Without concerted action, a UN panel said, resistant infections could kill 10 million people annually by 2050 and trigger an economic slowdown to rival the global financial crisis of 2008.
The problem threatens people around the world. During the next 30 years, UN experts said, 2.4 million people in Europe, North America and Australia could die from drug-resistant infections, making routine hospital procedures like knee-replacement surgery and child birth far riskier than they are today.
Dr Haileyesus Getahun, director of the UN Interagency Coordination Group on Antimicrobial Resistance, spent two years working on the report and called the issue a "silent tsunami".
“We are not seeing the political momentum we’ve seen in other public health emergencies, but if we don’t act now, antimicrobial resistance will have a disastrous impact within a generation," Dr Getahun.
The group, a collaboration of public health experts, government ministers and industry officials, called for the creation of an independent body with the stature and funding of the UN's panel on climate change.
The report’s dire predictions seek to raise public awareness and shake political leaders into action.
It proposes a series of measures that health officials say could help stem the rise of drug-resistant pathogens.
The recommendations include a worldwide ban on the use of medically important antibiotics for promoting growth in farm animals, financial incentives for drug companies to develop new antimicrobial compounds and more stringent rules to limit the sale of antibiotics in countries where drugs can often be bought at convenience stores without a prescription.
The report also highlights underappreciated factors in the spread of drug-resistant germs: the lack of clean water and inadequate sewage systems that sicken millions of people in the developing world.
Many of them are too poor to see a doctor and instead buy cheap antibiotics from street vendors with little medical expertise.
Sometimes they unknowingly purchase counterfeit drugs, a problem that leads to millions of deaths, most of them in Africa.
To reduce outbreaks of infectious disease, the report says, wealthier nations should help poor countries pay for improvements to public hygiene, and ensure greater access to vaccines and properly manufactured antibiotics.
Health officials are struggling to understand the scope of the problem because many countries are ill-equipped to monitor drug-resistant infections.
In a survey the United Nations conducted for the report, 39 of 146 nations were unable to provide data on the use of antimicrobials in animals, which experts say is a major driver of resistance in humans as resistant bacteria get transferred to people through contaminated food and water.
“We are flying pretty blind and working hard to get some clear vision,” chief medical officer of England Sally Davies said.
As a first step, the report calls on member states of the United Nations to create national stewardship plans to reduce the unnecessary use of antimicrobials.
A key element of the report is a call for new incentives to encourage the development of antimicrobial medicines.
Between 2010 and 2014, six new antimicrobial drugs were approved, most of them additions to existing drug classes, according to the World Health Organization.
By contrast, 19 new antimicrobial drugs were approved between 1980 and 1984.
The dearth of new drugs is tied to the perverse economics of antimicrobial resistance and the free market.
It can cost a half-billion dollars to develop a new compound, but doctors are discouraged from using the drugs to reduce the possibility that the targeted pathogens will become resistant.
Even when doctors prescribe the drugs, most patients take them for a week or two, limiting a drug company’s ability to earn back its initial investment.
“Everyone agrees that there is an absolute need for new antibiotics, but there is no sustainable market,” director general of the International Federation of Pharmaceutical Manufacturers & Associations Thomas Cueni said.
Incentives to develop new drugs could include generous government financing for research, or regulatory changes that would increase reimbursements for newly approved antibiotics considered medically important.
According to the World Bank, such investments would quickly pay for themselves; it notes that containing antimicrobial resistance costs $12.7 billion annually.
Mr Cueni, who also chairs the AMR Industry Alliance, a trade group working to address the problem of antimicrobial resistance, said more funding is needed.
“I applaud the U.N. for at least putting incentives on the map, but there needs to be more than talk,” he said.
Still, many public health advocates said the report was an important step in elevating a crisis that has failed to garner the attention of other global problems like climate change and AIDS.
Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, said he worried the report might not gain much traction with the Trump administration, which has been averse to multilateral cooperation.
Fear, he said, was the key to changing the status quo.
“Even if you don’t care about the suffering of people who drink unclean water and get resistant infections, you still have to recognise that these bacteria don’t recognise international borders,” he said.
“They will come here, and they will kill us. We have to let people know that the problem is closer than they think.”
By Andrew Jacobs © 2019 The New York Times