More than 1m people around the world die each year from infections linked to microbes resistant to antibiotics, according to a study that estimates the scale of a “silent pandemic” that is now more deadly than malaria or HIV.

The analysis published in the Lancet medical journal calculates that 1.27m deaths in 2019 were the direct result of drug resistant bacterial infections and 4.95m deaths were associated with them. That represents a sharp jump from previous estimates of 700,000 deaths a year.

Antimicrobial resistance (AMR) has been described by experts as one of the greatest threats to public health in the 21st century. The figures underscore the dangers of bacteria developing resistance to existing antibiotics as a result of overuse — including during the Covid-19 pandemic — against a backdrop of scant new vaccines and drugs under development to prevent or treat infections.