For years, we’ve been warned about the potential catastrophe of antibiotic-resistant infections.

Most often, probably, people will think of this as a problem in hospitals and aged-care settings.

Now and then, researchers will claim they’re on the cusp of developing a new kind of antibiotic, or vaccine, or even nano gadgets that can drill the hearts out of superbugs.

It was only in 2022 that the true scale of devastation being wreaked by antimicrobial-resistant infections (AMR) was revealed.

Analysis by the Global Research on Antimicrobial Resistance (GRAM) Project – a massive collaboration of 500 scientists, led by Oxford University – found that antimicrobial-resistant infections had killed about 1.27 million people in 2019.

That is, these infections killed twice as many people as malaria – a reality we’ve only been aware of for two years.

How bad it’s been, and how worse it will get

Now the GRAM Project has another scoop – published by The Lancet – the first global analysis of antimicrobial resistance (AMR) trends over time.

The main finding was that AMR has been killing more than a million people each and every year since 1990.

But that million a year isn’t stable. It has been going up and will continue to do so. The ageing and frailer population is one driver.

Between now and 2050, more than 39 million people are projected to die from AMR infections.

By 2050, the authors say, the annual death toll from AMR could be 1.91 million people, an increase of almost 70 per cent compared to 2022.

Over the same period, the number of deaths in which AMR bacteria play a role will increase by almost 75 per cent from 4.71 million to 8.22 million per year.

These are deaths where AMR isn’t directly the cause, but where an infection complicates other issues.

For the new study, researchers used 520 million records to estimate the number of deaths and disability-adjusted life-years (DALYs) – a quality-of-life measure – that can be directly attributed to or associated with AMR across 22 pathogens, 84 pathogen-drug combinations, and 11 infections.

The analysis spanned 204 countries and territories.

Not all bad news, just mostly

There is some good news. Over the three decades, from 1990, AMR deaths among children aged under five declined dramatically.

There was a 59.8 per cent reduction in direct AMR deaths. In 1990 488,000 young children died: in 2021, there were 193,000 deaths.

There was also 62.9 per cent reduction in deaths associated with, but not directly caused by AMR.

In 1990, there were 2.29 million of these linked deaths: In 2021, there were 840,00 deaths.

The authors say this decline coincided with major improvements in the delivery of infection prevention and control measures – such as vaccination programs – among infants and young children.

Meanwhile, over the 30-year study period, direct AMR deaths among adults 70 years or older increased by 89.7 per cent.

This was “due to rapidly ageing populations and older people’s greater vulnerability to infection”.

Study author Dr Kevin Ikuta of the University of California Los Angeles said of these trends: “The fall in deaths from sepsis and AMR among young children over the past three decades is an incredible achievement.

“However, these findings show that while infections have become less common in young children, they have become harder to treat when they occur.”

He said the threat to older people from AMR will only increase as populations age.

“Now is the time to act to protect people around the world from the threat posed by AMR,” he said.

Deaths directly from AMR increased most in five global regions, where annual deaths rose by more than 10,000 between 1990 and 2021: Western sub-Saharan Africa, Tropical Latin America, high-income North America, South-East Asia, and South Asia.

Improved access to health care and antibiotics could save a total of 92 million lives between 2025 and 2050.