Every year 750,000 deaths linked to drug-resistant superbugs could be prevented through better access to clean water and sanitation, infection control and childhood vaccinations, research suggests. Antimicrobial resistance, or AMR, is a huge global challenge, with the evolution of drug-resistant superbugs, driven by factors including inappropriate and excessive antibiotic use, raising the prospect of a future where modern medicine fails. Experts have warned that if the world does not prioritise action on AMR then there will be a steady increase in the death toll, with infants, elderly people, and those with chronic illnesses or requiring surgical procedures, at the highest risk. “It kills more people than HIV, malaria, and TB put together,” said Prof Ramanan Laxminarayan, of Princeton University, in the US, adding that tackling AMR was crucial for meeting goals for newborn survival, as well as healthy ageing. Experts have also warned of a scenario where once-trivial infections prove fatal, and crucial procedures in modern medicine, ranging from caesarean sections, to cancer treatments and organ transplants, become too risky to be feasible. According to data for 2019 an estimated 4.95m deaths were associated with bacterial AMR, including 1.27m deaths directly caused by such resistance. However, experts have warned that low- and middle-income countries (LMICs) were disproportionately affected by AMR. Models created by Laxminarayan and colleagues have suggested AMR-associated deaths in LMICs could be cut by 18%, equivalent to about 750,000 a year, through three key steps. The team suggests an estimated 247,800 deaths are preventable through universal access to clean water and improved sanitation and hygiene, while 337,000 deaths could be prevented through better infection prevention and control in healthcare settings. Another 181,500 deaths are preventable by means of childhood vaccinations, they add. This is not only by preventing infections that are resistant to current drugs, but by curtailing inappropriate consumption of antibiotics. While the team notes that 95,400 deaths among under-15-year-olds could be directly avoided each year through the use of vaccines against four key bacterial infections, vaccinations against viral infections also mattered. “People get symptoms … they cannot distinguish whether it’s viral or bacterial and just to be safe they take the antibiotic. But in creating that safety they are creating drug resistance,” said Laxminarayan, noting that influenza was the biggest driver of antibiotic consumption in the world. The study, published in the Lancet, is part of a series on AMR which includes the proposal of global targets called “10-20-30 by 2030” goals. These refer to a 10% reduction in mortality from AMR relative to 2019, a 20% reduction in inappropriate human antibiotic use, and a 30% reduction in inappropriate animal antibiotic use. While ambitious, the goals, said Laxminarayan, were feasible. He noted that while deaths from AMR had risen since 2019, inappropriate antibiotic use in animals had already fallen. The researchers also highlight the need for better access to and development of, antibiotics, diagnostic tests and vaccines, and have called for the establishment of an independent panel on antimicrobial access and resistance, similar to the Intergovernmental Panel on Climate Change (IPCC), to gather evidence on AMR and inform guidelines. The team stresses that time is of the essence. “The window of opportunity to ensure our ability to treat bacterial pathogens is shrinking,” they write. Laxminarayan added that AMR was not an intractable issue. “Why wouldn’t the world want to solve a big solvable problem?” he said. Prof Ben Cooper, of the University of Oxford, who was not involved in the research, said the estimate of 750,000 preventable deaths was based on careful and thorough analysis. “The work highlights how we already have affordable tools that we know could make a major dent in the problem, but achieving these reductions will require addressing the chronic global underinvestment in tackling antimicrobial resistance.” Dr Danna Gifford, an expert in AMR, at the University of Manchester, also said there would be challenges, with sustained commitment and collaboration on an unprecedented global scale needed to meet the proposed targets. But, she said, preventive measures were crucial. “It’s clear that reducing the global burden of resistance requires preventing the occurrence of infection, rather than simply relying on new antimicrobials.”