By: Shobha Shukla
So-called “superbugs” produced by overuse of antibiotic drugs are becoming one of humanity’s top public health threats, leading to increased illness, death, and healthcare costs, according to a new study by the World Health Organization.
Antimicrobial resistance, or AMR, is already killing millions. In 2021, bacterial infections caused an estimated 7.7 million deaths, 4.71 million of them linked to AMR with 1.14 million deaths directly attributed to resistant infections. Projections estimate millions more deaths and trillions in economic costs by 2050 without radical action, with such pathogens as gonorrhea, E. coli, pneumonia, and Staphylococcus at the top of the list.
Drawing from data on more than 23 million bacteriologically confirmed infections submitted by 104 countries to the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), the study estimates that one in six common bacterial infections globally were resistant to antibiotic treatment in 2023.
The report analyzes resistance to 22 critical antibiotics used to treat urinary tract, gastrointestinal and bloodstream infections, as well as gonorrhea. These first-line treatments are losing effectiveness, increasingly forcing healthcare providers to resort to intravenous therapy and “last-resort” antibiotics, which are costlier, harder to access, and frequently unavailable in low- and middle-income countries.
Regional disparities
The highest resistance rates were observed in Southeast Asia and the Eastern Mediterranean, where an alarming 33 percent of infections were resistant, followed by the African region, where 20 percent showed resistance. By contrast, resistance levels were lowest in Europe (1 in 10) and the Western Pacific (1 in 11). The disparities reflect underlying differences in healthcare systems, surveillance capabilities, and access to medicines.
The WHO warns that gram-negative bacteria, notoriously difficult to treat, pose the greatest danger. E. coli and Klebsiella pneumoniae are now the leading drug-resistant pathogens in bloodstream infections. These bacteria often lead to sepsis, organ failure, and death. Over 40 percent of E. coli strains and 55 percent of K. pneumoniae strains are now resistant to third-generation antibiotics used for treatment.
In the African region, resistance exceeds 70 percent for both pathogens. Other key pathogens, including Salmonella, Acinetobacter, and N. gonorrhoeae, are also developing resistance to carbapenems and fluoroquinolones, further narrowing treatment options.
Since GLASS was launched in 2016, country participation has grown from 25 to 104 countries by, showing increased global commitment to tackling AMR. However, 48 percent of countries didn’t submit data in 2023 and nearly half of reporting countries lack robust data systems. Even though participation from Southeast Asia was highest, with 91 percent of the countries in that region reporting data, surveillance coverage was the lowest in this region, as well as in the African region. Surveillance coverage was highest in Europe and Western Pacific regions. Surveillance coverage was highest in Europe and Western Pacific regions.
Countries with weak surveillance and low income levels consistently show higher resistance rates, highlighting a vicious cycle in which limited capacity to monitor and respond to AMR fuels its spread. The burden of AMR is not evenly distributed. It is heaviest in countries with weaker health systems and lower income levels, limited diagnostic capacity, and restricted access to effective and essential antibiotics. This shows that limited capacity to prevent, diagnose, and treat infections contributes to higher resistance.
“When we looked at the relationship between AMR and income and universal health coverage indicators in over 95 countries, we found that antibiotic resistance proportionately affects low middle income countries with weak health system,” said Silvia Bertagnolio, Unit Head for Surveillance, Evidence and Laboratory Strengthening in WHO’s AMR Division. “So countries facing the greatest burden often have the least capacity to assess their AMR situation. This means that the lesser countries are able to monitor resistance, the more resistance they tend to have. Without strong surveillance, resistance spreads unchecked.”
But she adds a word of caution: “higher level of resistance in countries with poor surveillance systems could also be influenced by an overrepresentation of tertiary hospital where severe cases are and therefore inflating resistance level.”
Prevention is key: The way forward
“If infections do not happen, resistance does not arise, said Yvan Hutin, director of WHO’s AMR Division. “That’s why we must prioritize WASH - water, sanitation, and hygiene - and vaccination.”
Hutin emphasizes scaling up access to existing vaccines (like pneumococcal and rotavirus vaccines), accelerating development of new ones, and investing in public health infrastructure to stop infections before they begin. He also stresses public awareness.
“Not every fever needs an antibiotic. If your doctor does not prescribe one, that often means it is a viral infection - and that is actually good clinical judgment,” he said. “As antibiotic resistance continues to rise, we are running out of treatment options and putting lives at risk, especially in countries where infection, prevention and control is weak and access to diagnostic and effective medicine is already limited. The less people have access to quality care, the more they are likely to suffer from drug resistant infections.”
Present danger, looming crisis
WHO warns that excessive, inappropriate use of medicines like antibiotics, antivirals, antifungals and antiparasitics could accelerate the crisis beyond control. Access must be balanced with stewardship - overuse today means no cure tomorrow.
The political declaration on AMR adopted at the United Nations General Assembly High Level Meeting in 2024 provides a roadmap for action. It urges countries to:
Strengthen health systems and surveillance infrastructure
Invest in infection prevention and control (IPC)
Scale up vaccination, diagnostics, and laboratory capacity
Optimize treatment protocols and preserve existing antimicrobial medicines
Implement a One Health approach, integrating human, animal, and environmental health efforts.
Antimicrobial resistance is not just a looming public health emergency - it is already here. Without urgent, coordinated global action, we risk entering a future where even minor infections could once again become deadly. All antimicrobial medicines we still have must be protected by using them wisely, monitoring resistance closely, and preventing infections before they happen.
Shobha Shukla is the founding Managing Editor and Executive Director of Citizen News Service (CNS)