Antimicrobial Resistance (AMR)
Antimicrobials are drugs – such as antibiotics – that kill or control disease-causing microbes. Antimicrobial resistance (AMR) occurs when microbes mutate or adapt in ways that enable them to withstand antimicrobials, rendering treatments ineffective. AMR is dramatically accelerated by the over-use and misuse of antimicrobials, including antibiotics, in people and animals.
Each year, 700,000 people die of AMR. Without action, the death toll could rise even higher, to as many as 10 million deaths annually by 2050 and cause a 3.8 percent reduction in annual gross domestic product (GDP), as identified in a 2017 report entitled ‘Drug-Resistant Infections: A Threat to Our Economic Future’. The world’s poorest people –those living in low- and middle-income countries are disproportionately vulnerable.
It also stands to have a significant impact on gender equity and countries’ human capital as it affects people’s lives through loss of time at school or at work, increased healthcare spending, and reduction in health facilities’ ability to quickly manage a patient’s health condition. Given the important role of health, agriculture and food systems, antimicrobials are critical to ensuring that countries can fully realize their human capital and that we can build more equitable societies.
What can be done to address AMR?
Much can be done to address AMR both at the individual and community levels. For example, public awareness campaigns, increased disease surveillance, and hand hygiene in hospital settings are critical steps in the fight against AMR to stop the spread of infectious agents. At the national level, effective prevention, detection, and response to antimicrobials requires a whole-of-society approach. This requires interventions in the health, water and sanitation, and also food and agriculture, for example:.
• Improving hand hygiene in healthcare settings: Hand hygiene is a cornerstone of infection prevention and control. In healthcare settings, when consistently practiced, hand hygiene reduces healthcare-associated infections (HAI) and thus limits AMU.
• Public awareness campaigns: Increasing awareness and knowledge of the significant and negative impacts of AMR can help limit demand for antibiotics where they are not relevant or appropriate.
Agriculture and Food
• Improving quality of veterinary medicinal products and their use under supervision by veterinarians: Prescribing guidelines will ensure that veterinarians only prescribe antimicrobials when necessary. In situations where animal health systems are weak, this also entails developing viable alternatives so that farmers can transition away from a reliance on antimicrobials.
• Behavior change campaigns and the provision of alternatives: Working with farmers, veterinarians, paraveterinarians and other stakeholders to support behavior change away from the use of antimicrobials in animal production can help to increase the prudent use of antimicrobials.
• Improve infrastructure to provide access to water and sanitation in health centers, schools and other facilities: Strengthening systems to ensure that facilities, particularly hospitals, health centers and schools, have access to clean water and sanitation reduces the spread of infection and disease.
• Implement effective treatment and disposal of sewage and wastewater: Advanced treatment technologies can help reduce the spread of antimicrobial residues and antibiotic-resistant bacteria into the environment
Read more about antimicrobials in the Pandemic Preparedness and One Health sections.
What is the World Bank is doing to address AMR?
Addressing AMR can be highly cost-effective, offering a rate of return on investment of 88 percent per year. Building on many decades of experience, the World Bank is financing 56 projects across 35 countries. These investments are aimed at strengthening and developing agricultural, health and water and sanitations systems, which are critical to preventing the emergency and spread of resistance.
Through its financing and policy dialogue, the World Bank also provides governments with technical assistance and implementation support for AMR-related investments. The World Bank also collaborates with international organizations, donors, and country partners to support improved awareness and understanding of critical issues relating to AMR through reports, trainings, seminars and international convenings.
Current World Bank projects tackling AMR: