The nightmare bugs are multiplying because our antimicrobial team has no real leadership and has shockingly inadequate funding. We don’t have much data on what is really happening, but my guess is the deaths-from-resistant-microbes curve is increasing at an increasing rate. Every year more patients discover that the post-antibiotic world has already arrived for them.
A new report by WHO–its first to look at antimicrobial resistance, including antibiotic resistance, globally–reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance–when bacteria change so antibiotics no longer work in people who need them to treat infections–is now a major threat to public health.
“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”
Globally we are falling further behind. Every year more resistant bacteria are discovered, more people die. The most recent data I have shows 2 million U.S. cases of antimicrobial resistance, resulting in 23,000 deaths. We know the actuals are higher because there is no requirement for hospitals to report cases or even outbreaks of resistance. Here is an example from the transcript of the PBS special “Hunting the Nightmare Bacteria”:
Nationally, most hospitals aren’t required to report outbreaks to the government, and most won’t talk publicly about them. (…snip…)
Dr. BRAD SPELLBERG: It’s not that the government agencies are not aware of the problem and are not— and are not doing anything. It’s that we have not had a comprehensive plan for how to deal with antibiotic resistance. We don’t have reporting mechanisms, like they do in Europe, to know where resistance is occurring, who’s using the antibiotics, are we overusing them?
DAVID E. HOFFMAN: Wait. You’re telling me we don’t know the answers to the extent of the problem?
Dr. BRAD SPELLBERG: That’s correct.
DAVID E. HOFFMAN: We don’t have the data?
Dr. BRAD SPELLBERG: That is correct. I do not know how many resistant infections are occurring right now. I don’t know what the frequency of resistance in different bacteria are. We do not have those data.
NARRATOR: FRONTLINE requested an interview with the secretary of Health and Human Services, Kathleen Sebelius. We wanted to ask about the lack of data and the about the priority the department is giving to the new superbug crisis. But she declined to be interviewed.
The “nightmare bacteria” have caught governments and public health authorities napping. They didn’t seem to notice that over the past twenty years the development of new antibiotics has collapsed. From the 2013 report by the CDC Antibiotic Resistance Threats this graphic illustrates that there is now almost no new antibiotic development.
The fundamental reason for the collapse in new antibiotics is the pharma marketplace doesn’t reward developers enough to pay for the R&D and the drug approval process (USD $600 million to $1 billion for a new drug). Those numbers inhibit every kind of drug – but let through those that sell to the chronic patient markets (cholesterol, hypertension, …). A successful new antibiotic may be sold to a patient for 10 days, not 30 years like a hypertension drug. And sadly there is nearly no high level level focus on the new antimicrobial market failure.
Resistance is an everyday process – microbes begin exhibiting resistance as soon as a new compound is deployed. There was already penicillin resistance when the drug was first commercially introduced. This issue didn’t start making the headlines in at the beginning of the 21st century because there were still a lot of drugs in the cabinet that could be tried when a new resistant bug surfaced. Today, for an increasing number of infectious diseases, the antibiotic cabinet has fewer effective drugs every year. From the CDC Antibiotic Resistance Threats report, this graphic illustrates key resistance events:
The PBS Frontline special is a useful introduction to this subject — with video, audio, transcript and a number of useful resource links. The CDC report Antibiotic Resistance Threats is an excellent, well-researched overview as of 2013. CDC has a Antibiotic / Antimicrobial Resistance websitethat can be your home base for researching and tracking progress on this issue. CDC is asking congress for $160M [Antibiotic Resistance Solutions Initiative — $160M: A Comprehensive Response].
So what can you do? Most important is to make it clear to your representatives that you expect them to support a major government focus. In the U.S. there should be at least an NIH Assistant Secretary devoted to antimicrobial resistance, whose mission should be new antimicrobial drug research and development, high-efficiency testing to fast-track diagnosis of new cases, case tracking/reporting, and OBVIOUSLY to radically slash the agricultural misapplication of antibiotics at sub therapeutic doses (about 80% by mass of US antibiotic sales).
To give you an idea of how inadequate the US response is read Can a New White House Plan Catch Up to the “Superbug” Threat?
Although that initiative represents the government’s first-ever attempt to broadly address the issue of antibiotic resistance, the plan has been quickly dismissed by some scientists and lawmakers for not going far enough. In an interview with Politico, Rep. Louise Slaughter (D-N.Y.), the only microbiologist in Congress, said that goals set for 2020 are too far off to make up for lost ground.
“I’ve said to people, ‘Right now your government is not going to protect you,’” said Slaughter. “They’re about 10 years behind.”
PS – if you have some elective surgery on your horizon, say a knee or hip replacement, you might want to think about getting that done while there are still a few antibiotics that could help save your life (or your leg).