The burden of bacterial antimicrobial resistance in the WHO Western Pacific Region 1990–2021: a cross-country systematic analysis with forecasts to 2050

Abstract

Background Antimicrobial resistance (AMR) is one of the most significant challenges to global health. Although reports from the WHO Western Pacific Region (WPR) increasingly recognise the implications of AMR, precise estimates of the problem's extent remain limited. We present a comprehensive time-trend analysis of AMR burden in the WPR between 1990 and 2021, with forecasts to 2050. Methods Using Global Burden of Disease (GBD) Study 2021 methods, we estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR across 11 infectious syndromes, 22 bacterial pathogens, and 84 pathogen–drug combinations for the WPR and its constituent countries. Data were drawn from mortality registries, surveillance platforms, hospital records, and systematic reviews. The modelling framework comprised five key components: estimation of deaths in which infection had a role, the proportion of infectious deaths attributable to specific syndromes, allocation of syndrome-specific deaths to individual pathogens, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and quantification of the excess mortality risk or prolonged infection duration associated with resistance. Burden was then estimated under two counterfactual scenarios: AMR-attributable (resistant infections replaced by susceptible ones) and AMR-associated (infections prevented altogether). Country-level estimates and forecasts to 2050 were generated using predictive statistical models, with uncertainty reported as 95% uncertainty intervals (UIs). Findings In 2021, we estimated 1,150,000 deaths (95% UI 1,000,000–1,290,000) associated with bacterial AMR and 248,000 deaths (215,000–281,000) attributable to bacterial AMR across 32 WPR locations. Between 1990 and 2021, deaths in children under 5 dropped by 87.3%, while deaths in adults 70 and older rose by 88.9%. Staphylococcus aureus , Streptococcus pneumoniae, and Escherichia coli accounted for over 50% of AMR deaths. The Solomon Islands and Kiribati had the highest age-standardised mortality rates; New Zealand had the lowest burden in 2021. By 2050, associated and attributable deaths could reach 1,840,000 (1,460,000–2,230,000) and 402,000 (322,000–480,000), respectively. Interpretation The WPR contributes substantially to global AMR burden, with considerable fatal and non-fatal impact from key resistant pathogens. Despite data limitations, these estimates support informed decision-making regarding resource allocation and funding—emphasising the need for collaborative, multi-sectoral action against AMR. Funding Wellcome Trust, and the UK Department of Health and Social Care using aid funding managed by the Fleming Fund.

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