In the last few decades, there has been a surge of antimicrobial resistance (AMR). In 2022, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) reported that the AMR rate had increased by 15% compared with 2017 for bloodstream E. coli and Salmonella spp. and gonorrhea Infections. Additionally, the Global Burden of Disease (GBD) study estimated that AMR was the third leading cause of death in 2019. There were 4.95 million deaths associated with AMR globally, and the majority of these deaths occurring in low- and middle-income countries (LMICs).

There are several factors contributing to the high AMR burden in LMICs including the high infectious disease burden, inadequate water, sanitation and hygiene, and lack of surveillance systems coupled with weak governance. These lead to a lack of regulation and poor antimicrobial stewardship programmes, resulting in the injudicious antimicrobial use in human, livestock and agriculture. 

What is the economic cost of AMR?

This high burden of AMR poses a major threat to both health systems and economies. Several frameworks have been developed to guide the cost estimation of AMR, which consider both the direct and indirect costs. Direct cost is defined as healthcare expenditure and resources needed to treat AMR, such as hospitalisation and medications. Indirect costs constitute present and future costs to society such as reduced labour supply due to morbidity and premature death, as well as business productivity costs. In LMICs, these factors are particularly dominant  in agriculture and livestock production. 

Several attempts have been made to quantify the economic burden of AMR. The World Bank estimated that AMR could cause up to 3.8% loss of global annual GDP by 2050, and this number was even higher in LMICs. The loss of GDP was the result of an additional US$1.2 trillion for AMR-related healthcare. Furthermore, healthcare expenditure coupled with low productivity could push an additional 24.1 million people into extreme poverty, of whom 18.7 million would be in LMICs. In 2014, the RAND Corporation projected that global $0.5-6 trillion (US) could be lost per year in 40 years’ time due to the reduced labour force, and most of this loss would happen in Eastern Europe and Asia. Furthermore, KPMG reported that more than 6% GDP would be lost in LMICs by 2050 if the current AMR rest is not contained. However, these estimations were at the macro-economic level and used extensive mathematical modelling and extrapolation due to data limitations in LMICs. 

Although AMR affects all countries, LMICs are disproportionally affected. The multiple impacts of AMR and the lack of data further complicate the effort to estimate the cost of AMR. Therefore, it is imperative to develop and implement comprehensive and effective strategies to combat AMR, with a particular focus on LMICs, to mitigate the potential impact on public health and economies.