The report’s language is sober but its numbers are apocalyptic. If antibiotics continue to lose their sting, resistant infections will sap $100 trillion from the world economy between now and 2050, equivalent to $10,000 for every person alive today. Ten million people will die every year, roughly one every three seconds, and more than currently die from cancer. These are conservative estimates: They don’t account for procedures that are only safe or possible because of antibiotics, like hip and joint replacements, gut surgeries, C-sections, cancer chemotherapy, and organ transplants.

And yet, resistance is not futile. O’Neill’s report includes ten steps to avert the crisis. Notably, only two address the problem of supply—the lack of new antibiotics. “When I first agreed to do this, the advisors presented it to me as a challenge of getting new drugs,” says O’Neill. “But it dawned on me very quickly that there were just as many, if not more, important issues on the demand side.” Indeed, seven of his recommendations focus on reducing the wanton and wasteful use of our existing arsenal. It’s inevitable that microbes will evolve resistance, but we can delay that process by using drugs more sparingly.

The first step is to improve sanitation. Fewer infections means less need for antibiotics. For richer nations, the focus lies in reducing infections in hospital settings. For poorer countries, ensuring clean water and better sanitation is paramount; as O’Neill writes, resistance “is intrinsically an issue of economic development.” In India, Nigeria, Indonesia, and Brazil alone, sanitation could save 300 million courses of antibiotics, currently used (often ineffectively) to treat diarrhea.

We also need a global surveillance network to understand the extent to which antibiotics are being used, the spread of resistant microbes and the genes behind their powers, and the effectiveness of different drug/bug combos. The World Health Organization has already planted the seeds of such a network, and following an earlier O’Neill report, the UK government launched the £195 million Fleming Fund to build surveillance in poorer countries.

Even without such data, some remedial steps are already obvious. In the U.S. alone, 70 percent of antibiotics that are medically useful to humans are given to animals instead, and not just for treating disease but for promoting growth or compensating for poor farming practices. So O’Neill’s report recommends that from 2018, countries should set ten-year reduction targets to reduce the unnecessary use of antibiotics in agriculture. It also argues for restrictions or bans on the agricultural use of any drug that’s a last-line defense for humans. And it suggests that meat should be transparently labeled so consumers can make informed choices.

A lot of human antibiotic use is wasteful too. Of the 40 million people who get antibiotics in the U.S. every year, only 13 million actually need them; the rest have viral infections that can’t be treated with these drugs. One solution is to develop better, faster, cheaper diagnostic tools, so doctors don’t have to assess vague symptoms, or rely on slow, expensive tests based on centuries-old technology. “I sometimes think that if there was a single most important thing here it might be diagnostics,” says O’Neill.