Commentary / World

China's role in fighting antibiotic resistance

by Jim O'neill


One of the most potent threats to global economic prosperity is too little discussed. Resistance to antibiotics, caused in large part by overuse and misuse, is already well established and recognized by specialists as a problem — but it doesn’t yet frighten the public. It should.

I’ve been looking into the issue closely since I was appointed chairman of a review into antimicrobial resistance (AMR) by the U.K. government.

We’ve just published some interim findings — and I have to tell you, I’m alarmed. This danger needs to sink in. The scale of the problem, left unattended, is truly unsettling.

Infections resistant to antibiotics claim about 50,000 lives each year across the European Union and United States. Hundreds of thousands more deaths are thought to be attributable to AMR worldwide.

A low estimate of the global total might be 700,000 deaths a year — about half as many as are caused by traffic accidents, or diabetes, or diarrheal disease. (There were an estimated 480,000 new cases of drug-resistant tuberculosis alone in 2013, most which went untreated.)

By 2050, the global total of AMR-related deaths could be more than 10 times bigger, at 10 million a year. That’s more than the current global toll of deaths from cancer. The economic cost would be staggering as well, at a cumulative $100 trillion, or roughly six years’ worth of U.S. gross domestic product.

These shocking numbers are conservative estimates. They’re based on two studies we commissioned from RAND Europe and KPMG.

The researchers looked at three bugs that you tend to catch in hospitals (E. coli, Klebsiella pneumonia and Staphylococcus aureus) plus three more well-known illnesses (HIV, tuberculosis and malaria). That list is far from exhaustive.

Also, the estimates don’t include indirect consequences, such as higher health care costs or the likelihood that treatments such as surgeries and chemotherapy might become prohibitively dangerous.

We looked out as far as 2050 because this period allows us to consider the full emergence of the BRIC countries (Brazil, Russia, India and China) and their followers in the MINT group (Mexico, Indonesia, Nigeria and Turkey) as major economies.

The combination of immature, inadequate health care systems and rising incomes to spend on drugs makes them especially susceptible to the AMR threat. As the report says:

“The variation in the AMR problems of individual countries is linked to huge differences in how heavily they use antimicrobial drugs.

“Global consumption of antibiotics in human medicine rose by nearly 40 percent between 2000 and 2010, but this figure masks patterns of declining usage in some countries and rapid growth in others. The BRIC countries plus South Africa accounted for three quarters of this growth, while annual per-person consumption of antibiotics varies by more than a factor of 10 across all middle and high-income countries.”

In China, our research suggests that by 2050 as many as 1 million people a year could die because of AMR. The cumulative economic cost would be $20 trillion — equivalent to two years of current Chinese output.

China assumes the rotating leadership of the Group of 20 in 2016. Its government should put AMR high on the agenda, and call for expedited work on the issue between now and then.

AMR is as much an issue for emerging economies as it is for the developed world. It does not discriminate according to form of government, race or nationality. It can and should unify G-20 governments.

As an institution, the G-20 made a good contribution to ensuring the world didn’t slip into a prolonged global depression in 2008 and 2009. Lately it’s lost some of that focus. AMR could and should be the issue to change that.

This year, my review team will explore some of the areas we highlight in the paper, with the aim of framing specific recommendations.

The hope is to form a global consensus in support of a United Nations agreement in the fall of 2016. Already, we are sure of two things:

First, more research of AMR and innovation to control it are vital. This means drawing outstanding scientists to the enterprise. A global fund to pay for this effort would help.

Second, modern technology should be better deployed to encourage and enforce stricter standards for the prescribing and selling of antibiotics. They are too easy to get. They are overused or misused, and AMR is the result.

Beyond this, we are keen to explore the costs of antibiotic use in agriculture and to weigh the alternatives.

We want ways to draw Big Pharma into this area, as well. We hope that the brains supported by our proposed global fund will generate ideas for them to develop.

It’s a matter of vital concern to recognize this problem and raise its profile worldwide.

In this effort, why shouldn’t China be at the forefront? It wants to play more of a global leadership role. Here’s its chance. The prize is as much in its own interests as in everybody else’s.

Jim O’Neill (, a Bloomberg View columnist, worked for Goldman Sachs Group Inc. from 1995 until 2013, serving most recently as chairman of Goldman Sachs Asset Management, and as the firm’s chief economist from 2001 to 2011.