A new report from the OECD today estimates that antimicrobial resistant infection is on track to kill 30,000 Americans per year by 2050, almost as many as die in motor vehicle accidents. The financial cost to the 33 developed countries included in the study could also be as high as $3.5 billion a year.

Earlier this year the U.S. Centers for Disease Control and Prevention (CDC) warned of 221 strains of “nightmare bacteria” it had detected. Bacteria with lucky (for them) mutations can survive treatment by antibiotics, leaving behind a generation of drug-resistant bacteria to wreak further havoc on humans.

Due to a combination of factors, including over-use of antibiotics in medical practices and for treating livestock, drug resistance has risen rapidly in the last few decades. Last year the World Health Organization listed 12 such strains, ranking them in terms of priority and urgency.

Antimicrobial resistance “costs more than the flu, more than HIV, more than tuberculosis. And it will cost even more if countries don’t put into place actions to tackle this problem,” warned OECD public health lead Michele Cecchini in an interview with Agence France Press. Poorer countries face the largest threat. In some, 60% of bacteria are already resistant to at least one medicine. The richest countries have rates around 5%.

The OECD calls on rich countries to implement five simple reforms to save lives in their own countries and pioneer methods applicable in other countries. First: better hand-washing and sanitation among health workers. Next: more careful antibiotic prescribing practices. Third, faster testing to determine whether a run-of-the-mill respiratory infection is viral or bacterial, to avoid prescribing antibiotics when they would do no good. Fourth, delaying antibiotic availability by three days, after which most viral infections would already be improving. Finally, a public health awareness campaign.

Perhaps just as important was the additional call for a “One Health” approach, which acknowledges that human health is tied to that of animals, both on farms and in the wild, and that complete health care must address animals alongside humans.

All of these approaches require government health authorities to stand up to private interests that would rather ignore the problem. A 2016 Reuters investigation showed how American authorities are failing to force health providers to report antibiotic resistant cases, making it harder to track and defeat the problem. Rather than admit that a drug-resistant infection killed her baby, one bereaved mother said, “they just threw a bunch of words on the death certificate.”