Counting the human cost of AMR: The global research on AMR project


In 2017, the researchers of the Institute for Health Metrics and Evaluation (IHME) and the University of Oxford developed a partnership to establish the human cost (burden) of AMR. This partnership gave birth to the Global Research on Antimicrobial Resistance (GRAM) project. Fast forward four years, 434 million individual records and 12,582 study-location-years' worth of data, and GRAM has become a household name for anyone in the industry.

The results

Published in The Lancet in January 2022, the capstone GRAM paper produced the most comprehensive analysis of the burden of AMR ever undertaken. It demonstrated for the first time that AMR is a leading cause of death globally, using the year 2019 as a reference point. It also highlighted specific areas of concern for governments and health communities to act on.

It found that in 2019 at least 1.27 million deaths per year were directly attributable to AMR. This shows that AMR is a leading cause of death globally, higher than HIV/AIDs and Malaria. In addition, of the 4.95 million deaths associated with AMR, Sub-Saharan Africa bore the highest burden.

Attributable deaths means that people died from a drug-resistant infection. Deaths associated with AMR includes the 1.27 million deaths attributable to AMR, as well as people who had a drug resistant infection when they died (but this may or may not have been the cause of death). These two figures can be thought of as the lower and upper bounds of the true burden of bacterial AMR.

All-age rate of deaths attributable to and associated with bacterial AMR by GBD region, 2019. Source: Antimicrobial Resistance Collaborators.

GRAM researchers were also concerned to find that young children are at significant risk. 1 in 5 deaths caused by AMR occurred in children under the age of 5.

Over a million people are now dying each year due to infections that could previously be treated by antimicrobials. This includes lower respiratory, bloodstream and intra-abdominal drug resistant infections, the most fatal being MRSA. The GRAM team noted that, out of the seven deadliest AMR bacteria, vaccines are only available for two.

Global deaths (counts) attributable to and associated with bacterial AMR by infectious syndrome, 2019. Source: Antimicrobial Resistance Collaborators.

The campaign

The GRAM consortium quickly recognised the results’ significance and agreed to disseminate as widely as possible. Janet Midega at the Wellcome Trust highlighted the importance of getting the data into the hands of policy makers.

Together with other supporters, the Fleming Fund designed a communications campaign spanning G7 Health Ministers’ meetings, social media toolkits (#AMRSOS), press releases tailored to geographic regions, and coverage in major news and journals. This culminated in an online launch event to target policy makers – the people able to turn findings into actions. There was widespread global coverage. 180 top-tier international outlets covered the report, including the BBC, Bloomberg, CNN, Financial Times, The Economist, Nature and Reuters.

Over 500 global health stakeholders attended the online launch introduced by Dame Sally Davies.

On social media, tweets in four different languages containing #AMRSOS in total, generated 7.9k engagements with a combined potential reach of 16 million.

AMR communications, discussions and policy documentations across the globe are using the GRAM results, including the G7 and the WHO. The Fleming Fund plans to continue the campaign throughout 2022, with the publication of burden level results keenly awaited.

“As funders of the research, Wellcome, the UK Department of Health and Social Care, and the Bill and Melinda Gates Foundation are fully committed to supporting effective use of the data to inform action on AMR. Solid data (…) does not mean much unless policymakers and the health community (...) take urgent action to avoid further preventable deaths.”

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The generation and sharing of antimicrobial resistance, use and consumption (AMR/U/C) data is invaluable for underpinning national and global AMR prevention and control strategies. However, these efforts are of limited use if such data and research findings are not simultaneously transformed into policy and practice actions.

The Fleming Fund has awarded an AMR surveillance project, ‘SEQAFRICA’, with an additional £2.4 million. SEQAFRICA uses the innovative technology whole genome sequencing (WGS) to improve antimicrobial resistance (AMR) surveillance and invests in training African scientists to help triple the capacity for gene sequencing across the continent.