The GRAM Project is a partnership between the University of Oxford and the Institute for Health Metrics and Evaluation at the University of Washington. Oxford GRAM is led by Professor Cooper and Professor Dolecek who are based at the Centre for Tropical Medicine and Global Health.
Published in The Lancet, the study is the first comprehensive analysis of bacterial AMR trends over time. It also forecasts these trends to provide future estimates of global AMR deaths from now until 2050, to provide policymakers with evidence to support data-driven decisions to address AMR.
The study forecasts a 67.5% increase in annual deaths directly attributed to bacterial AMR, rising from 1.14 million in 2021 to an estimated 1.91 million in 2050. Deaths associated with AMR are also expected to increase by 74.5%, from 4.71 million in 2021, to 8.22 million deaths in 2050.
Bacterial antimicrobial resistance (AMR) occurs when bacteria change in a way that makes them no longer respond to medicines. As such, people die from common infections such as pneumonia, urinary tract infections, and diarrhoea because bacteria have become resistant to treatment.
The estimates suggest bacterial AMR remains a constant and growing global health threat, with over a million lives lost each year since 1990 – a total of more than 36 million deaths. Among the different types of antibiotic-resistant infections, methicillin-resistant Staphylococcus aureus (MRSA) was responsible for the largest increase in deaths between 1990 and 2021.
Notably, for the first time, GRAM estimates show that that AMR poses the biggest threat to older adults, as deaths in adults aged 70 and older increased by more than 80% between 1990 and 2021. This suggests that the threat of AMR is set to grow even further over time due to rapidly ageing populations that are more vulnerable to infection.
Dr. Christopher J.L Murray, Director of the Institute for Health Metrics Evaluation and lead for the GRAM study explains: ‘New estimates indicate that AMR has always been, and remains, an urgent global health threat. With projections showing over 39 million deaths directly attributable to bacterial antimicrobial resistance from 2025-2050, we can better understand this the impact of this burden. By utilizing estimates provided in the GRAM report, policymakers can leverage data-driven decision making to effectively tackle this crisis.’
Dr. Timothy Jinks, Head of Interventions in Wellcome’s Infectious Disease team comments: ‘While there has been some progress tackling AMR in recent years, it isn’t enough and more needs to be done. The GRAM estimates are an important tool in the fight against AMR, and we hope that global policymakers utilise the paper’s findings to make evidence-based decisions, supporting the development and implementation of impactful National Action Plans. By doing so, the implementation of bold action on AMR can strengthen health systems and protect the world’s most vulnerable from infectious disease.’
The latest GRAM estimates suggest that low- and middle-income countries face a disproportionate burden. Sub-Saharan Africa and South Asia account for the highest rates of attributable and associated AMR deaths, with a particularly high number of deaths from multi-drug resistant (MDR) tuberculosis.
As well as causing death, AMR puts strain on vulnerable health systems and national economies, creating the need for more expensive and intensive care, and contributing to a GDP loss of $1-3.4 trillion per year by 2030.
Dame Sally Davies, the UK Special Envoy on Antimicrobial Resistance said: ‘This landmark study confirms that the world is facing an antibiotic emergency, with devastating human costs for families and communities across the world. It substantiates our calls to all sectors to take decisive action now to save lives and save modern medicine for generations to come, and address the needs of low-and-middle income countries who bear the greatest tragedies from AMR. Next week's High-Level Meeting is a crucial milestone for global leaders to commit to political action on AMR, and afterwards, we all need to work together to move forward.’
While action on AMR happens locally – primarily in health systems as well as in communities – urgent action from global leaders is needed to help secure faster progress and greater global impact. Ahead of upcoming political moments, GRAM partners call on global leaders and healthcare professionals to leverage this new evidence to correct the trajectory and take decisive action to protect people around the world from the growing threat of AMR.
Read the full study in The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01867-1/fulltextcet