While the world’s attention is fixed on wars, lab scandals, and the aftermath of the pandemic, another threat is quietly growing — antimicrobial resistance, which has already embedded itself in excess mortality statistics, and no one wants to look closely at that number.
Antimicrobial resistance—above all antibiotic resistance—is embedding itself inside the excess-death numbers that few want to examine too closely. The WHO already counted 14.9 million excess deaths linked to the pandemic years 2020–2021, far above the official COVID-19 tallies. Excess mortality is not a diagnosis. It is a statistical trend that should be falling. When it does not, the label of “excess deaths” hides more than one cause of death.
The subject therefore raises a larger question—what happens when other causes of premature death begin to hide inside the same statistical fog?
Antimicrobial resistance deserves to be examined as one of those causes.
The WHO itself now calls AMR a growing threat that strips the power from life-saving drugs and turns everyday infections and routine hospital procedures into high-stakes gambles. Its 2025 global surveillance report sifted through more than 23 million laboratory-confirmed cases reported by countries for 2023. The picture is not reassuring.
Antimicrobial resistance—especially the antibiotic variety—is no longer a future problem. It is already nesting inside the excess-death numbers that keep refusing to fall.
Those numbers became household talk during COVID-19. The WHO put the global excess-death toll for 2020–2021 at 14.9 million, far higher than the official COVID-19 body count. It is a statistical shadow: deaths above what should have occurred under ordinary conditions. When that shadow lengthens instead of shrinks, the question is simple—what else is accumulating inside the fog?
Antibiotic resistance belongs on that list.
The geopolitical significance is obvious. Modern medicine depends upon antibiotics working when they are needed. Surgery, cancer treatment, intensive care, transplantation and treatment of serious infections all depend upon the ability to control bacterial infections.
When that pharmaceutical safety net begins to fail, the consequences do not necessarily appear as a dramatic epidemic.They appear one patient at a time.
A personal encounter with the problem
I was reminded of this recently in the most personal way possible.
After years of searching for a sister from whom I had lost contact, I finally discovered her death notice. She had spent years working in nursing homes, an environment where vulnerable patients and infectious diseases are constantly present, like working in a biolab without safety measures.
I later learned from relatives that she had endured a prolonged and agonizing illness and died from antibiotic-resistant pneumonia.
One thing is for certain, as I was told by my niece, the strains were so infectious that they could have used the body as a bioweapon. Public health authorities highly recommended, maybe even insisted, that my sister’s body be cremated, as a public health safety measure.
But her death illustrates something larger. For someone whose job, mostly minimum waged, placed her around vulnerable patients and infectious disease, antibiotic resistance was not an abstract phrase in a WHO report. It became the difference between an infection that could be treated and one that could no longer be reliably controlled.
Georgia: a particularly revealing case
Writing about this from Georgia gives the question another dimension.
Georgia has experienced a substantial excess-mortality burden during the pandemic period. WHO has noted that excess mortality from COVID-19 far exceeded the WHO European Region average, while its more recent health-system assessment also warns that historical weaknesses in mortality data—including deaths for which the cause was unknown—have complicated analysis of mortality trends.
Because if the objective is to understand why people are dying earlier than expected, the quality of the underlying death certificate and surveillance system becomes almost as important as the headline death count.
AMR does not announce itself as a geopolitical crisis. There is no single television graphic showing the number of people who died because an antibiotic that once worked no longer does.
Instead, the infection appears in the hospital. The treatment fails. Another drug is tried. Then another. The patient deteriorates. The death certificate may record pneumonia, sepsis or another immediate cause. The deeper story is antimicrobial resistance, including the nexus to many clinical trials run by drug companies, far in excess of what you would expect for a country of 4 million.
TB is where the warning turns brutal.
Georgia’s tuberculosis numbers offer one of the clearest windows into drug resistance in the wild. WHO’s 2023 European surveillance logged 136 pulmonary rifampicin-resistant or multidrug-resistant TB cases—12.1 percent of bacteriologically confirmed pulmonary cases with available data. Of those, 43 were already pre-extensively drug-resistant. WHO estimated roughly 150 rifampicin-resistant cases overall in the notified population.
Drug-resistant TB is antimicrobial resistance, yet it is not the same as the everyday resistance born of repeated courses for coughs and colds. It grows from incomplete treatment, the wrong drug mix, interrupted therapy, or the simple transmission of a strain that is already resistant. WHO itself brands drug-resistant TB a major engine of the global AMR crisis and a direct threat to health security.
Georgia presents a paradox. Its TB surveillance is relatively advanced: 96.6 percent of relevant notified cases in 2023 carried drug-susceptibility results. At the same time, WHO has flagged persistent weaknesses in antimicrobial stewardship across human medicine, veterinary practice and agriculture. Prescription laws exist for human drugs; regulatory gaps remain wider in the animal and farming sectors, due to the overuse of antibiotics in cattle and poultry feed and a wide range of drugs used in animal health.
The real story is less about individual doctors or patients and more about the system that produces, sells and consumes antibiotics. Regulations, pharmaceutical markets, agricultural policy, hospital incentives and the basic resilience of a national health system all sit inside the frame. That is what turns antimicrobial resistance into a geopolitical problem.
The next excess-death question
The central mistake would be to treat excess mortality as a single phenomenon with a single cause.
COVID-19 produced an enormous mortality shock. But the post-pandemic period is not occurring in a vacuum. Populations are aging. Chronic diseases remain major killers. Health systems have accumulated backlogs. Drug-resistant infections continue to evolve.
The gravestones do not tell us everything. Neither do the spreadsheets. But when an infection that should have been treatable becomes fatal because the available drugs no longer work, something is very wrong.
The silent pandemic is not simply about bacteria becoming resistant to antibiotics. It is about modern medicine gradually losing one of the tools on which it built its confidence—and the deaths resulting from that loss may be appearing in mortality statistics long before the political system recognizes the pattern.
Jeffrey K. Silverman is a freelance journalist and international development specialist, BSc, MSc, based for 30 years in Georgia and the former Soviet Union
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