimicrobial stewardship programmes
• A simplified blood culture system adapted for LMICs to enable the use of point-of-care tests for AMR detection or price reduction for existing automated systems
• Demonstration studies on cost-effectiveness of bundled AMR diagnostic solutions for level two of the healthcare system, including digital solutions
• Support for the development of decentralized surveillance systems in two countries