First, some background. President Obama unveiled his fiscal 2015 Budget last week and we see that he proposes to double federal funding to fight the emerging problem of antibiotic resistant infectious disease in the United States
The numbers alone warrant the close attention of any budget-meister because antibiotic resistance germs continue to cause more than 2 million illnesses and 23,000 deaths in the United States every year. MRSA alone kills a minimum of over 11,000 people and causes over 80,000 severe infections – again, every year. (Canada, population adjusted, has a similar infection rate of about 200,000 a year, but 2 ½ times the death rate – about 8,000 every year.)
To appreciate the scope of the problem, consider that over the next 5 years there will be more deaths caused by antibiotic resistant germs than there weredeaths by combat in the Vietnam War and the American Revolutionary War, combined (115,000 deaths from resistant disease; 110,848 from the 2 wars).
Given these monstrous numbers, the president therefore proposes (p.82), to double the funding to the Centers for Disease Control and Prevention to $30 million annually for the next 5 years.
The CDC says that with this increased funding they could achieve a 30% yearly reduction in invasive MRSA infections alone, and reductions of anywhere between 25 and 50% for 4 other kinds of infections, for an overall harm reduction of 37%. That would save a lot of pain and a lot of lives.
So how, exactly, does the CDC plan to do all this?
Press reports like this one and the CDC website tell us there will be construction of a country-wide 5-area regional Lab Network that will allow for early detection of outbreaks and thus quicker and more effective treatment. And we’re told that hospitals will be part of this network and they will have new programs to reduce the spread of bacteria.
Now be honest, what does that really tell you?
Here’s the way to think about it, using a war analogy that compares bad bugs to an invading army.
In 1775 the British launched attacks against a loosely organized band of American colonists at various points along the eastern seaboard from Lexington and Concord, Massuchesetts in the north to Chesapeake Bay, Virginia, some 560 miles south. At each point of attack the colonists would rally and do what they could to fight back, each colony operating on their own and largely unaware of what was happening at other outposts. Reports of the fighting would filter back to General George Washington after the event. From there, strategies, such as they were, were hastily cobbled together.
Now imagine, instead, that the colonists were an organized group of professional soldiers with a coordinated chain of command, a sophisticated communication system, and a network of spies. These things would allow them to know when the British were coming, where they were, what direction they were headed, how many there were, what kind of weapons they had, and so on. Such early detection and information immediately shared amongst the colonists would have permitted a coordinated rapid response, precisely tailored to meet each threat as it materialized along with the ability to constantly monitor the invaders. In other words, this enhanced capacity would have told Washington exactly where to attack, when, and with what force and weaponry. And thus a 37% reduction is American casualties would have been reasonable to expect – the same reduction the CDC is looking for based on the changes envisioned in the Budget.
The crucial change is the proposed Lab Network that would be strung across the bug battleground that is the whole of the United States. For the CDC and its partners, now armed with the latest technology, it would mean the ability to engage in rapid diagnoses, a precision and coordinated response, early and more effective treatment, and a continued monitoring of any abnormal bug presence – and a 1/3 reduction in harm to Americans that would otherwise have been caused by bugs that antibiotics can’t touch.
The present system, however, can be described as every man – or hospital – for himself, and is in the sense described in the war analogy, an 18th century throwback..
Dr. Brad Spellberg is an infectious disease specialist and leader in the field of developing ways to combat drug resistant infections. In a wide-ranging interview with Frontline (in bold) last October he basically indicted the current system:
… Is the government doing enough? Is the kind of action that we see up to the nature of the crisis?
“When reporters like you ask me how many resistant E. coli infections do we have, it’s pretty sad that I have no idea what the answer to that question is. It’s not that the government agencies are not aware of the problem 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 is using the antibiotics. Are we overusing them?
You’re telling me we don’t know the answers to the extent of the problem? We don’t have the data?
That is correct, 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. They are not presented publicly. They are not gathered on a large scale.
There are pieces of data acquisition, but there is not a concerted, coordinated effort to gather the information and make it available. Nor is there a concerted effort to apply financial or regulatory constraints to overuse, either in humans or in animals.
… It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms, or who’s using what antibiotics when. Europe has taken great strides to solve this problem, and we haven’t.”
These, then, are exactly the problems that the proposed Budget aims to correct. It could be a game changer. Of course there is one obstacle that remains – our friend, the Congress – perhaps the greatest bastion of resistance that we have today.