The impact is 10 million deaths a year- AMR already causes 5 million a year

It has been estimated that by 2050, AMR could cause more than 10 million deaths per year [78]. If this trend will not be reversed, according to this prediction, the AMR will become the first cause of death worldwide [79]. Because of the AMR impacts on the health of animals and crops, it has been estimated that up to 24 million people could undergo extreme poverty by 2030 [80]. A significant portion of antimicrobials globally is also used in food-producing animals as prophylaxis or to promote faster growth [81], especially in LMICs [82, 83]. The antimicrobials used in agriculture, aquaculture, veterinary, and human healthcare are often the same [84, 85]. Therefore, the overuse and misuse of antimicrobials in human medicine, livestock, fisheries, and crop production have caused high AMR emergence and contributed to the development of resistance in humans. Therefore, it is of fundamental importance that the use of antimicrobials will become appropriate across the “One Health” universe including humans, animals, and environment [86].

The AMR issue has been typically addressed by searching and developing new antibiotics. Although many investments have been made in the research and development space, the development of new antibiotics is scientifically challenging and very expensive. Considering the rate of onset of resistance and the time needed for a new antibiotic to become obsolete, incentives will be needed for R&D to promote science independently by the investment returns from sale volumes. In this perspective, vaccines represent a very valid solution to prevent the spread of resistant pathogens and to reduce the incidence of disease and the need for antibiotic treatments. A recent review summarizes all vaccines which are already available and those that are in clinical or preclinical phases that can counteract the rise in antimicrobial resistance [87]. Interestingly, 61 new vaccines are in the development phase and 94 in the preclinical phase. This very high number of existing and potentially new vaccines shows how the advent of new technologies in the vaccine field is opening the way to the prevention of many infectious diseases and potentially to the reduction of AMR pathogens.

The implementation of global surveillance programs for the rapid detection of resistance and dissemination of antibiotic resistance will be critical to controlling the ongoing antibiotic resistance pandemic. An efficient surveillance health-system approach to monitor antibiotic drug use and antimicrobial resistance is urgently needed to monitor the resistance particularly in developing countries. Indeed, in 2015, WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS), the first global collaborative effort to standardize the AMR surveillance via the collection, analysis, and interpretation of data from countries [38]. GLASS is based on the strong commitment of participating countries and close collaboration with AMR regional networks. Cutting-edge technologies such as digital surveillance and next-generation sequences introduced for the COVID-19 experience could open the way to control AMR spreading. This is important considering that AMR microorganisms do not recognize “country borders,” and this is of particular concern in an era of globalization. Following travel to countries with high rates of AMR, travelers can become colonized by strains with new AMR genes. Travel to China, India, or Northern Africa increased the level of colonization of Swedish travelers with extended-spectrum β-lactamase producing Enterobacteriaceae from 2.4 to 68%, and then up to 1 year was needed to return to the levels before traveling [88]. One of the key genes for carbapenem resistance (NDM-1) was first isolated in India and then detected worldwide [89, 90]. The mcr1 gene that confers resistance to colistin was also first detected in China [91] but then has been found worldwide [92].

Despite the perception raised by COVID-19, which was estimated to cause 14.9 million (13.3–16.6) deaths between 2021 and 2022 [93], bacteria can also be responsible for pandemics with devastating outcomes. Plague and cholera pandemics disseminated along trade and military routes and the speed at which new pathogens and infectious diseases are disseminated around the world have only accelerated throughout history. In comparison to COVID-19, which was caused by a single microorganism and vaccines that are currently available, AMR is caused by a broad spectrum of very distinct pathogens, and the trend is on the rise due to the absence of broadly protective strategies (Fig. 2).

The estimate of 4.95 million (3.62–6.57) deaths associated with bacterial AMR globally in 2019 by the GDB study is already of serious concern, but the trend of AMR data indicates that these numbers can increase dramatically in the future. Unfortunately, public awareness and concern about AMR are disproportionately lower compared, for example, to the COVID-19 pandemic or to cardiovascular diseases or cancers, despite the evidence indicating that it is already a threat, with the potential to become in the near future the most important health problem worldwide.