Global Health | Antibiotic Crisis as a Social Problem

"Antibiotic resistance threatens the achievements of modern medicine and the health of families worldwide." Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), stated this on Monday in Geneva at the presentation of the new Glass study. The acronym stands for the Global Antimicrobial Resistance and Use Surveillance System, which the WHO established ten years ago to collect and analyze data on the topic. The study provides, for the first time, estimates of the prevalence of resistance in 93 pathogen-antibiotic combinations.

The results are alarming: By 2023, one in six laboratory-confirmed bacterial infections worldwide was resistant to antibiotics. These antibiotics therefore lose their effectiveness in killing bacteria or inhibiting their growth. Between 2018 and 2023, antibiotic resistance (AMR) increased in over 40 percent of monitored cases, increasing by 5 to 15 percent annually.

In 2024, the UN General Assembly set the goal of reducing the number of AMR-related deaths by 10 percent by 2030. However, trends are moving in the opposite direction. The increase in resistance among so-called Gram-negative bacteria is particularly worrying: For example, the resistance of the hospital-acquired pathogen Klebsiella pneumoniae to the broad-spectrum antibiotic imipenem increased by 15.3 percent annually between 2018 and 2023.

Gram-negative bacteria also include E. coli, a common cause of bloodstream and urinary tract infections, as well as non-typhoidal Salmonella, which causes gastrointestinal inflammation. The latter is promoted by the use of antibiotics in factory farming. According to the report, industrial agriculture is a key driver of resistance development.

"It is unlikely that effective treatments for many of these threats will be available in the near future."

Yvan Hutin WHO

Added to this is the pharmaceutical industry's reluctance to develop new antibiotics. "The pipeline is weak, and it's unlikely that effective treatments for many of these threats will be available in the near future," said Yvan Hutin, director of the WHO's AMR department. Many new drugs are simply modifications of existing antibiotics.

The AMR crisis is not only a medical problem, but also a social one. The WHO describes it as a syndemic, in which antibiotic resistance and underfunded health systems reinforce each other. Glass data show that low-income countries with weak health systems have particularly high resistance rates. Medical alternatives are lacking there, which is why antibiotics are often used unchecked. The consequences are serious: "Infections that were once easily treatable now require more expensive and often more toxic antibiotics and pose a higher risk," explained Silvia Bertagnolo, head of the WHO's AMR Surveillance Department. The poorest population groups are particularly at risk.

The highest rates in 2023 were measured in Southeast Asia and the Eastern Mediterranean region, where almost one in three infections was resistant. In Sub-Saharan Africa, it was one in five. Germany is slightly below the global median. The Robert Koch Institute warns that the number of deaths from resistant pathogens could rise to almost 10 million per year worldwide by 2050.

The high rates in low- and middle-income countries are also linked to a diagnostic gap. In sub-Saharan Africa, only about 1.3 percent of laboratories can perform bacterial testing, as a recent study in the journal "The Lancet" shows.

Viktoria Schneitler, senior physician at Düsseldorf University Hospital, points out the consequences: Without laboratory tests, doctors would have to decide whether to let patients die untreated or prescribe the strongest available antibiotic on suspicion. They often resort to reserve antibiotics that are actually intended only for multi-drug-resistant pathogens and require strict monitoring—assuming these medications are even available.

To address the problem, according to the WHO, laboratory capacity must be expanded. And robust surveillance systems are needed, which are still lacking in several countries and regions. By 2030, all countries should be able to report high-quality data to Glass.

This requires significant investment in healthcare systems worldwide, rather than cutting funding. As part of the One Health approach, the organization also calls for stricter controls on the use of antibiotics in agriculture, especially in animal husbandry. The WHO also sees the pharmaceutical industry as having a responsibility: Companies urgently need to invest more in the development of new antibiotics, the report states.