Why antimicrobial resistance is no longer a future threat
The looming health challenge is already a major driver of global mortality and a growing source of operational risk for healthcare organizations.
Antimicrobial resistance is frequently described as an emerging challenge, a looming wave for which health systems still have time to prepare. That characterization is no longer accurate.
Antimicrobial resistance (AMR) is already a measurable driver of global mortality and an accelerating source of operational risk for health systems worldwide. The data are unequivocal. The CDC reports that antimicrobial resistance was responsible for at least 1.27 million deaths worldwide and associated with nearly 5 million deaths in 2019. Meanwhile, the World Health Organization has classified AMR as a critical threat to global health, food security and development.
For healthcare leaders, the central question is no longer whether AMR represents a legitimate threat. Rather, the issue is whether health systems are prepared to address it as the systemic risk that it has already become – one that directly affects patient outcomes, care delivery capacity, cost structures and public trust in healthcare institutions.
Why AMR continues to escalate
AMR occurs when microorganisms evolve mechanisms that enable them to survive exposure to drugs designed to eliminate them. This includes bacteria, viruses, fungi and parasites. As resistance develops, standard treatments lose effectiveness, infections persist longer, transmission risk increases, and treatment becomes more complex, costly and uncertain.
The drivers of resistance are well understood. Decades of antimicrobial overuse, inappropriate prescribing, incomplete treatment courses and insufficient regulatory controls across both human medicine and agriculture have created sustained selective pressure favoring the emergence of resistant organisms.
These concerns are not new. Nearly a century ago, Alexander Fleming warned that improper antibiotic use would accelerate resistance, a risk later substantiated through extensive research on the origins and evolution of antibiotic resistance. What has been missing is the development of healthcare operating models that fully internalize antimicrobial risk as a long-term systems issue rather than an isolated clinical decision.
A global burden shaped by structural inequity
AMR is a global phenomenon, but its burden is unevenly distributed. In high-income countries, resistance often emerges within advanced care environments characterized by frequent antibiotic exposure, complex procedures and high patient acuity. In these settings, gaps in infection prevention and control enable resistant organisms to establish and spread.
In low- and middle-income countries, the problem is compounded by various structural constraints. These include under-resourced facilities, limited access to diagnostics, inconsistent infection control practices, weak regulatory oversight and widespread availability of antibiotics without prescription. A systematic review has documented the global prevalence of non-prescription antimicrobial use, frequently driven by barriers to clinical access and affordability.
Compounding these challenges is the fact that inadequate sanitation and infection prevention infrastructure accelerate transmission. A major Lancet systematic review and meta-analysis of healthcare-associated infections in developing countries identified a substantial endemic burden and the structural conditions that sustain it.
The inequity embedded in AMR is not only a moral concern – it is an operational one. Resistant organisms do not respect national borders. Global travel, food supply chains and trade facilitate the movement of resistant pathogens and resistance genes. Antibiotic use in food animals plays a significant role in this ecosystem, and global trends have been well documented in PNAS research on antimicrobial use in food animals.
For this reason, AMR is increasingly framed as a quintessential One Health issue, recognizing the interconnectedness of human, animal and environmental health.
AMR as an economic and operational threat
AMR should be viewed alongside other risks that healthcare leaders already recognize as both clinical and financial. These include hospital-acquired infections, sepsis, supply chain fragility, workforce strain and readmissions.
Drug-resistant infections increase lengths of stay, complicate treatment pathways and drive reliance on higher-cost therapies. They impair throughput in high acuity settings and introduce variability that strains staffing models and capacity planning. Beyond healthcare delivery, AMR affects labor productivity, household stability and national economic output.
The macroeconomic implications have been clearly spelled out. The O’Neill Review on AMR estimated that drug-resistant infections could cost the global economy as much as $100 trillion by 2050 if it’s not addressed. Similarly, the World Bank has projected substantial reductions in global economic output, with low-income countries bearing a disproportionate share of the burden.
For healthcare executives, these projections should not be dismissed as distant forecasts. They represent an accumulating operational headwind. As resistance rises, clinical pathways become less predictable, first-line therapies fail more frequently and the likelihood of complications increases.
AMR’s place on the health data agenda
AMR is not solely a pharmacologic challenge. It is fundamentally a data problem.
An effective response requires reliable visibility into prescribing behavior, resistance patterns, infection control compliance, outbreak detection, and the interactions among clinical, environmental and community drivers of resistance.
This level of insight depends on integrated surveillance systems, standardized reporting and strong data governance. Global initiatives like WHO’s GLASS program aim to standardize data collection and strengthen coordinated response. In the U.S., national programs like the CDC’s National Healthcare Safety Network provide a foundation for tracking healthcare-associated infections and resistance trends.
As AMR accelerates, health systems increasingly will depend on robust surveillance architectures, operational accountability and analytics-driven decision-making to sustain safe and effective care delivery.
AMR is not a challenge that can be resolved solely through clinical excellence. It requires system-level alignment across surveillance, stewardship, policy enforcement, infection prevention and innovation. It also requires leaders to treat antibiotics as a finite shared resource rather than an unlimited clinical convenience.
This series will examine what that leadership posture looks like in practice. Part Two will explore how health systems and the broader ecosystem continue to fuel resistance, how control mechanisms inadvertently break down and why overuse persists even in highly sophisticated care environments. Part Three will focus on the forward-looking response, including modern surveillance models such as genomics, effective stewardship programs, and the innovation landscape spanning novel therapeutics and AI-enabled discovery.
AMR is no longer a future threat. It is a present crisis, one that will increasingly define the cost, complexity and credibility of healthcare delivery.
Dr. Julia Rehman FACHE, FACHDM, is vice president – Middle East & North Africa (MENA) at the American College of Healthcare Executives and is the founder and chief operating officer of Kota Kompany.