• Ramanan Laxminarayan, Precious Matsoso, Suraj Pant, Charles Brower, John-Arne Røttingen, Keith Klugman, and Sally Davies.
• Princeton Environmental Institute, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India. Electronic address: ramanan@cddep.org.
• Lancet. 2016 Jan 9;387(10014):168-75.

AbstractRecent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. The challenge of simultaneously expanding appropriate access to antimicrobials, while restricting inappropriate access, particularly to expensive, newer generation antimicrobials, is unique in global health and requires new approaches to financing and delivering health care and a one-health perspective on the connections between pathogen transmission in animals and humans. Here, we describe the importance of effective antimicrobials. We assess the disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics.Copyright © 2016 Elsevier Ltd. All rights reserved.

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