Antimicrobial resistance: Fleming's warning, our era's challenge

When Alexander Fleming, who discovered penicillin, gave his Nobel Prize lecture in 1945, you might have expected a victory lap. Antibiotics had just saved thousands of soldiers wounded on World War II's battlefields.

Instead, Fleming delivered a warning – about the risks of antimicrobial resistance (AMR). An insufficient dose of penicillin against a simple sore throat, he cautioned, could have fatal consequences for people infected later by bacteria that no longer respond to treatment.   

Eighty years later, Fleming's fears about AMR have come to pass: a new United Nations report  concluded that one in six laboratory-confirmed bacterial infections worldwide are antibiotic-resistant. Last-line-of-defense antibiotics reserved for highly resistant infections are also losing their potency. 

With World AMR Awareness Week from 18-24 November, it's worth noting that the UN's status update is just the latest sobering report about AMR's trajectory. Another recent study published in The Lancet projects that without action, AMR-associated deaths could rise to 8.2 million globally in 2050, about 75% above 2021 levels.

At Swiss Re, we've prioritised raising AMR awareness, given its potential to disrupt healthcare systems and add to the overall burden of morbidity and mortality.

As our teams documented in Antimicrobial resistance: a silent threat to our future, AMR affects every nation. In the US, experts estimate treating just six of the most alarming antimicrobial resistance threats adds more than USD 4.6 billion in annual healthcare costs, while the OECD pegs AMR's impact on Europe at EUR 11.7 billion.

Still, emerging economies bear a disproportionate share of the global AMR burden. In sub-Saharan Africa, mortality rates attributable to antimicrobial resistance are more than 300 percent higher than in Australia and New Zealand. Fragile health systems, unchecked antibiotic access, and underfunded public health deepen the crisis.

Antibiotics overuse and misuse in humans and livestock have long been a concern. Weather- and climate-related catastrophes that damage sanitation infrastructure may contribute to AMR spread, as well.

Recently, there has been increased attention on conflict zones from Iraq and Ukraine to Syria and Gaza driving proliferation of drug-resistant infections. Terrible wounds, broken healthcare systems, human displacement and migration all amplify AMR risks.

Antibiotic development has also lagged. It's been decades since the last new class of antibiotics reached the market. Unlike cancer breakthroughs, the aim with antibiotics is minimising use, preserving their efficacy but challenging development models that rely on sales volumes.

There are promising initiatives underway, but we need more innovative efforts to spur discovery of novel agents, because even with careful stewardship, resistance often emerges soon after a new antibiotic is released.

Overcoming these hurdles demands a focused, public-private push across sectors and regions. Last year, the UN established new targets, among them reducing the nearly 5 million annual AMR-related deaths by 10% by 2030. With multilateral funding tight, this is ambitious, but millions of lives depend on translating better global surveillance into more effective policy and practice.

At Swiss Re, we're also optimistic about the potential for new technology to open up new frontiers.  

This January, I'll participate in a Science House dialogue in Davos, Switzerland, during the World Economic Forum. There, I'm planning to join biotech innovators, health officials, and regulators to discuss ways to accelerate novel antimicrobials and diagnostics. I'm sure AI-assisted efforts will be on the agenda, as scientists turn to machine learning to help design and screen millions of promising compounds. 

Swiss Re has also supported SPEARHEAD, a consortium backed by the Swiss government and other partners to leverage technology to improve Switzerland's response to AMR. The initiative's milestones include a real-time antibiotic monitoring system at University Hospital Basel, as well as a nanomotion test developed by Swiss scientists, enabling faster, more accurate diagnoses of urinary tract infections.

This week, Swiss Re hosted SPEARHEAD and beyond: Sustaining the fight against antimicrobial resistance at the Swiss Re Centre for Global Dialogue near Zurich, to mark the consortium's conclusion after four years and get an update from global AMR experts on progress and emerging obstacles in what will be a decades-long fight. 

The power of bringing industry, government, and science together was strongly underscored by an anecdote from the keynote speaker, Peter Beyer, the Deputy Executive Director of the Global Antibiotic Research & Development Partnership (GARDP), a non-profit group developing new treatments for AMR infections.

Beyer recalled how, at a previous Swiss Re-organised conference in 2018, informal discussions between sessions sparked the idea that would become the AMR Action Fund, the world’s largest venture capital fund dedicated to new antimicrobial therapeutics. “Between 2018 and 2025, positive things have happened,” Beyer told attendees. “These meetings matter.”

I couldn't agree more. Swiss Re is honored to play a role as a convenor in connecting partners to collaborate on solutions to big challenges.

Eighty years ago, Fleming had this advice for a society still awakening to the possibilities and pitfalls of antibiotics: “If you use penicillin, use enough." Today, enough is not enough. We must use antibiotics wisely while confronting the deeper conditions that threaten to make AMR more tragic for coming generations.