Why investors must engage on the growing threat of antimicrobial resistance

Antibiotics are among the most transformative innovations in medical history.

In 1928, a chance event in a London laboratory led to the discovery of penicillin and changed the course of medicine. Since then, these powerful drugs have saved countless lives by combating bacterial infections that once led to severe illness or death.

Antibiotics treat many infectious diseases as well as enable complex medical procedures, such as cancer treatments and organ transplants. They also play an essential role in safeguarding public health and supporting agricultural productivity.

However, overuse of antibiotics is driving the emergence of drug-resistant microbes, making infections increasingly difficult to treat. This leads to longer hospital stays, higher medical costs, and increased mortality.

Antimicrobial resistance (AMR) is a natural process where bacteria, as living organisms, evolve over time to withstand the drugs designed to kill them. The emergence and spread of AMR is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.

The World Health Organization (WHO) lists AMR as one of the top global public health and development threats. It is estimated that AMR was directly responsible for 1.2 million deaths worldwide in 2019 and that is likely to rise to 1.9 million annual deaths by 2050.

The Review on Antimicrobial Resistance, commissioned by the UK Government and Wellcome Trust and published in 2016, estimated that without intervention, the number of deaths associated with AMR globally will rise to 10 million by 2050 — surpassing cancer as a leading cause of mortality.

They also estimate that $100 trillion of economic output is at risk due to the rise of drug-resistant infections. In the UK alone, the annual cost of AMR to NHS is already estimated to be £180 million due to higher treatment costs for drug-resistant infections.

The main sectors that drive antibiotic consumption are healthcare, pharmaceutical industry, farming and food production. Antibiotics are widely used in agriculture, with much of their global use not aimed at treating sick animals but rather at preventing infections or promoting growth.

The quantity of antibiotics used in livestock is substantial. In the United States, for instance, over 70 per cent (by weight) of antibiotics classified as medically important for humans by the U.S. Food and Drug Administration (FDA) is used in animals. This significantly contributes to the development of resistant bacteria that can spread to humans through food, water, and the environment.

Lack of innovation in antibiotic development is also a contributing factor, as pharmaceutical companies face economic and regulatory challenges. The commercial returns on investment for antibiotics are lower compared to drugs for chronic conditions, which has led to a decline in research and development.

In addition, there are inadequate regulations and enforcement in many countries allowing over-the-counter sales of antibiotics, further promoting misuse.

There is a strong link between AMR and climate change, where both exacerbate each other. Intensive farming practices often lead to soil and water contamination with antibiotics, fostering the spread of resistance genes and disrupting local ecosystems. These contaminated environments become breeding grounds for resistant bacteria.

Climate change also alters ecosystems, creating conditions that favour the survival and spread of resistant bacteria. In addition, rising temperatures and changing weather patterns increase the prevalence of infectious diseases, necessitating more frequent use of antibiotics, which further accelerates the development of AMR.

Addressing AMR aligns with the United Nations Sustainable Development Goals (SDGs), particularly those related to health (SDG 3), clean water (SDG 6), responsible consumption (SDG 12), and climate action (SDG 13).

Sustainable practices in healthcare, agriculture, and environmental management are essential to mitigate the AMR crisis.

Investors can play a role in combating antimicrobial resistance by:

• Supporting sustainable and responsible practices in industries that contribute to the problem.
• Investing in companies that prioritise reducing antibiotic use in agriculture and developing alternative methods for disease prevention.
• Investing in companies focused on developing new antibiotics, rapid diagnostic tools, and alternative therapies.
• Funding initiatives that prioritise sustainable healthcare and environmental practices. This includes supporting technologies for wastewater treatment and antibiotic residue management.

Investors can also influence corporate behaviour by engaging with companies to adopt better practices. Supporting initiatives that promote antibiotic stewardship and investing in public health infrastructure can also contribute to mitigating AMR.

Antimicrobial resistance is a pressing global challenge that threatens human health, economic stability, and the environment. While antibiotics are a foundational pillar of medical progress, their overuse and misuse have led to the growing threat of AMR.

This challenge, driven by practices in healthcare, agriculture, and environmental management, poses severe risks to public health and ecosystems with potentially significant economic costs.

Addressing AMR requires a comprehensive approach that includes stronger regulations, increased innovation, and global collaboration.

Governments and industries must support initiatives aimed at reducing antibiotic use, developing new treatments, and improving public health infrastructure.

Investors can play a pivotal role by driving sustainable practices, engaging with companies to improve stewardship, and directing capital toward innovation in antibiotics, diagnostics, and alternative therapies. Through collective efforts, we can mitigate the impact of AMR and safeguard the effectiveness of antibiotics ensuring a sustainable and resilient future.

Anastassia Johnson is a researcher at the Thinking Ahead Institute at WTW, an innovation network of asset owners and asset managers committed to mobilising capital for a sustainable future.