ANTIMICROBIAL Resistance (AMR) is no longer a future risk; it is a current crisis affecting human health, animal production, the environment and national economies.
AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial medicines such as antibiotics, making infections harder to treat and increasing the risk of severe illness and death. Misuse, abuse and overuse of antimicrobials, especially antibiotics are major accelerators of this “silent pandemic.”
The global burden is already devastating. In 2019, 1.27 million deaths were directly attributable to AMR, while 4.95 million deaths were associated with AMR. Newer estimates show 1.14 million deaths attributable and 4.7 million deaths associated in 2021. Alarmingly, around 20% of AMR deaths occur in children under five, reflecting the unequal toll on vulnerable populations.
AMR is multifactorial and multidimensional. It is fuelled by prescriptions that do not follow standard guidelines, limited access to diagnostics, low access to WASH, weak infection prevention and control (IPC), suboptimal quality of care and the availability of substandard or falsified medicines. When diagnostics are missing and infection control is weak, antibiotics are often used “just in case,” driving resistance further. In human health, resistance is spreading rapidly: 1 in 6 bacterial infections globally is antibiotic-resistant, with particularly high resistance in E. coli, Klebsiella pneumoniae and Staphylococcus aureus. Animal health and agriculture are also central to the crisis. 70–80% of global antibiotics are used in food-producing animals, with 99,500 tonnes of antimicrobials used in animals glob-ally in 2020 and further increases projected by 2030. In many settings, antimicrobials are still used routinely for growth promotion and prophylaxis, creating resistant bacteria that can spread through the food chain and direct contact.
The environment is both a reservoir and a transmission pathway. Around 80% of global wastewater is released without adequate treatment, allowing antibiotic residues from hospital wastewater, pharmaceutical effluents and agricultural runoff to contaminate rivers, soil and sewage systems. Resistant genes have been detected widely, showing that AMR is not confined to clinics and farms. It is embedded in ecosystems.
The economic impact is equally serious. Current direct healthcare costs due to AMR are about US$66 billion per year, projected to rise to US$412 billion annually by 2035. AMR could drive US$3.4 trillion per year global GDP loss by 2030 and a 3.8% reduction in global GDP by 2050. Between 2025 and 2050, 39 million cumulative deaths are projected, while global investment needs are estimated at US$63 billion per year to control AMR.
Pakistan faces a heavy burden. In 2021, 39,700 deaths were directly attributable and 161,000 deaths associated with AMR, while combined estimates suggest over 200,000 deaths per year. Antibiotics represent around 60% of all prescriptions and consumption exceeds 20 DDD per 1,000 people per day, with high resistance in E. coli, Klebsiella and Salmonella.
In Pakistan, livestock consumed 3,072 metric tonnes of antibiotics in 2019 (54% human, 34% animal, 12% via animal feed), including 805.39 tonnes of critically important human antibiotics (2017–19) and 577.18 tonnes through poultry feed, with resistance in food animals exceeding 50% for E. coli and Salmonella. Addressing AMR requires a One Health approach that integrates human, animal and environmental health, supported by stronger regional cooperation, improved diagnostics, better infection prevention and control, responsible atimicrobial use and coordinated research and training to safeguard health, food and economic security.
—The writer is contributing columnist, based in Islamabad.
