The burden of bacterial antimicrobial resistance in the WHO Western Pacific Region 1990–2021: a cross-country systematic analysis with forecasts to 2050
- 1Department of Health Metrics Sciences Director of Subnational Burden of Disease Estimation Institute for Health Metrics and Evaluation , University of Washington School of Medicine , 3980 15th Ave. NE , Seattle , WA , 98195 , USA
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.
Related
- In vitro antimicrobial resistance in clinical isolates of bacterial pathogens causing bovine respiratory disease: a systematic review and meta-analysis
- Editorial: Evolution of antimicrobial resistance in intracellular bacterial pathogens: a genomic and historical perspective
- Phage-ICE tandems facilitate bacterial adaptation and antimicrobial resistance spread
- Bacterial Mercury Resistance Reveals a Robust Species-Structured Human Antimicrobial Mobilome
- Anticipating the Next Recorded Bacterial Hosts of Plasmid-Borne Antimicrobial Resistance Genes: A Temporal Graph Analysis of Plasmid and Surveillance Data.
BibTeX
@article{mestrovic2026burden,
title = {{The burden of bacterial antimicrobial resistance in the WHO Western Pacific Region 1990–2021: a cross-country systematic analysis with forecasts to 2050}},
author = {Tomislav Meštrović and Gisela Robles Aguilar and Nicole Davis Weaver and Daniel T Araki and Anna Gershberg Hayoon and Authia P Gray and Chieh Han and Rebecca L. Hsu and Kevin Shunji Ikuta and Lucien R Swetschinski and Eve E Wool and Rasheed Adisa Abdulraheem and Richard Gyan Aboagye and Isaac Yeboah Addo and Nurudeen Adedayo Adegoke and Ripon Kumar Adhikary and Qorinah Estiningtyas Sakilah Adnani and Ebenezer Afrifa‐Yamoah and Danish Ahmad and Tauseef Ahmad and Ibrar Ahmed and Jude Oluwapelumi Alao and Kefyalew Addis Alene and Ashraf Alhumaidi and Sheikh Mohammad Alif and Hamid Alinejad Rokny and Mohammed Ahmed Al-kaif and Joseph Uy Almazan and Anayochukwu Edward Anyasodor and Geminn Louis C. Apostol and Mosab Arafat and Aleksandr Y. Aravkin and Elizabeth Ashley and Bernard Kwadwo Yeboah Asiamah-Asare and Ratna Dwi Puji Astuti and Beatriz Paulina Ayala Quintanilla and A.K.M. Azad and Biswajit Banik and Dinesh Bhandari and Eshetie Melese Birru and Colin Stewart Brown and Linh Bui and Chiranjib Chakraborty and Haowei Chen and Junhao Chen and Allen C. Cheng and William C.S. Cho and Bryan Chong and Dinh‐Toi Chu and Eric Chung and S. Y. Chung and Muhammad Chutiyami and Omid Dadras and Xiaochen Dai and Sadia Din and Christiane Dolecek and Nattwut Ekapirat and Muhammed Elhadi and Ibrahim Elsohaby and G Fekadu},
journal = {The Lancet Regional Health. Western Pacific},
year = {2026},
month = oct,
doi = {10.1016/j.lanwpc.2026.101997},
url = {https://doi.org/10.1016/j.lanwpc.2026.101997},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The burden of bacterial antimicrobial resistance in the WHO Western Pacific Region 1990–2021: a cross-country systematic analysis with forecasts to 2050
AU - Tomislav Meštrović
AU - Gisela Robles Aguilar
AU - Nicole Davis Weaver
AU - Daniel T Araki
AU - Anna Gershberg Hayoon
AU - Authia P Gray
AU - Chieh Han
AU - Rebecca L. Hsu
AU - Kevin Shunji Ikuta
AU - Lucien R Swetschinski
AU - Eve E Wool
AU - Rasheed Adisa Abdulraheem
AU - Richard Gyan Aboagye
AU - Isaac Yeboah Addo
AU - Nurudeen Adedayo Adegoke
AU - Ripon Kumar Adhikary
AU - Qorinah Estiningtyas Sakilah Adnani
AU - Ebenezer Afrifa‐Yamoah
AU - Danish Ahmad
AU - Tauseef Ahmad
AU - Ibrar Ahmed
AU - Jude Oluwapelumi Alao
AU - Kefyalew Addis Alene
AU - Ashraf Alhumaidi
AU - Sheikh Mohammad Alif
AU - Hamid Alinejad Rokny
AU - Mohammed Ahmed Al-kaif
AU - Joseph Uy Almazan
AU - Anayochukwu Edward Anyasodor
AU - Geminn Louis C. Apostol
AU - Mosab Arafat
AU - Aleksandr Y. Aravkin
AU - Elizabeth Ashley
AU - Bernard Kwadwo Yeboah Asiamah-Asare
AU - Ratna Dwi Puji Astuti
AU - Beatriz Paulina Ayala Quintanilla
AU - A.K.M. Azad
AU - Biswajit Banik
AU - Dinesh Bhandari
AU - Eshetie Melese Birru
AU - Colin Stewart Brown
AU - Linh Bui
AU - Chiranjib Chakraborty
AU - Haowei Chen
AU - Junhao Chen
AU - Allen C. Cheng
AU - William C.S. Cho
AU - Bryan Chong
AU - Dinh‐Toi Chu
AU - Eric Chung
AU - S. Y. Chung
AU - Muhammad Chutiyami
AU - Omid Dadras
AU - Xiaochen Dai
AU - Sadia Din
AU - Christiane Dolecek
AU - Nattwut Ekapirat
AU - Muhammed Elhadi
AU - Ibrahim Elsohaby
AU - G Fekadu
PY - 2026
DA - 2026/10/01
JO - The Lancet Regional Health. Western Pacific
DO - 10.1016/j.lanwpc.2026.101997
UR - https://doi.org/10.1016/j.lanwpc.2026.101997
AB - 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.
SN - 2666-6065
ER -