New data reveals the true cost of antimicrobial resistance

On 20 January 2022, The Lancet Medical Journal published the most comprehensive analysis to date regarding the global burden of AMR.

The multi-partner Global Research on Antimicrobial Resistance (GRAM) study estimates that drug resistance accounted for a staggering 1.27 million deaths in 2019. This is at least as high as the deaths attributed to Malaria or HIV/AIDs.

To estimate these figures, the GRAM study collated 471 million data sources (records and isolates) across systematic literature reviews, hospitals, and surveillance systems. Authors estimated deaths and disability-adjusted life-years (DALYs) attributed to bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019.

Key findings

  • AMR is a leading cause of death around the world.
  • 1.27 million global deaths in 2019 are attributable to AMR.
  • The highest burden of AMR attributed deaths is within LMICs.
  • 1 in 5 AMR attributed deaths occur in children under the age of five.
  • There are six major pathogens linked to AMR attributed deaths (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa)
  • Lower respiratory tract infections account for the highest burden of AMR attributed deaths.

These new figures dwarf the 700,000 annual death estimates of the O’Neill report (2016) which, until now, has been the go-to document when discussing the scale of AMR and drug resistant infections.

Moreover, both the O’Neill report and GRAM study focus on antibiotics within human health care. We recognise that over half the antimicrobials used globally are within animal health and that antimicrobial treatments include many more medications than antibiotics alone. This only emphasises the need for a stronger One Health approach to tackle AMR.


The GRAM study makes the following recommendations:

  • Understanding the burden of AMR and the pathogen–drug combinations contributing to it is crucial to making informed and context-specific policy decisions.
  • Policy decisions to reduce AMR attributable deaths could include infection prevention and control programmes, access to essential medicines, and research and development of new vaccines and antimicrobials.
  • We must address the serious data gaps in many low-income settings to improve our understanding of AMR, emphasising the need to expand microbiology laboratory capacity and data collection systems.
  • These data shine a spotlight on the issue of AMR and challenges world leaders to face the so-called ‘silent pandemic’ head on. This only heightens the importance of the AMR@Leeds vision and the value of interdisciplinary AMR action across the University of Leeds research portfolio.

Page published: January 2022

Written by: Dr Jessica Mitchell (CE4AMR)