5-Questions: State of the World's Antibiotics in 2021

1. We were excited to read the second edition of your milestone report, State of the World’s Antibiotics which presents extensive data on global antimicrobial use and resistance as well as drivers and correlates of antibiotic resistance. How did this research come about? Where can our readers read your report?

Ever since we put out our first State of the World’s Antibiotics report in 2015, our intent has been to update the. Metrics on AMR are hard to come by and unless we periodically and consistent document the key indicators of AMR, it is difficult to understand whether or not we are making progress. When we got down to formulating these metrics, we realized that progress is constituted of a variety of indicators that cover both proximal and distal determinants of antimicrobial resistance. Proximal indicators could include antibiotic consumption and hospital infection rates. Distal indicators are those that determine the need for antibiotics and include childhood vaccination coverage, water and sanitation and public health spending. Compiling these data took the better part of two years and because these numbers were not readily available anywhere, we had to rely on a number of CDDEP papers that were published in peer-reviewed journals along the way. For example, our study on levels and trends in antimicrobial resistance in animals that was published in Science in 2019 was an independent project that fed into this larger report. The final report is now available online at https://cddep.org/wp-content/uploads/2021/02/The-State-of-the-Worlds-An…

2. What do you consider to be the most significant finding(s) from this most recent report?

Our main conclusion in comparing the situation with drivers of antimicrobial resistance between 2015 and 2021 was that despite many calls for global action, there had been only modest improvements in our ability to fight resistant pathogens over that six year period. Our report also highlights the multiple indicators on which progress is essential in order to address the resistance problem. In that sense, AMR is far more like climate change (requiring multisectoral progress and globally coordinated action) than of addressing a more direct health problem like TB or malaria.

3. Your report says that if nothing changes to alter global antibiotic use and misuse, antibiotic consumption is likely to increase worldwide by 200 percent between 2015 and 2030. Can you tell us how this could impact public health around the world?

Antibiotic consumption continues to rise unabated because of a combination of rising incomes and affordability. That per se is not a bad thing since lack of access to antibiotics continues to cause a lot of harm to health and perhaps more than resistance even today. However, resistance is fast becoming the greatest barrier to access to antibiotics since many older antibiotics have been rendered useless and new antibiotics are simply too expensive for many. Therefore, my concern is more about increasing levels of inappropriate consumption of antibiotics than it is about just overall consumption which will surely rise absent strong interventions.

4. Can you tell us about the country-level dashboards you introduced this year and how countries can use them to decrease the need for antibiotics and their inappropriate use?

The country level dashboards indicate the need to make progress on multiple fronts to tackle resistance. They also show that countries that have a large AMR problem share common features including poor WASH, low levels of immunization and poor health governance.

5. After finishing the report, what among your findings freaks you out the most? What gives you the most hope?

As the world’s attention remains on COVID-19, I am enthused by the level of cooperation and innovation that has brought so many vaccines to the fore. It gives me hope that the world can come together to tackle AMR as well. If we can develop vaccines against a virus within a year of its emergence, why can we not do the same for bacterial pathogens that cause AMR or viruses that drive much of antibiotic consumption. My only hope is that we will not wait too long while many die because of resistance, simply because their suffering is invisible.