New global targets proposed to reduce AMR-linked deaths and improve access to essential antibiotics

Access to effective antibiotics is essential to all health systems in the world. Antibiotics prolong lives, reduce disabilities, limit health care costs and enable other life-saving medical interventions such as surgery. However, antimicrobial resistance (AMR) threatens this backbone of modern medicine and is already leading to deaths and disease which would have once been prevented.

Speaking at the World Health Assembly on May 28, 2024, leading scientists who authored the new Lancet series—including researchers at St George's, University of London—are calling for urgent global action on AMR to ensure more sustainable access to antibiotics and increased investment in new antibiotics, vaccines and diagnostics.

Each year, an estimated 7.7 million deaths globally are caused by bacterial infections—1 in 8 of all global deaths, making bacterial infections the second largest cause of death globally. Out of these, almost 5 million deaths are associated with bacteria which have developed resistance to antibiotics.

Scientists warn that if the world does not prioritize action on AMR now, we will see a steady increase in the global death toll with young infants, elderly people, and people with chronic illnesses or requiring surgical procedures at the highest risk.

Improving and expanding existing methods to prevent infections—such as use of pediatric vaccines, hand hygiene, regular cleaning and sterilization of equipment in health care facilities, availability of safe drinking water and effective sanitation—could prevent more than 750,000 deaths associated with AMR every year in low- and middle-income countries.

The '10-20-30 by 2023' goals

In The Lancet series on AMR published May 23, an article by Professor Mike Sharland and colleagues proposes ambitious yet achievable global targets to address the need for more sustainable access to effective antibiotics: the "10-20-30 by 2030" goals:

• A 10% reduction in mortality from AMR by scaling up public health interventions to prevent infections in the first place, reducing both antibiotic use and resistance and enabling great access.
• A 20% reduction in inappropriate human antibiotic use.
• A 30% reduction in inappropriate animal antibiotic use to be achieved by incremental actions in many sectors.

They say these goals should be adopted at the upcoming High-Level meeting as part of the United Nations General Assembly in September 2024 within a framework of universal access to effective antibiotics.

"The Lancet AMR series focuses on the need for clear actionable targets to combat AMR, with the panel recommending a 20% reduction in inappropriate use of antibiotics. The ADILA project, a collaboration between St George's and the University of Oxford, led the modeling of potential future targets of optimal use.

"The ADILA team have shown that current global patterns of use are neither fair or equitable, with lower income countries having a higher burden of infection and mortality and using fewer antibiotics. Future antibiotic targets should take a risk-based approach," says Professor Sharland.

To ensure these targets are achieved, Professor Sharland and other AMR experts will also call for the establishment of an independent scientific body—an Independent Panel on Antimicrobial Access and Resistance—to expand the evidence base for policy implementation and to inform new targets.