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The state of the world’s antibiotics in 2021

by Sam Willcocks

The Center for Disease Dynamics Economics and Policy (CDDEP) has published The State of the World’s Antibiotics in 2021 as a follow-up to their 2015 report. This comprehensive body of work provides the most up-to-date snapshot of where we stand in the AMR crisis. 

In addition, this report is an excellent resource for at-a-glance statistics on AMR in different countries around the world. Want to know what percentage of Salmonella spp. isolates are tetracycline resistant among UK chickens? How many tonnes of antibiotics were used in animal production in Thailand last year? You can find the answers in this report.

It is thanks to the tireless work of everybody involved in collating this data that we have at least some grasp of where we are, where we are headed, and what yet needs to be done. I wish I could say that the future looks rosy, especially after the year we have all just had – but the truth is that to many of our readership, the key messages of the report will appear woefully familiar. In all the metrics that matter most, we are, globally speaking, heading in the wrong direction.

AMR is a complex challenge, solving it is difficult. To highlight just one example from the report: “Although AMR poses an urgent global public health threat, more people in low- and middle-income countries die from lack of access to antimicrobials than from resistant infections”. How do we practically and ethically resolve the implicit conflict between reducing antibiotic use and ensuring equitable access? Such is the task at hand.

To paraphrase Marie Skłodowska-Curie, whose name now adorns the pale stone edifice of LSHTM in Keppel St: “I was taught that the way of progress was neither swift nor easy”.

Key findings from the report:

  • The so-called ‘One Health’ approach has remained more a concept than a widely adopted practice in managing disease risk.
  • Both the use of antimicrobials and AMR continues to rise globally; weighted average resistance levels are generally higher in low- and middle-income countries (LMICs).
  • Resistance to first-line antimicrobial agents is rapidly emerging among the pathogens that cause HIV, malaria, and typhoid fever, threatening global progress in eliminating these infectious diseases.
  • Vaccines against many infectious agents are available, but low vaccination coverage, coupled with poor water, sanitation, and hygiene (WASH) infrastructure, leave many people vulnerable to infection and dependent on antibiotics for treatment.
  • The enormous increase in the demand for animal protein has rapidly increased the use of antimicrobials in the animal health sector
  • China and India represented the largest hotspots of resistance, with new hotspots emerging in Brazil and Kenya.
  • Antibiotic research and development lags behind clinical need, and the antibiotic pipeline is not equipped to mitigate the effect of increasing resistance to current antimicrobials.
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