Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 2025

As superbugs ravage hospitals and communities, healthcare costs are stacking up. Analysis by the Organisation for Economic Co-operation and Development (OECD) finds that the annual cost of AMR across 34 OECD and European countries totals nearly $66 billion (adjusted by purchasing power parity, or PPP) every year. Health systems alone bear an estimated $28.9 billion (PPP) of this burden, while the broader economies in these countries are hit by the remaining $36.9 billion.22 The primary obstacles to tackling AMR are economic rather than scientific, as the production and distribution of antibiotics are plagued by market and government failures. For example, the lack of suitable and sufficient antibiotics leads to a rampant trade in substandard, counterfeit antibiotics: according to the World Health Organization (WHO), an estimated 70,000 to 170,000 deaths in under-five children suffering from pneumonia can be attributed to counterfeit drugs.23 The golden era of antibiotic discovery has given way to a dark age of lacklustre innovation, with just 15 new antibiotics approved between 2000 and 2018, compared to 63 in the preceding two decades.24 In fact, 1987 marked the last time that a new class of antibiotics was successfully introduced as treatment – all new antibiotics introduced since then have been optimizations or combinations of already known compounds. The journey from laboratory to market for a new antibiotic is a monumental task, demanding over a decade of time and more than $1 billion in investment. Given the time- and capital- intensive nature of the endeavour, fewer than 1 in 70 candidates make it to market, according to analysis by Wellcome.25 For the few that do make it to market, the average return on investment – a cumulative revenue of $440 million over 10 years – falls well short of recouping the costs of drug development and commercialization.26 A major challenge facing the commercialization of new antibiotics is that, in good clinical practice, clinicians reserve newer antimicrobials as the last line of defence in treating infections, in order to prevent resistance from developing. This disincentivizes investment into antimicrobial drug development. “The result is a tragedy of the commons: everyone uses antibiotics a little too much and we will be left with none that work,” write Katherine Klemperer and Anthony McDonnell in their article for the World Economic Forum, “Market failures cause antibiotic resistance. Here’s how to address them.”271.4 Market failures and economic impact Antimicrobial resistance is only getting worse yet we’re not developing new products fast enough to combat the most dangerous and deadly bacteria. Innovation is lacking, yet even when new products are authorized, access is a serious challenge. Antibacterial agents are simply not reaching the patients who desperately need them, in countries of all income levels. Yukiko Nakatani, Assistant Director-General for Antimicrobial Resistance ad interim, WHO.28 Climate change and AMR are two of the most pressing global health challenges of our time. Recent research has revealed a worrying synergy between these issues, with climate change potentially exacerbating the spread and impact of AMR. A comprehensive study examining 375 known infectious diseases found that close to 60% of such diseases could be aggravated by climate change.29 Freak climate hazards can damage health infrastructure and sewage systems, forcing people into unsafe situations that facilitate disease outbreaks. For example, drought forces people to drink unsafe water, while floods and storms are associated with wastewater overflow that leads to direct and foodborne transmission of viruses. As global temperatures rise, bacterial and fungal infection rates are likely to increase and diseases may spread to previously unaffected regions at higher altitudes and latitudes.30 Heatwaves increase the heat resistance of viruses, causing greater virulence in human populations as viruses can cope better with the human body’s main immunity defence response of fever. Consistent exposure to life-threatening climate hazards induces stress, which can reduce the body’s capacity to deal with pathogens. Atmospheric warming and precipitation changes can also lead to the range expansion and increased biting rates of vectors such as mosquitoes, causing diseases such as dengue and malaria. While such diseases are viral in nature, they are often mistakenly treated with antibiotics, leading to the development of drug resistance over time.311.5 The impact of climate change A comprehensive study examining 375 known infectious diseases found that close to 60% of such diseases could be aggravated by climate change. Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 8