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Superbugs could be ‘worse than global financial crisis’: World Bank

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The rise of drug-resistant superbugs could cost more than US$1 trillion a year in extra health costs, plunge millions into extreme poverty and inflict greater economic damage than the global financial crisis if left unchecked, the World Bank has warned.

As world leaders prepare to discuss the threat of antimicrobial resistance (AMR) at the UN General Assembly in New York, the World Bank has released projections showing that the current widespread and often indiscriminate use of antibiotics will have severe health and economic consequences unless urgent action is taken.

“The scale and nature of this economic threat could wipe out hard-fought development gains and take us away from our goals of ending extreme poverty and boosting shared prosperity,” World Bank Group President Jim Yong Kim said.

Modelling by the global development agency indicates that without more careful use of antibiotics, AMR will have an increasing effect. Growing numbers of people, particularly in poorer countries, will succumb to infectious diseases; people will get sick more often; health costs will soar; livestock production will tumble and global trade will shrink.

Even in the best case scenario, the World Bank warns that without urgent action to curb AMR, by 2050 global economic growth would be 1.1 per cent lower, health costs will be up by US$300 million a year, global trade would be down by 1.1 per cent and an extra eight million people would be thrown into extreme poverty.

But the consequences could be much worse.

In its more pessimistic high-AMR scenario, the agency estimates that by 2050 global growth could be cut by 3.8 per cent, the number in extreme poverty would soar by an extra 28.3 million and countries would have to spend an extra US$1.3 trillion a year on health care.

“Drug-resistant infections, in both humans and animals, are on the rise globally,” the World Bank said.

“If AMR spreads unchecked, many infectious diseases will again be untreatable. Without AMR containment, humanity may face a reversal of the massive public health gains of the past century, and the economic growth, development, and poverty reduction that they enabled.

“The annual costs could be as large as those of the global financial crisis that started in 2008.”

The World Bank said these “immiserating” effects would fall hardest on low-income countries and would derail current progress toward the goal of eliminating extreme poverty by 2030.

The AMA has been at the forefront of efforts to curb the use of antibiotics, supporting campaigns such as the Choosing Wisely initiative to educate doctors and, more importantly, patients, about the appropriate application of such medications.

One of the biggest targets of these campaigns has been to educate patients, particularly parents, about the inappropriateness of prescribing antibiotics for the treatment of colds and other viral infections.

Sydney GP and former Chair of the AMA Council of General Practice Dr Brian Morton advised in 2014 that, “prudent use of antibiotics…includes not using them when their benefit is minimal. Patients…need to understand that the symptoms they are experiencing is their own immune system working to resolve the infection. They also need to understand that using antibiotics in such cases may actually do more harm than good. Not only can it contribute to the development and transfer of resistant bacteria but patients risk possible side effects, such as upsetting the balance of gut bacteria and rashes”.

The World Bank has urged a holistic approach to tackling AMR, warning it cannot be treated as a discrete health problem.

“Drug-resistant diseases are very much like infectious diseases with pandemic potential: because there is “no cure,” their spread can be hard to control. The surveillance, diagnostic, and control capacity to deal with the first group of diseases is the same capacity that is required to control of diseases in the second group,” it said.

The World Bank said investing in core human and veterinary public health systems in low- and middle-income countries was fundamental to establishing the surveillance needed to identify and control AMR.

“Increased global cooperation is essential as AMR containment is a global public good. It will require coordinated efforts to monitor, regulate, and reduce the use of antibiotics and other antimicrobials,” the agency said.

The World Bank report can be viewed at: http://pubdocs.worldbank.org/en/527731474225046104/AMR-Discussion-Draft-…

Adrian Rollins